Singapore

Owned by Federica Andreoni
Last updated: Nov 22, 2024
7 min read

Country’s healthcare system in a nutshell

The healthcare system in Singapore is managed by the Ministry of Health, part of the Singaporean government. The country has achieved universal health coverage through a mixed financing system known as the 3Ms: MediShield Life, MediSave, and MediFund. These schemes can overlap to cover the costs of a single treatment episode.

MediShield Life, a mandatory universal insurance scheme for citizens and permanent residents, covers large hospital bills and certain costly outpatient treatments. However, it generally excludes primary care, outpatient specialist consultations, and prescription medications. Patients are required to pay premiums, deductibles, co-insurance, and any costs that exceed claim limits. MediShield Life is complemented by MediSave, a compulsory medical savings account that helps residents cover inpatient and selected outpatient costs, including out-of-pocket expenses. Contributions to MediSave, which range from 8% to 10.5% of an individual’s salary depending on age, are mandatory for all working citizens and permanent residents. Additionally, residents may choose to purchase supplementary private insurance or receive employer-provided coverage. For low-income individuals who are unable to afford healthcare costs, even with MediSave, the government provides MediFund as a safety net (Tikkanen et al., 2020).

According to the most recent data from 2010, health insurance covered the entire population of Singapore. This coverage encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.).

Global consulting firm Towers Watson has recognized Singapore as having "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes" (Tucci, 2004).

According to the 'Smart Nation Singapore' webpage, the number of elderly citizens in Singapore is projected to reach 900,000 by 2030. Combined with low birth rates, this will significantly increase the demand for senior care, making healthcare needs a top priority. As part of its Smart Nation initiative, Singapore continues to explore technological solutions to meet these evolving healthcare needs.

Currently, health initiatives focus on equipping Singaporeans with the information and tools to manage their health more effectively. One such initiative is HealthHub.

Public vs private

 

Screenshot 2024-11-22 at 17.19.23.png
Source: The World Bank.
The pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.

The national PHR

History

To understand Singapore's national Personal Health Record, we must begin with the National Electronic Health Record (NEHR).

Since 2011, the NEHR has been implemented in both public and private healthcare institutions across Singapore. It is a fundamental component of the country’s vision of 'One Patient, One Health Record,' enabling patients to move seamlessly through the national healthcare system and receive coordinated, patient-centred care. Authorised clinicians and healthcare professionals—including doctors, nurses, and pharmacists—are granted secure access to a patient’s summary health record. This promotes better care coordination, informed decision-making, and supports accurate diagnosis and treatment.


The data contributed to the NEHR focuses on a summary of the patient’s medical history rather than detailed doctors’ notes for each consultation The summary health records are transmitted from the providers’ electronic systems to the NEHR. The required data includes patient demographics, patient visits, diagnoses, discharge summaries, medications, laboratory reports, radiology images and reports, OT notes/procedures/treatments, immunizations, allergies, referral notes, appointments, problem lists, ECGs, and care management programs (care plans).

The NEHR is owned by the Ministry of Health and managed by Synapxe (formerly known as the Integrated Health Information Systems, IHiS), an organisation established by the Ministry of Health.

Patients do not have direct access to the NEHR itself. However, they can view some of their clinical records held within the NEHR through the government portal 'HealthHub' (Synapxe Pte Ltd, 2024).

The concept for a comprehensive portal and mobile app providing Singaporeans with access to a variety of health content and e-services was first conceived in late 2013. HealthHub, an initiative by the Ministry of Health and the Health Promotion Board - with support from MOH Holdings and Integrated Health Information Systems (IHiS) - began development in May 2014. By 2015, the portal was launched, featuring both a web platform and a mobile application that includes a Personal Health Record function known as ‘myHealth’ (GovInsider, 2015; Government Technology Agency of Singapore, 2017).

Features

The information presented within HealthHub is sourced from various systems, including the National Electronic Health Record (NEHR), School Health System, School Dental System, and the National Immunisation Registry.

HealthHub provides access to a wide range of data from public healthcare institutions, including:

  • Personal hospital records, such as hospital discharge summaries.

  • Lab test results (particularly for chronic diseases).

  • Medical appointments.

  • Referral letters.

  • Immunisation records.

  • Dental health information.

  • Medication records, including prescriptions—patients can also set reminders for when to take their medication.

  • Screening records.

  • Risk assessments for diabetes.

  • Information on lifestyle facilities and services, such as the locations of polyclinics, healthy food outlets, and sports facilities.

Through the Caregiver Access module, patients can grant their caregivers permission to access their health and medical records, as well as view medical appointments. Parents are also able to access and add data to their children's health records.

Additionally, patients can pay their medical fees via the platform.

(Synapxe Pte Ltd, 2024)

Challenges and areas for improvement

One of the challenges that was faced during the development of the HealthHub system was related to data fragmentation, as the platform needed to integrate data from various IT systems used by public hospitals and clinics before it could display the information in a unified format (GovInsider, 2015).

While HealthHub offers valuable services, there are several areas for enhancement:

  • Limited Data Entry: Patients can only input limited personal data, specifically in the measurements section, while most of the record is ‘view-only’.

  • Restricted Data Sources: The platform exclusively sources data from public institutions, limiting the comprehensiveness of the records.

  • Lack of Messaging Feature: Patients cannot communicate directly with healthcare professionals through the platform.

(PKB research, 2024).

Published outcomes - statistics

Unfortunately, we couldn’t find any recent statistics about the use of HealthHub in Singapore. If you have access to this information or can put us in touch with someone who has, please contact us at book@phr4gov.org

The latest available statistics are from January 2017, stating the HealthHub website has had 8.5 million page views — and over 84,000 Singaporeans have downloaded the app (Gov Tech Singapore website)

Screenshots

All the screenshots are from: https://www.healthhub.sg/healtheservices

Patients can log in to view and manage their medical records. Once logged in, they can access and manage their appointments, view vaccination records, and see test results from the past three years. Patients can also check medical alerts, adverse drug reactions, and allergies, as well as screening results, and discharge and admission information from public hospitals or healthcare institutions (up to three years). Additionally, they can track measurements like blood glucose, blood pressure, and BMI, request certificates, view current prescriptions and medications, authorise the Ministry of Health for subsidies, MediSave, and MediShield Life, complete health-related self-assessments, make payments, request prescription renewals, check their Community Health Assist Scheme (CHAS) subsidy balance, see upcoming screenings, and view Chest X-Ray and Mammogram reports.

Bibliography

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