Singapore's Healthcare System Analysis

This assignment delves into the intricate workings of Singapore's healthcare financing system. It examines the diverse funding sources, encompassing government contributions, private health insurance, and out-of-pocket expenses. The analysis highlights the strengths and weaknesses of this hybrid model, exploring its effectiveness in ensuring universal access to quality healthcare while managing costs. Key aspects like public hospital infrastructure, pharmaceutical pricing policies, and the role of technology in healthcare delivery are also scrutinized.

Running head: HEALTHCARE SYSTEM
COMPARISON OF HEALTHCARE SYSTEM
-Singapore, United States and Canada
Name of the Student
Name of the University
Author Note

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Introduction:
Healthcare Systems are affected by its funding, funding system, GDP growth and
spent of healthcare,and its performance can be analyzed through indicators like maternal
mortality rate, infant mortality rate and life expectancy at birth as well as through health
system performance indicators like prevalence of low birth weight, obesity, diabetes, asthma,
hypertension and cancer. Additionally, efficient management of quality and safety of
healthcare systems ensures the providence of healthcare, and maintains the standards of
efficient system. The aim of the report is to compare the healthcare system and its governance
between Singapore, United States of America and Canada. Singapore has been considered to
provide cheap and good quality healthcare to its citizens (Ranked 6th by World Health
Organization) (Frakt & Carroll, 2017). The Hybrid Model used by Singapore, makes it one of
the best healthcare systems (Tan, 2017). A comparative analysis of the key aspects affecting
healthcare systems and performance indicators can allow to identify the different aspects
where developments can be further made to the healthcare systems of Singapore, to ensure an
improved care for its citizen, and maintain the quality and efficiency of the care.
Funding, Funding System, GDP spent on health:
Funding:
As of 2017, reports show the Singapore government spends USD 381 per capita on
healthcare (Klein, 2017). Lim, (2017) points out that the Singapore government spends a
third of the healthcare cost, while the citizen pays two thirds of the expense. An estimated
amount of USD 30 billion is invested by the government towards Medifund. The funding is
ranked fifth for public funds (Bai et al., 2012).

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The expense of the United States Government on healthcare costs, per capita is
estimated to be USD 5,960 out of the total per capita expense of USD 9,267 (and the citizen
paying the rest USD 3,307. This placed US above Canada and United Kingdom in healthcare
funding (Almberg, 2016).
The spending by the Canadian government is estimated to be about USD 2,209 per
capita, out of the total cost of USD 4,095, with the citizens paying the rest of USD 1,886. The
total investment of the government adds up to about USD 68.5 billion (Barua, Palacois &
Emes, 2017).
Funding System:
Singapore employs a mixed funding system for healthcare, using multiple tiers of
protection to ensure the providence of healthcare for every Singaporeans. The system
includes 4 levels of funding, with Subsidies acting as the first safety net that allows
affordability of healthcare, followed by the next safety net, the Medisave that allows the
building of savings for smaller healthcare expenses. The third line of protection is provided
by Insurance schemes (like MediSheild Life, Integrated Shield Plans, ElderSheild and
ElderSheild supplement) that support large medical expense, and long term medical care. The
final tier of protection is provided by Medifund that assist the needy citizens to meet their
healthcare costs (Moh.gov.sg, 2018).

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Figure 1: Funding levels on healthcare in Singapore; source: (Moh.gov.sg, 2018).
Government Funding for healthcare in US is through programs like Medicare and
Medicaid (Trivedi, 2018). The healthcare professionals are paid through private insurance,
government insurance and personal payment by citizens in the form of out of pocket funding.
Private insurances are also subsidized by the government, and are purchased by corporations
to benefit the employees, and exempted from taxation. The Patient Protection and
Affordable Care Act (PPACA) or Affordable Care Act (ACA) is aimed to improve both
availability and affordability of healthcare service to citizens (HHS.gov, 2018). Apart from
Medicare (for the healthcare of elderly, disabled and long term treatment) and Medicaid (for
people with disability or those below the poverty level), the government also has other
programs like State Children’s Health Insurance Program (for uninsured children), Tricare
(for military personnel and their families), Veterans Health Administration (VHA) (for
military veterans) and Indian Health Service (for American Indians and Alaskan natives).
Healthcare funding in Canada is through Canada Health Transfer from the federal
government that funds provinces and territories, and Fiscal Transfer for additional federal
funding (Canada.ca., 2018). The finances are provided via taxation system apart from lottery

