How Singapore's healthcare system works

In Singapore, we tend to have the attitude that healthcare is something to be sought only when you fall ill. We know about health insurance and MediSave, but that’s only half of it.

It’s better to know how the healthcare system in Singapore works before you need to use it, not after.

TL;DR: Healthcare in Singapore at a glance

In Singapore, there are two main branches of healthcare — subsidised government healthcare and unsubsidised private healthcare.

Subsidised healthcare is heavily managed by the government. Due to the government subsidies, the price varies depending on whether you’re a Singapore citizen, PR or foreigner. For this reason, government healthcare is typically much cheaper than private healthcare for Singapore citizens and PRs.

Medical costs for Singaporeans and PRs can be paid for through the three “3Ms” of healthcare, namely:

• MediSave: All CPF members have a MediSave account, into which a portion of their salaries or earnings must be paid. The money in Medisave is meant to be used to pay for medical costs, but limited to approved uses and subject to caps.
• MediShield Life: MediShield Life is a form of compulsory government health insurance, covering certain types of medical costs such as hospitalisation. It is very basic, however, and grossly insufficient if you use private healthcare. Hence, many people choose to enhance MediShield Life with an Integrated Shield Plan from a private insurer.
• MediFund: This is a fund set up by the government to help patients facing financial difficulties with their medical bills. All applications for MediFund, and the amount offered to successful applicants, are determined on a case-by-case basis.

Public hospitals a.k.a. restructured hospitals

Public hospitals, also known as restructured hospitals, are owned by the government or state-owned organisations.

There are 16 public (acute and community) hospitals in Singapore:

• Changi General Hospital
• KK Women’s and Children’s Hospital
• Sengkang General Hospital
• Singapore General Hospital
• Khoo Teck Puat Hospital
• Tan Tock Seng Hospital
• Alexandra Hospital
• National University Hospital
• Ng Teng Fong General Hospital
• Bright Vision Hospital
• Institute of Mental Health
• Jurong Community Hospital
• National Heart Centre
• Outram Community Hospital
• Seng Kang Community Hospital
• Yishun Community Hospital

Most fees across the board are cheaper at public hospitals than at private hospitals.

If you get warded at a public hospital as a Singapore citizen or PR, you have the added benefit of enjoying subsidies based on your income and ward type. Non-PR foreigners only get subsidies for services in the Emergency Department.

Subsidies for Singapore citizens (PRs get 10per cent less)

Patients who are not working enjoy the highest tier of subsidies, unless they live in a property with an annual value of more than $11,000, in which case they receive the lowest tier.

To put things in perspective, here’s an example of subsidised rates for hospitalisation at Singapore General Hospital:

• From $35 per day in Class C wards
• From $79 per day in Class B2 wards
• From $451.45 per day in Class B1 wards

These charges are based on the maximum subsidy level for a Singapore citizen.

Can you be a “private patient” at a public hospital?

Seeking care at a public hospital involves a longer wait than doing so at a private hospital. Expect to wait a few hours for drop-in visits, or even a few months if you’re placed on the waitlist for a particular test or treatment.

Get around this by visiting a public hospital as a private patient. Private patients do not receive subsidies, so they are allowed to jump the queue.

How to qualify as a private patient:

• Specify the name of the specialist you wish to see. (Subsidised patients don’t get to choose.)
• Have a referral from a private practitioner or private hospital.
• Make sure you’re referred by a public or restructured hospital where you’re a private patient.
• Be a foreign resident or non-resident of Singapore. (Subsidies don’t apply, so there’s no need to queue with patients who receive them.)

Moving on to private hospitals…

Is private healthcare really better? While there are world-class doctors at both private and public hospitals, you enjoy some perks by going private.

First, just compare the amount of time you spend queuing at a private GP clinic compared to a polyclinic. ‘Nuff said.

And with private healthcare, you get to choose your doctor – a big deal if you’ve a serious illness and want the best doctors available.

However, private healthcare is a lot more expensive. Unless you’re loaded, you’ll need to ensure you’ve some form of private hospitalisation insurance (like an Integrated Shield Plan) before you get hospitalised at a private hospital.

So what’s the difference between going to a private hospital and using a public hospital as a private patient?

Private hospitals tend to offer a “premium” experience compared to public hospitals. That doesn’t matter if you’re just there for a quick check-up, but for those getting hospitalised, it can make quite a difference.

The cheapest private hospital rooms tend to start at 4 beds, while the most expensive rooms are individual and luxurious. Meanwhile, the cheapest public hospital rooms start at 8 or 9 beds in Class C wards, while even the more expensive Class B1 wards have 4 beds.

Estimating the cost of healthcare in Singapore

Want to know how much a particular procedure costs? MOH’s fee benchmarks are a good place to start. They publish historical transacted bill sizes and fee benchmarks for both public and private hospitals where available, so you can find out how much other patients have been charged.

For instance, here is the median hospital bill for conventional heart bypass surgery. The bill includes the fees for operation, implant and others such as consultation, medication and tests.

Ward class	Total hospital bill
Public hospital – C	$6,046
Public hospital – B2	$8,312
Public hospital – B1	$34,204
Public hospital – A	$38,251
Private hospital	$81,338

Now that you understand the healthcare system, what’s next?

To recap, the healthcare system in Singapore isn’t as binary as public vs. private. There are actually 3 options:

• Public hospital: Full subsidies, but can be slow and you can’t choose your doctor
• Private patient at public hospital: Less subsidy, more options, potentially cheaper than going “full” private
• Private hospital: Most expensive but most luxurious option

When choosing between private and public hospitals, price is the key deciding factor for many. If your main concern is to skip long waiting times while keeping costs affordable, go to a public/restructured hospital as a private patient.

Whichever your choice is, getting a private health insurance policy is a good idea as it can reduce your out-of-pocket costs when you hit your MediShield Life and MediSave limits.

The most economical way to do so for Singapore citizens is to get an Integrated Shield Plan, which complements your existing MediShield Life protection. 

This article was first published in MoneySmart.