JANUARY

SINGAPORE
To keep demand for services in check, the government possesses numerous tools, including copayments,
deductibles, and restrictions on the use of Medisave and MediShield for consultations, treatments, and
procedures. These controls discourage unnecessary doctor visits, tests, and treatments, resulting in more careful
use of health system resources.
Price transparency: Another factor in controlling costs is price and outcome transparency. On its website, the
Ministry of Health makes available hospital bills for common illnesses, treatments, and ward classes. Patients can
look up costs for specific surgeries and tests, the number of cases treated in each hospital, and more. Data for
public sector hospitals are complete; since private hospitals supply data voluntarily, the information may not
offer the same level of detail. Armed with pricing information, consumers are able to shop better for the
services they require.
Pooling of funds and purchasing: The Group Purchasing Office consolidates drug purchases at the national
level. One goal of this system is to keep drug prices affordable by containing the costs of pharmaceuticalrelated
expenditure. The Group Purchasing Office also purchases medical supplies, equipment, and IT services
for the health care system.
What major innovations and reforms have been introduced?
Government spending: Since 2012, Singapore has been conducting a major review of the health care financing
framework. In the 2012 health care budget, the Minister of Finance announced the government would increase
its annual share of expenditure on health care from SGD4 billion (USD4.6 billion) to SGD8 billion (USD9.1
billion) over four years (Ministry of Health, 2012). The contribution by the government will soon rise from onethird
to approximately 40 percent of the total, with the prospect of future increases.
Outpatient subsidies: To maintain affordability of health care, subsidies to lower- and middle-income patients
at Specialised Outpatient Clinics in public hospitals were increased starting in September 2014. Subsidies for
standard drugs will also be increased these patients beginning in January 2015. Increases are means-tested.
Medisave: Medisave use has been expanded gradually to cover chronic conditions and health screening and
vaccinations for selected groups. In early 2015, Medisave will also cover outpatient scans needed for diagnosis
and treatment.
MediShield Life: Changes to MediShield are being implemented to address the growing need for chronic
disease care and long-term care. Coverage has become universal and compulsory, and now includes individuals
with preexisting conditions. Previously ending at age 90, coverage is now for life. The lifetime cap on benefits
has been removed, and the annual limit increased to SGD100,000 (USD114,000). Another recent change
provides better protection from large hospital bills by reducing coinsurance payments below 10 percent, for the
portion of the bill exceeding SGD5,000 (USD5,702) (Ministry of Health, 2014).
Medifund: In 2013, the government added SGD1 billion (USD1.1 billion) to Medifund’s capital fund, which now
totals SGD4 billion (USD4.6 billion). This increase will support the implementation of Medifund Junior, which will
target assistance to needy children. It also allows for the extension of Medifund coverage in 2013 to primary
care, dental services, prenatal care, and delivery. In the same year, annual assistance increased by almost
30 percent, to SGD130 million (USD148 million) (Ministry of Health, 2013).
Community Health Assist Scheme: Previously set at 40 years, the minimum age qualification for the program
was removed in 2014. The household income ceiling for eligibility increased from SGD1,500 (USD1,711)
to SGD1,800 (USD2,053) per capita per month. More chronic diseases were added, and subsidies for
recommended health screening were introduced. These enhancements have enabled more lower- and middle
income Singaporeans to benefit from the portable subsidies available at more than 1,000 medical and dental
clinics (Ministry of Health, 2014).
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The Commonwealth Fund