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Singapore

Singapore

Owned by Federica Andreoni
Last updated: Jan 20, 2025 by Mohammad Al-Ubaydli
7 min read

Singapore’s spending on health care is lower than that of every OECD country. It is just 5.6% of GDP. Yet Singapore’s health outcomes are better than most of these rich countries. Its government does this by focusing on the causes of good health such as diet, exercise and screening. The government also reduces the price of health care by forcing direct payments (instead of insurance) and by strict cost controls (without rationing).

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. It covers large hospital bills and certain costly outpatient treatments. But it does not cover primary care, outpatient specialist consultations, and prescription medications. For these, patients must 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. Separately, residents may choose to purchase supplementary private insurance or receive employer-provided coverage. MediFund is a safety net the government provides. It is for low-income individuals who cannot afford healthcare costs, even with MediSave (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).

Demand for senior care will significantly rise as the number of elderly citizens in Singapore reaches 900,000 by 2030 and birth rates are low. This makes healthcare needs a top priority according to the 'Smart Nation Singapore' webpage. 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).

All public and private healthcare institutions have implemented NEHR since 2011. It is a fundamental component of the country’s vision of 'One Patient, One Health Record,' so patients receive coordinated, patient-centred care. Authorised clinicians and healthcare professionals—including doctors, nurses, and pharmacists—have 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 in 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 providers’ electronic systems to the NEHR. NEHR’s data requirements includes patient demographics, patient visits, diagnoses, discharge summaries, medications, laboratory reports, radiology images and reports, 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 see 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. The portal launched in 2015, featuring both a web platform and a mobile application. It included a Personal Health Record function known as ‘myHealth’ (GovInsider, 2015; Government Technology Agency of Singapore, 2017).

Features

HealthHub shows information from various systems, including the NEHR, School Health System, School Dental System, and the National Immunisation Registry. It provides access to a wide range of data from public healthcare institutions, including (Synapxe Pte Ltd, 2024):

  • 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

The Caregiver Access module allows a patient to grant carers' access to their medical records and appointments. Parents are also able to access and add data to their children's health records.

Medical fees payments are also possible via the platform.

Challenges and areas for improvement

Data fragmentation was a challenge during development of HealthHub. The platform needed to integrate data from various IT systems used by public hospitals and clinics before it could show the information unified (GovInsider, 2015).

While HealthHub offers valuable services, there are several areas for enhancement (PKB research, 2024):

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

  • Public sector: 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.

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 had 8.5 million page views and that over 84,000 Singaporeans had downloaded the app (Gov Tech Singapore website)

Screenshots

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

Patients 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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