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Healthcare Providers

The healthcare system in Singapore is divided into two sectors; statutory boards and institutions (which are then divided into public and private streams). There are a variety of statutory boards in place, including the Medical Council, Dental Council, Nursing Board, Pharmacy Council, and Optometrists and Opticians Board. Healthcare institutions can be divided into public and private hospitals and healthcare providers. All hospitals in Singapore have been structured as government coporations since the 1990s, constantly competing with one another to have the most advanced services, and technology available. There are multiple spheres and levels to both the public and private streams.

Public Sector

Singapore has an incredible reputation for health services and healthcare systems; in 2000, the country was ranked sixth in the world by the World Health Organization. Public hospitals have autonomy over management decisions, and compete with one another for patients. General hospitals have a variety of functions and services; they mainly represent multi-disciplinary acute inpatient and specialist outpatient services, have 24-hour emergency centers, and often specialize in a specific field of medicine (cancer research, neuroscience, dental care, cardiac care, etc.). Singapore has an array of hospitals and health services available, as well as community hospitals that exist as an intermediate form of healthcare for people who do not require the services of a general hospital but cannot cope at home. The funding behind Singapore's public health sector can be broken down into the Ministry of Health of Singapore, MediSave, MediShield Life, and MediFund.

Ministry of Health of Singapore

The Ministry of Health of Singapore is a system designed to ensure that all citizens have equal access to health care. The ministry funds eight public hospitals, six of which are general, one specializes on women and children, and one on psychiatry. thumb|Central Provident Fund Board Logo

MediSave

The Central Provident Fund Board, a social security system, allows the citizens of Singapore to put aside funds for a variety of expenses including retirement, healthcare and mortgage. Citizens can make monthly contributions to three different accounts: 1) ordinary accounts for housing, insurance, investment, and education, 2) special accounts for retirement, and investment, and 3) MediSave accounts for hospitalization expenses and medical insurance. MediSave contributions are usually between 8-10.5% of an individual's wage, and is caped at a $52,000 limit. This form of a health savings account is required by all workers; those below the age of 55 are required to deposit 20% of their earnings. This contribution is almost matched by the employer who contributes 17% of the workers earnings.

MediShield Life

MediShield Life is a form of healthcare that almost all Singaporeans are covered under. It is very inexpensive, with monthly instalments and has an annual limit of $100,000. This form of healthcare covers almost all hospitalization expenses.

MediFund

MediFund is Singapore's safety net program, which covers only the lowest class of hospitalization fees and services. This form of coverage and insurance is only available to citizens of Singapore once they have depleted their MediSave and MediShield funds. The amount of funding and coverage is dependent on the individuals' income, health condition, and socioeconomic status.

Private Sector

The private healthcare sector in Singapore has a huge market, with a more exclusive clientele. Private healthcare often attracts individuals in search of more advanced and complicated treatments such as stem cell therapy, or specialized cancer treatments. The private sector is more appealing and preferred by expatriate citizens as opposed to public for the short wait times, and greater availability of services. The private sector consists of private hospitals, and private insurance.

Private Hospitals

There is no shortage of private hospitals and clinics in Singapore. Three hospital groups operate the majority; Parkway Holdings, Pacific Healthcare Holdings, and Raffles Medical Group. These private hospitals are typically smaller, offer patients more privacy, and typically specialize in certain procedures or surgeries.

Raffles Medical Group

Raffles Medical Group (RMG) is one of the largest private healthcare providers in Asia, with hospitals and clinics located in several cities, including Singapore. RMG owns Raffles hospital in Singapore, which specializes in obstetrics and gynecology, cardiology, oncology, and orthopedics.

Private Health Insurance

There are a variety of choices for healthcare insurance in Singapore, and within the private sector. Depending on an individual, or families level of income, lifestyle, location, and medical history, there are monthly insurance plans ranging from $75 SGD to $400 SGD. Companies include but are not limited to Allianz, Aviva, Great Easter, and Prudential.

Cost Comparison of Public and Private Sectors

There is a vast difference in the cost of health insurance, hospital bills, and procedures from the public to private sector. The table below illustrates some of the differences in cost associated with a variety of conditions/procedures.

Cost Comparison of Procedures in Public/Private Hospitals

Condition/Procedure	Government Hospitals	Private Hospitals
Hip replacement surgery	$8,171 SGD	$19,538 SGD
Kidney stones	$3,545 SGD	$5,610 SGD
Cataract surgery	$853 SGD	$2,547 SGD
Appendix removal	$3,300 SGD	$12,041 SGD
Colonoscopy	$1,334 SGD	$1,674 SGD

Health Indicators

Some common indicators used to indicate health include Total Fertility Rate, Infant Mortality Rate, Life Expectancy, Crude Birth and Death Rate. As of 2017, Singapore has a Total Fertility Rate of 1.16 children born per woman, an Infant Mortality rate of 2.2 deaths per 1000 live births, Crude Birth Rate of 8.9 births per 1000 people and a Death Rate of 3 deaths per 1000 inhabitants. The average lifetime expectancy at birth slightly increased from 83 to 83.1 between the period 2016 and 2017. In comparison, the average lifetime expectancy for China grew from 76.3 in 2016 to 76.4 in 2017. Other parameters are outlined below:

Parameters Organized by Year

	1960	1970	1980	1990	2012	2013	2014	2015	2016	2017
Life Expectancy at Birth	61.3	66.0	72.2	75.3	82.0	82.3	82.55	82.8	83.0	83.1
Total Fertility Rate (per female)	5.76	3.07	1.82	1.83	1.29	1.19	1.25	1.24	1.2	1.16
Infant Mortality Rate (per 1,000 live births)	35.6	22.0	12.0	6.2	2.2	2.1	2.1	2.1	2.2	2.2
Under 5 Mortality Rate/Child Mortality (per 1,000 live births)	47.8	27.4	14.8	7.7	2.8	2.7	2.7	2.7	2.8	2.8

In general, all indices showed improvement except for the Total Fertility Rate, which dropped to 1.16 in 2017, making it the lowest figure since 1.15 in 2010 and the second lowest ever recorded in the city-state. This general slow-down can be explained by the ‘demographic-gift’, term defined by the United Nations Population Fund (UNFPA) according to which increases in income, education and health and the changing role of women in the workforce were strongly connected to levels of low fertility rate.