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proceedings, and revenues of the federal, provincial and territorial governments (Funding for
Health Care., 2018). As per Canada Health Act, exempts payment for premiums on health
insurances, and funds are allocated via Canadian Health and Social Transfer (CHST)
(Canadian-healthcare.org., 2018).
GDP spent on health:
Singapore spends about 4% of their GDP on national healthcare expenditures
(Moh.gov.sg, 2018). This marks in increase in healthcare expense from 1.6% of GDP in
2013, 1.8% of GDP in 2014, 2.1% of GDP in 2015 (Moh.gov.sg, 2018).
As of 2013, US spent 16.4% of their GDP on healthcare , placing them at the top of
healthcare funding compared to Netherlands, Switzerland, Sweden, Germany and France
(Merckmanuals.com, 2018). This ensures the lowest share of public expenditure of healthcare
services (Cicconi & Strug, 2018).
Canadian government spends 7.3% of their GDP as of 2016, showing a higher than
average annual growth in healthcare spending in the last 5 years (at 2.6% of GDP). This is
associated with a 116.4% increase in the total healthcare spending between 2001 and 2015,
while the economy grew by only 77.4% in the same period (Fraserinstitute.org., 2018).
System governance arrangements:
The healthcare system in Singapore is governed and administered by the Ministry of
Health that assesses the health needs and plans delivery services through a network of health
and hospital services, day cares, nursing homes and medical facilities. The financing involves
Publicly Financed programs like Medisave, MediSheild and Medifund, also called the 3M
system. The system is based on the philosophies of individual responsibility and provision of
affordable healthcare for everyone. Medisave is a medical savings account that is contributed

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by each worker by a percentage of their salary, and an equal contribution from the employers.
It covers for medical expenses like hospitalization, day surgery and outpatient services for the
employee and their families. MediSheild covers long term medical expenses, not covered
under Medisave, and operates on co-payments and deductibles, and can be paid through
Medisave. It covers the Singaporean citizens automatically. Medifund supports the poor and
needy citizens who are unable to cover the medical expense in spite of Medisave and
MediSheild coverage. Private Health insurances like Integrated Shield Plans acts to
supplement MediSheild coverage, and are purchased from their MediSave account.
MediSheild pays 80%-90% of the claimable amount exceeding the deductibles for treatments
like kidney dialysis, chemotherapy, erythropoietin, for chronic kidney failure. A co-insurance
of 20% is imposed for outpatient services on the patient. Medifund services are also extended
for needy children by Medifund Junior and for elderly patients from low and middle income
profiles in intermediate and long term care by Eldercare fund
(International.commonwealthfund.org, 2018).
The US Department of Health and Human Services (HHS) is the principal agency
under the federal government associated with healthcare, and includes Centers of Medicare
and Medicaid services, Centers of Disease Control and Prevention, National Institutes of
Health, Health Resources and Services Administration, Agency for Healthcare Research and
Quality, Food and Drug Administration, Center for Medicare and Medicaid Innovation and
Patient-Centered Outcomes Research Institute (International.commonwealthfund.org, 2018).
The Governance Institute, (2018) is a service under NRC health, provides trustworthy and
independent data, resources, tools, and solutions to board members, healthcare professionals,
healthcare leaders to support their efforts towards leadership and governance of the
healthcare organizations.

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In Canada, organization, healthcare service delivery, and supervision of providers are
done by the provincial and territorial governments, often through regional health authorities.
These authorities are responsible for the provision of funding, and delivery of hospital based,
community based or long term care, apart from mental and public health services, in
adherence to the Canada Health Act (1985). The services generally covered by the federal
contributions include physicians, diagnostic costs, and hospital expenses (like inpatient
prescriptions). Additional benefits like outpatient prescription costs, non physician mental
healthcare, vision care, dental care, home care, hospice services are also covered by the
territorial and provincial governments. Out of pocket expense is not applicable for insured
physician, diagnostic and hospital service, and covers 21% for prescription drugs, 22% for
long term care, 16% for dental care, 9% for vision care and 10% for over the counter
medicines (international.commonwealthfund.org, 2018).
Population health indicators (maternal mortality rate, infant mortality rate, life
expectancy at birth):
Maternal mortality rate
In Singapore, as of 2015, the maternal mortality rate was estimated to be about 4.8
(per 100,000 live births), dropping from 7.1 on 2014, however showing a rise since 2013 and
2014 at 2.5 and 2.4 respectively (Data.gov.sg, 2018).
Maternal mortality rate in the US is at 26.4 (per 100,000 live births), as of 2015,
which places it above UK, Portugal, Germany, France, Canada, Netherlands, Spain,
Australia, Ireland, Sweden, Italy, Denmark and Finland. The mortality rate is about 3 times
that of UK, and has seen a constant growth from 2000 which had a maternal mortality rate of
about 15.

