JANUARY

SINGAPORE
intended to encourage low-wage workers to save more for their retirement and medical needs and to have
better access to care.
What is being done to promote delivery system integration and
care coordination?
Singapore’s Agency for Integrated Care was created in 2009 to bring about a patient-focused integration of
primary and intermediate- and long-term care. The agency, which operates at the patient, provider, and system
levels, works to encourage health care providers to coordinate their efforts on behalf of the patient. The agency
also advises patients and families about appropriate health care services and helps them navigate the system. A
primary example of the issues it addresses is follow-up treatment for chronic-disease patients discharged from
the hospital. Another major initiative seeks to expand and improve health care capabilities at the community
level. To achieve better integration of all care services, all six public hospital clusters in Singapore are
undergoing a systemwide transformation to a regional health care system model. Hospitals will work in close
partnership with other providers in their region, such as community hospitals, nursing homes, general
practitioners, and home care providers.
Another significant role for the agency is to ensure integration of health and social care services for elderly and
disabled populations. The agency coordinates and facilitates the placement of sick elderly people with nursing
homes, community providers, day rehabilitation centers, and long-term care facilities, and manages referrals to
home care services. The agency also actively helps the elderly and people with disability apply for available
financial assistance.
What is the status of electronic health records?
Singapore is building a sophisticated national electronic health record system. The system collects, reports, and
analyzes information to aid in formulating policy, monitoring implementation, and sharing patient records. The
long-term goal is to allow medical professionals to access clinical data on patient treatment and safety. System
capabilities include: a master index that matches patient records from a variety of sources and includes a unique
identifier as well as other patient identity information; a summary care record for each patient that offers an
overview of recent medical activity; access to overviews of specific events, such as hospital admissions; and
access to health data in Singapore’s registries for immunization, medical alerts, and allergies.
When fully developed, the system will allow data to be accessed and viewed in appropriate formats by medical
professionals, patients, and researchers. Data sources will include the electronic medical record systems of
public hospitals and polyclinics. There are plans to enable patients to view and possibly contribute to their
personal health records.
How are costs contained?
Singapore spends just 4.7 percent of its GDP on health care (World Bank Health Data, 2014). Cost is controlled
in a number of ways, perhaps foremost by the manner in which the government both fosters and controls
competition—intervening when the market fails to keep costs down. Public and private hospitals exist side by
side, with the public sector having the advantage of patient incentives and subsidies. Because it regulates
prices for public hospital services and regulates the number of public hospitals and beds, the government is
able to shape the marketplace. Within this environment, the private sector must be careful not to price itself out
of the market.
At the same time, the government sets subsidy and cost-recovery targets for each hospital ward class, thereby
indirectly keeping public sector hospitals from producing excess profits. Hospitals are also given annual budgets
for patient subsidies, so they know in advance the levels of reimbursement they will receive for patient care.
Within their budgets, hospitals are required to break even.
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