Commentary: Healthcare in Singapore is world-class - and under-utilised
SINGAPORE: When our family moved to Singapore in the 1990s, we asked Singaporean friends for recommendations for a family doctor. All suggested a private clinic. None suggested the public health system.
When I needed minor surgery in the early 2000s, I went to a polyclinic and was sent to Singapore General Hospital.
All went well. What stood out, though, was a remark by our private family physician as he took out the sutures and said with surprise: “They did excellent work.” I was somewhat surprised by his remark.
Singapore is recognised as a top location globally for healthcare. The healthcare system has come a long way from Singapore General Hospital’s early days as a wooden shed set up in 1821 on Bras Basah Road to cater to injured European soldiers.
By the early 2000s, the World Health Organization ranked Singapore as the sixth best in the world. Singapore’s healthcare system is also ranked best in the world on the Legatum Prosperity Index by British think tank Legatum Institute.
From polyclinics and private practices to general hospitals and specialised facilities such as the National Heart Centre, Singapore’s healthcare quality is superb.
Compare this with the United States where I’m originally from. Despite being one of the most expensive in the world, the US trails far behind other high-income countries on measures of healthcare affordability, administrative efficiency, and outcomes, according to a 2021 report by The Commonwealth Fund.
In Singapore, while healthcare spending is expected to drive increases in social spending, the country has delivered good health outcomes given its spending of 4 per cent of GDP on healthcare, said Health Minister Ong Ye Kung in parliament in May. This compares with 17 per cent for the US and 10 per cent for the UK.
Another recent healthcare incident exemplifies this. At the end of 2022, I was in the US on holiday and a doctor recommended a complex test, quickly. The results were ambiguous.
I checked with the healthcare system in Singapore when I returned home, and the doctor had me do the same test to get it properly recorded here. The cost was more than 80 per cent less than in the US, written reports were more thorough, and a physician took time to explain the results, which the doctors in the US did not do. Thankfully, all was okay.
PASSIVE ABOUT PREVENTIVE CARE
Despite the tremendous advances, however, there is still a significant gap in Singapore’s healthcare. The issue is not the staff or the technology. It’s not budgets. Instead, it’s the people. Even as the quality of care has surged, many people do not seem to be proactively managing their health well.
When answering questions recently by a doctor for a series of tests I had to take, I answered: Daily exercise, a healthy diet, never smoked, regular dental visits, regular health screenings.
After a few more questions, the doctor said she should use me as an example for other patients. Her comment was not so much about my health. Rather, it was a somewhat sad commentary on how few patients that doctors see are taking adequate care of their own health.
A recent study by Doctor Anywhere found that even though 70 per cent of individuals understand that preventive healthcare is applicable to them, 60 per cent have not scheduled a health screening in the last 12 months. One-third associated having no symptoms with good health, with little need to do anything to look out for themselves.
Along with a gap in managing their own healthcare, many people seem sceptical about technology. Research funded by the Ministry of Health showed older adults in Singapore may perceive healthcare-related technology as unnecessary or do not know how to use it.
Singapore’s spending on healthcare tripled to S$11.3 billion from 2010 to 2019, and it is expected to increase to S$27 billion by the end of the decade.
Current mindsets may mean that outcomes are not as good as they could be despite more spending. To change fundamental attitudes about healthcare, which holds back prevention and treatment as well as potential further gains, interventions may be needed to change people’s behaviours.
NUDGING PEOPLE TO TAKE MORE CONTROL OVER THEIR HEALTH
The Healthier SG programme is one positive step. The national initiative, which aims to have Singaporeans and permanent residents take charge of their own healthcare by enrolling with a single doctor to support them in their health needs throughout their lives, was officially launched on Saturday (Jul 8).
Those who enrol with a family doctor may get fully subsidised recommended health screenings and vaccinations. Healthier SG is expected to benefit more than 2 million Singapore residents by the end of 2024.
Another effective intervention could be to increase the usage of “nudge theory”, which shapes messages to improve outcomes. When the Health Promotion Board nudged people to participate in its free workouts by giving them a nametag, a small group to join and a WhatsApp chat, for instance, participation increased by up to 30 per cent.
Overseas, researchers at University College London found that more patients completed their medication cycle when pharmacists had them sign a commitment letter and warned them about the risks of non-adherence.
Plenty of other practices to encourage proactive responsibility show promise and can work well too.
It’s a delight to live in a nation with superb healthcare. It’s a disappointment that more people don’t take full advantage of it.
Taking steps to ensure more people use the excellent healthcare services in Singapore can keep the nation at the top of healthcare quality, and - most importantly - help residents stay healthy.
Richard Hartung is a freelance writer who has resided in Singapore since 1992 and covers a wide range of local and international news.
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