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In Canada, the maternal mortality rate as of 2015 was 7 (per 100,000 live births), that
showed a slight drop from 2010 that had a mortality rate of 8, and 2005 with a rate of 9
(Who.int, 2018).
Infant mortality rate
In Singapore, as of 2016, the infant mortality rate was estimated to be 2.4 (per 1000
resident life births, with the mortality rate of males at 2.3, females at 2.5, neonates at 1.4, and
2.7 for mortality under the age of 5 years. The infant mortality rate has increased since 2015
(at 1.7 for both male and female, 2.2 for male and 1.2 for female) (Data.gov.sg., 2018).
Infant mortality rate in US was about 5.9 (per 1,000 live births) in 2015 (amounting to
about 23,000 deaths), with the southern states having the highest number of deaths. Also, the
infant mortality rates were higher among Non-Hispanic black (11.3), followed by American
Indian and Alaskan Notices (8.3) (Cdc.gov., 2018).
In Canada, the infant mortality rate as of 2015 was estimated at 4.5 (per 1000 live
births, and have shown a slow decline since 2000 (that showed a mortality rate of 5.2)
(Data.worldbank.org, 2018).
Life expectancy at birth
As of 2015, the estimated life expectancy of Singaporeans was estimated to be 80
years for male, and 86 years for female (Singapore, 2018). While life expectancy at birth for
Canadians was estimated to be 80 for male and 84 for female (Canada., 2018). For US, the
life expectancy at birth was estimated to be 77 for male and 82 for female (United States of
America., 2018). This shows Singapore having better average life expectancy, compared to
US and Canada (Life expectancy of females). This is a key indicator of health among
Singaporeans.

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Health System performance (prevalence of low birth weight, obesity, diabetes, asthma,
hypertension, cancer):
Prevalence of low birth weight
According to WHO, the percentage of low birth weight in Singapore was 10%, as of
2011, amounting to about 5 in number per 1,000 babies. United States has a lesser percentage
of low birth weight incident at 8% (as of 2010), while for Canada, it was 6 (as of 2011)
(Data.unicef.org, 2014). This shows that Canada has a better birth weight ratio, compared to
US and Singapore, which has the highest birth weight ratio.
Obesity
Obesity is a condition characterized by a Body Mass Index higher than 30. WHO
estimates that the worldwide prevalence of obesity have almost doubled since 1980, and as of
2014, 11% of men and 15% of women above 18 are obese (Apps.who.int, 2014). Singapore,
as of 2014 had an obesity rate of 5.4 (4.8 for males and 6.1 for females) for citizens above 18
years. In comparison, United States has an overall obesity rate of 32.4 (30.8 for males and
34.0 for females), and for Canada, the obesity rates are 25.9 (24.6 for males and 27.2 for
females) (Who.int., 2016). This shows a much lower incidence of obesity among
Singaporeans, compared to Americans and Canadians.
Diabetes
The Global prevalence of Diabetes in 2014 was estimated by WHO to be at 9%, contributing
to 4% of death due to non communicable diseases. In Singapore, as of 2014, WHO estimates
shows diabetes 9.8% (11.7% for males and 7.9% for females). For US, is estimate to be 8.4%
(9.4% for males and 7.5% for females) and for Canada it was 7.1% (8.1% for males and 6.1%

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for females) (GLOBAL STATUS REPORT on no communicable diseases, 2014). As per
reports, Singapore has one of the highest number of diabetes in the world (Nlb.gov.sg, 2018).
Asthma
Reports suggest about 300million people suffering from Asthma globally as of 2007
(Aaaai.org, 2018).In Singapore, the number of death due to asthma and chronic respiratory
disease (CPD) was 19.5 for males and 5.8 for females, per 100,000 individuals of the
population. For United States, the rate was 43.1 for males and 32.8 for females, while for
Canada, it was 28.0 for males and 18.6 for females per 100,000 populations (Apps.who.int,
2014).
Hypertension
Hypertension is characterized by a systolic blood pressure above 140, and diastolic
blood pressure above 90. The prevalence of Hypertension or high blood pressure among
Singaporeans, as of 2014 was estimated by WHO to be at 17.7% with 20.8% for males and
14.6% for females. While for US, the rate was estimated at 18.1%, with 19.7% for males and
16.5% for females, and for Canada it was 15.1% with 17.9% for males and 12.4% for
females, (Apps.who.int, 2014). This shows Singapore has more prevalence of hypertension
compared to Canada, but lesser then US (Apps.who.int, 2014).
Cancer
Number of deaths due to cancer among Singaporeans in 2014, was estimated at 127.1
for males and 86.0 for females, per 100,000 individuals of the population. For US, the
mortality due to cancer was 143.6 for males and 104.2 for females (per 100,000 population),
and for Canada, it was 138.9 for males and 104.0 for females (Apps.who.int, 2014).
Management of quality and safety in health system:

