JANUARY

The Singaporean Health Care System, 2015
Chang Liu and William Haseltine
Duke-NUS Graduate Medical School and ACCESS Health International
What is the role of government?
The government of Singapore planned, built, and continues to develop and maintain the nation’s public health
care system. It also regulates both public and private health insurance in the country. The health care system is
administered by the Ministry of Health, which has responsibility for assessing health needs and for planning and
delivering services through networks of health and hospital facilities, day care centers, and nursing homes. The
ministry manages, plans for, and maintains staffing throughout the system and is also responsible for financing
policies and governance of the entire public health care system. Because Singapore is a very small nation-state,
there is little regional- or local-level funding or regulation; the national government takes on full responsibility
for the health system. Singapore offers universal health care coverage to citizens, with a financing system
anchored in the twin philosophies of individual responsibility and affordable health care for all.
Who is covered and how is insurance financed?
Publicly financed health care: The Singapore health care system is funded directly by the national government
through its Ministry of Health. The ministry’s budget for fiscal year 2013 was SGD5.9 billion (USD6.7 billion),
or 1.6 percent of GDP. The funds come from general revenue, and they are used for subsidies, campaigns to
promote good health practices, manpower development and training, and infrastructure expenses. Most of the
budget is devoted to subsidies for patients receiving medical care at public hospitals, polyclinics, community
hospitals, and certain institutions providing intermediate and long-term care. Other budget allocations are for
initiatives addressing obesity prevention, tobacco control, childhood preventive health services, chronic disease
management, and public education (Ministry of Health, 2013).
Singapore offers its citizens universal health care coverage, funded through a combination of government
subsidies, multilayered financing schemes, and private individual savings, all administered at the national level.
The first tier of protection is provided by government subsidies of up to 80 percent of the total bill in public
hospitals and primary care polyclinics. There are also subsidies of up to 80 percent in the government-funded
intermediate and long-term care institutions. This is supported by a system of savings and insurance programs
to help individuals and families pay for their care—known as the “3Ms,” for the Medisave, MediShield, and
Medifund programs. Together, these play a critical role in maintaining Singaporeans’ health and welfare.
Medisave is a mandatory medical savings program that requires workers to contribute a percentage of their
wages to a personal account, with a matching contribution from employers. Individual contributions to and
withdrawals from the accounts are tax-exempt. Account funds are used, under strict guidelines, to pay for health
services such as hospitalization, day surgery, and certain outpatient expenses, as well as health insurance for the
account holder and family members.
MediShield is a low-cost catastrophic health insurance scheme to help policyholders meet medical expenses
for major or prolonged illnesses that their Medisave balance would not be sufficient to cover. All permanent
residents are automatically enrolled in the program; undocumented immigrants and visitors are not covered.
MediShield operates on a copayment and deductible system, with premiums payable by the insured through
Medisave. A universal health insurance scheme will replace MediShield at the end of 2015 (see below).
International Profiles of Health Care Systems, 2015 143