JANUARY

SINGAPORE
Public hospital funding is derived from a block budget. Part of the budget is based on Casemix, which classifies
medical conditions based on diagnosis-related groups. Hospitals can reallocate savings from the block budget
to develop other aspects of public health care services. The block budgets are reviewed every three to five
years to ensure that subvention models keep up with changes in models of care and hospital operations.
In addition to the block grants, government funds are available for manpower training and research.
Wards in Singapore’s public hospitals are tiered in four main classes, according to level of amenities. Patients
in the highest-class wards are treated as private patients and therefore not subsidized. Patients in the other
classes receive varying subsidies depending on the choice of ward and means-testing levels.
The private sector provides about 20 percent of secondary and tertiary care services. Raffles Medical Group and
Parkway Health are two of the main private hospital groups; they generally offer faster service and more
amenities, and are also more involved in medical tourism, than public facilities do. The public sector has begun
renting private hospitals’ spare capacity to treat subsidized patients, as private hospitals currently have more
beds available.
Mental health care: Health care and social service agencies involved in mental health care are guided by the
National Mental Health Blueprint of 2007, and provide integrated services such as education and prevention,
early detection, and treatment for at-risk individuals or people facing emotional difficulties. The blueprint laid
the groundwork for a network of care and support systems that will enable integrated community living. The
Institute of Mental Health is Singapore’s only acute tertiary psychiatric hospital. It provides psychiatric,
rehabilitative, and counseling services for children, adolescents, adults, and the elderly, as well as long-term
care and forensic services. Patients with addictions can be treated in the Institute’s National Addictions
Management Services unit. General and specialized treatment services for eating, sleep, and addictions
disorders, and for geriatric psychiatry, are also offered at a number of public hospitals.
To cope with projected increase in demand for mental health care and to improve accessibility, the National
Mental Health Blueprint calls for more community-based mental health services, led mainly by tertiary facilities.
Components of the program include multidisciplinary shared-care teams operating in service networks in the
community; support for caregivers; community safety networks for people with dementia and depression and
their caregivers; and general practitioner training and support for the care and management of people with
mental illnesses. There are also community-based mental health programs targeting youth, adults, and the
elderly. Most cases requiring residential care or a transition period, with close supervision provided by the
Institute of Mental Health and by two voluntary welfare organizations (Singapore Association for Mental Health
and Singapore Anglican Community Services).
Long-term care and social supports: Management of long-term care services for the elderly is provided by
voluntary welfare organizations and private operators. Services are financed in a number of ways, including
direct payment by individuals and families, direct government subsidy to patients through providers, and capital
and recurrent funding for intermediate and long-term care providers to provide means-tested, subsidized care.
ElderShield, a long-term care insurance program regulated by the government but run through designated
private insurers, is also available. ElderShield makes monthly direct cash payouts to those who can no longer
take care of themselves. These payouts are intended to be setting-neutral, so that families and seniors can
choose the type of care that best suits their needs. Eligible care includes nursing home, facility-based, and
home-based health care, including hospice care.
Financial support is available for informal and family caregivers. The Agency for Integrated Care administers
the Caregivers Training Grant that provides an annual SGD200 (USD228) subsidy to attend approved training
courses in caring for elderly or persons with disability. The grant is allocated per care recipient, not per
caregiver. Care recipients must be Singaporeans or permanent residents age 65 or older or with disability.
The Foreign Domestic Worker Grant, a monthly grant of SGD120 (USD137) for hiring a foreign domestic worker
to care for the frail elderly or for an individual with at least moderate disability, is also available through the
Agency for Integrated Care. Eligibility requires a maximum household monthly income of SGD2,600 (USD2,965)
(Ministry of Health, 2013).
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The Commonwealth Fund