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Quality Management
In Singapore, quality of healthcare is maintained by Singapore Ministry of Health,
apart from setting policy directions, managing the healthcare system and its responsiveness to
the needs of its citizens. They are also involved in the assessments of healthcare needs,
planning of healthcare services, healthcare personnel planning, governance and financing of
healthcare systems, setting up provider fee, cost control, and utilization of health information
technology. The regulation is through a system of legislation and enforcements
(International.commonwealthfund.org, 2018).
In the US, the Department of Health and Human Service maintains the quality of
healthcare system through the National Quality Strategy, which is a component of the
Affordable Care Act (ACA). The policy enables reporting of provider performance data, like
hospital compare service that compares the data of more than 4,000 hospitals, across aspects
like care process and outcomes and patient experience, which promotes transparency and
quality of care. Additionally, consumer led groups like Consumer’s Union and Leapfrog
group also monitor quality and safety (International.commonwealthfund.org, 2018).
Canadian Medical Association, provincial regulatory colleges, is responsible for
licensing healthcare professionals as well as the development and enforcement of standards
of healthcare practice. Additionally, providers are also self governed under provincial and
territorial legislatures, which ensures quality of healthcare, apart from the training and
education of healthcare professionals, and maintenance of standards of care. Agencies are
also there in many provinces that monitor and reports healthcare system performance, the
data of which can be used to monitor and improve the quality.
Safety Management

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Safety in healthcare in Singapore is managed through SafetyNet that is aimed to
support the needy and poor. Professional bodies like Medical Council, Dental Council,
Nursing Board, Pharmacy Council, regulates and manages safety, quality and efficacy,
through a set of guidelines, code of ethics and conduct, while Health Sciences Authority
regulates the manufacture, import, supply, presentation and advertisement of healthcare
products, ensuring that they meet the international standards of quality and safety
(International.commonwealthfund.org, 2018).
In the US, SafetyNet ensures healthcare for the uninsured, poor and vulnerable
patients through a network of public hospitals, local health department, free clinic and
Medicaid. The Centers Of Disease Control and Prevention researches on public health and
safety. Agency for Healthcare Research and Quality utilizes evidenced based research
practices to ensure safety. Additionally, public reporting services and Consumer led groups
also monitors and reports quality and safety (International.commonwealthfund.org, 2018).
In Canada, efficacy and safety of medical devices, pharmaceuticals, health products,
health research, are regulated by the Federal Government. Different provinces and territories
also have different policies regarding the providence of Safety Net for the uninsured. The
federal ministry of health, Canadian Patient Safety Institute additionally monitors the safety
of healthcare, and develops strategies and tools to maintain the standards of safety
( international.commonwealthfund.org, 2018).
Conclusion:
With a comparative overview of the health performance indicators of Singapore, USA
and Canada, it can be understood that Singapore provides an affordable care for its citizens.
However, the comparison shows that US and Canadian Governments spends the highest
percent of its GDP, and investment per capita towards healthcare. In Singapore, the citizens

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are still required to pay for two thirds of their healthcare costs. It can be suggestible therefore
to increase the funding and investment on healthcare by the Singapore government. However,
it can also be seen that Singapore has a better performance across population health
indicators, showing the lowest incidence of maternal mortality, infant mortality and a higher
average life expectancy, compared to US and Canada, which highlights the efficiency of
Singapore’s healthcare systems, making it one of the best among the developed countries.
However, the prevalence of low birth weight, Diabetes and Hypertension for Singapore is
still higher than Canada or US, while the prevelance of Obesity, Cancer and Asthma is
comparatively lower. This points out the key health conditions (like Diabetes and
Hypertension) that needs to be addressed, and its prevelance further reduced to improved the
health of the population as well as fostering further improvement in the healthcare system of
Singapore.

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