Singapore's health-care system: key features, challenges, and shifts.

Tan, Chorh Chuan

Lam, Carolyn SP

Matchar, David B

Zee, Yoong Kang

Wong, John EL

2021-09-23T04:07:23Z

2021-09-23T04:07:23Z

2021-09-02

2021-09-23T04:07:22Z

Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds-namely, beyond health care to health, beyond hospital to community, and beyond quality to value.

S0140-6736(21)00252-X

0140-6736

1474-547X

https://hdl.handle.net/10161/23843

eng

Elsevier BV

Lancet (London, England)

10.1016/s0140-6736(21)00252-x

Singapore's health-care system: key features, challenges, and shifts.

Journal article

Matchar, David B|0000-0003-3020-2108

School of Medicine

Duke Clinical Research Institute

Duke Global Health Institute

Pathology

Medicine, General Internal Medicine

Duke

Institutes and Centers

University Institutes and Centers

Institutes and Provost's Academic Units

Clinical Science Departments

Medicine

Published