JANUARY

SINGAPORE
Public consultation: The government takes the views of patients and other stakeholders into account through
various means, including the “Our Singapore Conversation” sessions and an online survey. Public consultation
occurs before policies are enacted to ensure that public sentiment, concerns, and feedback are added to the
discussion; that diverse views are heard and ideas are tested and refined; and that public understanding and
support are cultivated to facilitate implementation. As an example, after public consultation, Medisave was
expanded to include a variety of preventive and treatment services, such as mammograms and colonoscopies,
treatment of some mental health disorders and chronic diseases, and palliative care.
What are the major strategies to ensure quality of care?
Singapore’s Ministry of Health conducts an annual survey to gauge patient satisfaction and expectations
regarding public health care institutions. The survey measures satisfaction with waiting times, facilities, and care
coordination, among other health system attributes. Results of the 2012 survey show that 77 percent of
respondents were satisfied, and that 78 percent of patients would “strongly recommend” or “likely
recommend” institutions to others based on their own experience (Ministry of Health, 2013).
Public and private hospitals, clinics, laboratories, and nursing homes are required to submit applications to the
health ministry for operating licenses. Physicians wishing to practice in Singapore must secure a position with a
health care institution and register with the Singapore Medical Council, which maintains the official Register of
Medical Practitioners. Physicians are required to fulfill continuing medical education requirements administered
by the Medical Council. For institutions, prelicensing inspections are conducted to ensure standards.
Singapore uses a performance measurement and management process to help health care providers assess and
benchmark their performance against peers. The National Health System Scorecard uses internationally
established performance indicators to compare performance. The Public Acute Hospital Scorecard is used
to measure institution-level performance. Its indicators cover clinical quality and patient perspectives. Similar
scorecards for providers are being rolled out in primary care facilities and in community hospitals.
The scorecards define standards of service and key deliverables required of public health care institutions, and
institutions are monitored to ensure compliance. The scorecards incorporate internationally accepted indicators
and definitions where possible, such as the U.S. Center for Medicare and Medicaid Services’ Joint Commission–
aligned measures for acute myocardial infarction and stroke.
In 2008, Singapore introduced national standards for health care to set priorities for improvement efforts and
alignment with planning initiatives. These standards focus on key areas of concern and are intended to promote
a culture of continuous quality improvement. The national standards are implemented through the network of
Healthcare Performance Offices, each chaired by a senior clinical leader who reports directly to the institution’s
chief executive officer or medical board chairman. Resulting quality improvement outputs can then be
incorporated into the National Health System Scorecard and the Public Acute Hospital Scorecard for
performance analysis and monitoring.
What is being done to reduce disparities?
Community Health Assist Scheme: The Community Health Assist Scheme subsidizes treatment for lower- and
middle-income Singaporeans at private primary care sites. The subsidies cover acute conditions, 15 chronic
conditions, and a range of dental procedures. Subsidies are also available for recommended screenings for
obesity, diabetes, hypertension, lipid disorders, colorectal cancer, and cervical cancer.
Revised Central Provident Fund contribution rates: The Central Provident Fund is the umbrella account
under which Singaporeans save for retirement, housing costs, and medical care (through the “3Ms”). There have
been periodic increases in both employee and employer matching contribution rates in recent years, with
another increase in the employer contribution rate to Medisave slated for January 2015. These increases are
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The Commonwealth Fund