Age Pyramid of Resident Population, Singapore Department of Statistics

Age Structure

The median age of the resident population rose from 40.0 years to 40.5 years between June 2016 and June 2017. Residents aged 65 years and over made up 13% of the resident population in Singapore in 2017, compared to 12.4% in 2016.

Dependency Ratio

The Age dependency ratio in Singapore was reported at 37.98% in 2016, according to the World Bank collection of development indicators, and is expected to reach 36.3% by 2030 and 60.6% by 2050. The retired population will therefore make up a growing share of the population in the upcoming years. Factors contributing to this growth include rising life expectancy and falling birth rates.

Medical Issues in Singapore

Malnourishment

Further information (including graphs): http://apps.who.int/nutrition/landscape/report.aspx?iso=SGP&rid=1620&goButton=Go

Malnourishment is “a condition caused by inadequate, excessive or imbalance intake of nutrients". Common indicators used to measure malnourishment are body mass index and vitamin deficiencies.

Children

From 1977 to 2000, children malnutrition for those aged five and younger had moments of improvement and backtrack. The prevalence of children being underweight, having stunted growth or being weak has improved. More specifically, in 2000 it was 8.9% less common for a child to be underweight compared to rates in the 1970s. Conversely, between the years of 1970 and 1977, the prevalence of a children being overweight increased. Similarly, in 2016 22.4% of school-aged children and adolescents aged 5 to 19 years were overweight.

Women

From 1980 to 2016, the World Health Organization (WHO) measured females malnutrition based on body mass index (BMI). BMI is utilized to identify if an individual is normal weight, overweight or underweight. From 1980 to 2016, the percentage of females who were underweight stayed at 8%, indicative of the static relationship and trend.From 1980 to 2010, the percentage of females who were overweight increased from 25% to 33.6%. WHO indicates that being overweight is a “major determinant of many non-insulin-dependent diabetes mellitus, coronary heart diseases and stroke," along with many other health consequences. The percentage of females who are overweight has, however, decreased from 33.6% to 27.4% from 2010 to 2016. Conversely, the percentage of females who are obese has increased steadily from 2.5% to 6.1% from 1990 to 2016. Obesity, as indicated by the WHO, can be mitigated through lifestyle changes.

Common health issues

Dengue Fever

Further information: http://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

The prevalence of dengue fever is high in Singapore given its tropical temperature. Despite risk being present year round, dengue fever has a higher transmission rate from September to February (the rainy season).

Symptoms of Dengue Fever

Dengue fever is a mosquito-born disease, present in the Aedes Aegypti species. Transmission of the dengue virus occurs through the bite of the infected insect. Once bitten, an individual can either exhibit symptoms or not. No symptoms indicate that the dengue infection is asymptomatic. Those with symptoms can experience headaches, high fevers, pain behind the eyes, muscle, joint and bone pain, and a skin rash with red spots within 4 to 7 days of being infected. Severe dengue can lead to death. In the week of 16-22 June 2013, Singapore experienced an outbreak of dengue fever. By mid-July, more than 13,000 people were infected with the virus.

Diagram depicting Myopia - nearsightedness

Myopia

Further information: https://www.healthhub.sg/live-healthy/487/myopia_aworldwedontwantforourkids

Singapore is believed to have the highest prevalence of myopia in children worldwide. More specifically, about “65% of children aged 12 in Singapore are myopic”. Myopia is a vision problem, affecting an individual’s ability to see distant objects. The major causes are still unclear. However, near work activities such as staring at a screen or reading a book are said to worsen the condition.

Environmental impacts on health issues

Haze

Picture illustrating the haze period in Singapore

Annually from May to October, Singapore experiences a smoke haze which can cause or worsen pre-existing health issues. The haze is largely caused by, “winds bringing in tiny particles of ash,” from the burning of forestry in Indonesia, the neighbouring country. A person’s likelihood of developing viral and bacterial infections is increased by breathing in an excess of these particles. Additionally, individuals may experience irritation of the eyes, nose and throat if exposed to an excess amount of the haze. However, in most cases these aforementioned health issues will resolve on their own. The haze can also perpetuates existing heart and lung conditions, such as asthma.

Air Pollution

Further information: https://www.nea.gov.sg/our-services/pollution-control/air-pollution/air-quality

Compared to most cities in Asia, Singapore’s levels of air pollution are rather lower. Singapore has experienced rapid urbanization and industrialization over the years. Thus, “the main sources of air pollution in Singapore are emissions from the industries and motor vehicles". The National Environment Agency has indicated that the most concerning air pollutants are particulate matter, carbon monoxide, ozone nitrogen dioxide and sulphur dioxide. Continuous exposure to these air pollutants can “cause respiratory symptoms and aggravate existing heart or lung disease”.