JANUARY

SINGAPORE
Medifund is the government endowment fund set up to aid the indigent. The fund covers Singapore citizens
who have received treatment from a Medifund-approved institution and have difficulties paying their medical
bills despite government subsidies, Medisave, and MediShield coverage.
Privately financed health care: According to the World Health Organization (2013), in 2010, private
expenditure amounted to 69 percent of the nation’s total expenditure on care, 10.1 percent coming from
private prepaid plans.
Private insurance is available from a number of for-profit companies, usually in the form of Medisave-approved
Integrated Shield Plans. These plans serve as a supplement to MediShield, providing, for example, additional
benefits and coverage when a patient opts for Class A and Class B1 wards in public hospitals or private
hospitalization. Individuals can use funds from their Medisave accounts to pay the premiums for Integrated
Shield Plans.
Employers also may offer private insurance to their employees as a staff benefit. Typically, employer-sponsored
insurance cover primary care and other outpatient visits, in addition to hospitalization.
What is covered?
Services: Subsidies are available for care provided by public hospitals and polyclinics, as well as by
government-funded intermediate and long-term care providers. MediShield, the second of the “3Ms,” provides
low-cost insurance coverage for treatments in the subsidized wards of public hospitals and outpatient care for
certain conditions, including kidney dialysis and cancer treatments. As a catastrophic insurance program,
MediShield generally does not cover primary care, prescription drugs, preventive services, mental health care,
dental care, or optometry. MediShield is operated by the Central Provident Fund Board.
Cost-sharing and out-of-pocket spending: The government of Singapore contributes to building and
maintaining the system and subsidizing a portion of the cost of patient care, based on the individual’s ability to
pay. Copayments after subsidy can be covered by MediShield insurance or paid for through Medisave savings.
For MediShield, an annual deductible against claims must be met before coverage can begin. Coinsurance for
inpatient bills ranges from 20 percent to 10 percent as the bill increases. Therefore, after government subsidies,
MediShield pays between 80 percent and 90 percent of the claimable amount that exceeds the deductible for
selected outpatient treatment charges claimable under MediShield (e.g., kidney dialysis, chemotherapy for
cancer, and erythropoietin for chronic kidney failure). Other outpatient services are fully paid from private funds
or, in some cases, employer benefits. Deductibles do not apply to outpatient treatments. Instead, a 20 percent
coinsurance is imposed. There is no annual cap on out-of-pocket spending.
The health care system requires individuals to be ultimately responsible for their own health and to share in the
cost of the services they use. Consequently, patients approach their health care choices knowing that they will
pay a portion of the bill. In the Singapore system, patients are responsible for copayments and deductibles that
are often higher than in other nations. According to the World Health Organization (2013), private spending
amounts to 69 percent of total health care expenditure, of which 88 percent is out-of-pocket, including costs
that are covered and reimbursed by employer medical benefits.
Safety net: Medifund, the third of the Singapore system’s “3Ms,” is an endowment program funded by the
government as a health care safety net. It was established in 1993, and its mission is to help the poor pay
for their care. Money from the fund is disbursed each year to approved institutions, and a committee at each
institution evaluates and approves financial assistance to patients. Government-funded providers (whether
public or private institutions, or voluntary welfare organizations) are able to tap Medifund assistance for
their patients.
Medifund generally covers necessary medical treatment, including drugs, services, and tests. Medical social
workers are in place to assist patients with the application process required before aid is granted. The amount
of aid granted is determined by the patient’s and the family’s income, the social circumstances of the patient,
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The Commonwealth Fund