Singapore
- Federica Andreoni
- Mohammad Al-Ubaydli
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 may overlap in covering a single treatment episode.
MediShield Life, a universal basic insurance scheme, is mandatory for citizens and permanent residents. It covers large hospital bills and certain costly outpatient treatments but generally does not include primary care, outpatient specialist visits, or prescription medications. Patients are responsible for premiums, deductibles, co-insurance, and any costs exceeding claim limits. The MediShield Life system is supplemented by MediSave, a compulsory medical savings account that helps residents cover inpatient and selected outpatient expenses, including out-of-pocket medical costs. Contributions to MediSave, ranging from 8% to 10.5% of personal and employer salaries depending on age, are mandatory for all working citizens and permanent residents. Additionally, individuals may opt for extra private insurance or obtain it through their employers. For low-income Singaporeans who cannot afford their medical expenses, even with MediSave, the government has established MediFund as a safety net.
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).
The 'Smart Nation Singapore' webpage states that the number of elderly citizens in Singapore is expected to reach 900,000 by 2030. Coupled with low birth rates, this will increase the burden of caring for seniors, making healthcare needs a priority. As Singapore advances towards becoming a Smart Nation, it is continually exploring technological solutions to address these healthcare needs.
Presently, health initiatives are aimed at providing Singaporeans with the information and tools necessary to better manage their health. One such initiative is 'HealthHub'.
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.).
Public vs private
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 discuss the Singaporean national Personal Health Record, it's essential to start with the ‘foundation’, which is the National Electronic Health Record (NEHR).
The NEHR has been deployed to both public and private healthcare institutions in Singapore since 2011. It is a key enabler of the country’s vision for 'One Patient, One Health Record,' allowing patients to move seamlessly across the national healthcare network and receive coordinated, patient-centric care. Authorized clinicians and healthcare professionals (including doctors, nurses, and pharmacists) have secure access to a patient’s summary health record. This enables greater coordination and informed decision-making, as well as supports better diagnosis and treatment.
The data contributed to the NEHR focuses on a summary record of the patient’s medical history and does not include doctors’ personal case 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, founded by the Ministry of Health).
Patients do not have direct access to the NEHR; however, they can access some of their clinical records held in the NEHR through the government portal 'HealthHub' (Synapxe Pte Ltd, n.d.).
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 established, 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 drawn from multiple sources such as the NEHR (National Electronic Health Record) System, School Health System, School Dental System and National Immunisation Registry,
HealthHub provides access to data from public healthcare institutions, including:
personal hospital records, including hospital discharge summary;
lab test results (for chronic diseases);
medical appointments;
referral letters;
immunisation records;
dental health;
medication records, including prescriptions- patients can also set reminders on when to take their medication;
screening records;
risk assessment for diabetes;
information on lifestyle facilities and services, such as locations of polyclinics, healthy food places and sports facilities.
With the Caregiver Access module, patients can grant their caregivers access to their health and medical records and medical appointments. Parents can also view their children’s record and add data to it.
Patients can also pay their medical fees through the platform.
Challenges and areas for improvement
One of the challenges that was faced during the development of the system was related with data fragmentation, trying to integrate data from different IT systems from various public hospitals and clinics, before displaying it on HealthHub.
There are also several areas where the HealthHub platform could be improved. Currently, patients can only add limited personal data, specifically in the measurements section, while most of the record is ‘view-only’. Additionally, the data available on the platform comes exclusively from public institutions, limiting its sources. Lastly, there is no messaging feature that allows for direct interaction between patients and healthcare professionals.
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@patientsknowbest.com
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
Bibliography
GovInsider. (2015) How we built it… Singapore HealthHub. Available at: https://govinsider.asia/intl-en/article/how-we-built-it-singapore-health-hub (Accessed: 30 July 2024).
Government Technology Agency of Singapore. (2017) A healthy hub at your fingertips. Available at: https://www.tech.gov.sg/media/technews/a-healthy-hub-at-your-fingertips/ (Accessed: 30 July 2024).
Smart Nation and Digital Government Office. (2024) Smart Health Initiatives. Available at: https://www.smartnation.gov.sg/initiatives/health/ (Accessed: 30 July 2024).
Synapxe Pte Ltd. (n.d.) About National Electronic Health Record (NEHR). Available at: (Accessed: 30 July 2024).
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. and Wharton, G. A. (2020) International Health Care System Profiles, Singapore. The Commonwealth Fund. Available at: (Accessed: 30 July 2024).
Tucci, J. and Watson, T. (2004) The Singapore health system–achieving positive health outcomes with low expenditure. Healthcare Market Review, 26.