The organization of health and social care provision within in Singapore

Singapore has achieved universal health coverage through a mixed financing system. The country’s public statutory insurance system, MediShield Life, covers large bills arising from hospital care and certain outpatient treatments. Patients pay premiums, deductibles, co-insurance, and any costs above the claim limit. MediShield Life generally does not cover primary care or outpatient specialist care and prescription drugs. 

MediShield Life is complemented by government subsidies, as well as a compulsory medical savings account called MediSave, which can help residents pay for inpatient care and selected outpatient services. In addition, individuals can purchase supplemental private health insurance or get it through an employer. The national government is fully responsible for the health system.

Singapore’s health care financing system is underpinned by the belief that all stakeholders share responsibility for attaining sustainable universal health coverage. Singapore has a multipayer health care financing framework, where a single treatment episode might be covered by multiple schemes and payers, often overlapping. The system, known as the 3Ms, comprises the following programs:

MediShield Life, a universal basic health care insurance, is mandatory for citizens and permanent residents and provides lifelong protection against large hospital bills and selected costly outpatient treatments. It was launched in 2015 to replace MediShield, an opt-out catastrophic illness insurance scheme.

MediSave, a national medical savings scheme, helps cover out-of-pocket payments. Personal and employer salary contributions (8%–10.5%, depending on age) to MediSave accounts are mandatory for all working citizens and permanent residents. These tax-exempt, interest-bearing (currently 4% to 5%) accounts can be used to pay for family members’ health care expenses.

MediFund is the government’s safety net for needy Singaporeans who cannot cover their out-of-pocket expenses, even with MediSave.

Role of government:

The Ministry of Health’s mission is to promote good health and reduce illness, ensure access to good and affordable health care, and pursue medical excellence. The Ministry of Health is responsible for regulating the public health system and the health care system overall.

The government relies on competition and market forces to improve service and raise efficiency but intervenes directly when the market fails to keep health care costs down. For example, the Ministry of Health performs workforce planning to determine the number of health care professionals required, coordinates the training capacity, and dictates land availability for hospital and other health care facility development. The ministry also ensures that longer-term population needs are met through sustainable investment, especially in preventive and community-based care.

The Ministry of Health has centralized certain functions to prevent fragmentation and to encourage economies of scale. National organizations with important functions include the following:

MOH Holdings, the holding company for public health care institutions. It also handles infrastructure development and coordination of manpower and talent development for the national health system. Subsidiaries of MOH Holdings include:

Integrated Health Information Services, which integrates, delivers, and manages information technology systems across all public health care institutions.

The Agency for Integrated Care, which coordinates and facilitates placement of individuals with community providers, enables community providers through service development and capability-building and administers some subsidy schemes. In 2018, the agency was also charged with coordinating the delivery of aged-care services across both the health and the social domain.

The Agency for Care Effectiveness, Singapore’s national health technology assessment agency, guides cost-effective drugs and treatments.

The Health Sciences Authority, which regulates the manufacture, import, supply, storage, presentation, and advertisement of health products to meet appropriate safety, quality, and efficacy standards.

The Health Promotion Board, responsible for promoting healthy living in Singapore. The board formulates health policies, implements health promotion and disease prevention programs (like those for school health and workplace health), and works with industry partners for healthier food products

The Central Provident Fund Board, which administers the MediSave and MediShield Life schemes on behalf of the Ministry of Health.

Singapore Governance Graphic

Role of public health insurance:

Singapore’s national health expenditures stood at 4.47 percent of GDP in 2016. Between 2009 and 2016, the government’s share of health expenditures increased from about 32 percent to 41 percent due to increased public subsidies, which are intended to help reduce out-of-pocket costs.8 Correspondingly, the out-of-pocket share of health expenditures fell from 43 percent to 31 percent. Singapore’s average annual health care inflation was 2.6 percent, compared to 2.3 percent for all goods and services, between 2007 and 2017.

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