Health Delivery System in Singapore
There is a dual system of healthcare delivery in Singapore. The public system is run by the government
while the private system is provided by private hospitals and general practitioners. The healthcare delivery
system is made up of primary health care provision at private medical practitioners' clinics and outpatient
polyclinics, and secondary and tertiary specialist care in the private and public hospitals.
The eight public hospitals comprise of five acute general hospitals (SGH, NUH, CGH, TTSH, AH), a hospital
obstetrics & gynaecology and paediatric medicine and surgery, a psychiatry hospital and one community hospital.
The five general hospitals provide multi-disciplinary acute inpatient and specialist outpatient services
and a 24-hours accident and emergency service.
In addition, there are 6 specialty centres for eye, skin, cancer, heart, neuroscience (study of nerve system) and dental. Liver
transplant surgery is centralised in one of the larger hospitals, the National University Hospital while the kidney transplant surgery is centralised in both
the Singapore General Hospital and National University Hospital. Heart transplant is carried out by the National Heart Centre, while Lung Transplant
is carried out together by the National Heart Centre, the National Cancer Centre and the Singapore General Hospital.The
private hospitals have similar specialist disciplines and comparable facilities.
80% of the primary healthcare services is provided by the private practitioners
while the government polyclinics provide the remaining 20%. For the more costly
hospital care, it is the reverse situation with 80% of the hospital care being
provided by the public sector and the remaining 20% by the private sector.
The public healthcare delivery system was re-organised into two vertically integrated delivery networks,
National Healthcare Group (NHG) and Singapore Health Services (SHS). This is to enable more integrated
and better quality healthcare services through greated cooperation and collaboration among public sector
healthcare providers. This system will minimise the duplication of services and ensure optimal development
of clinical capabilities.
Patients have the freedom to choose which provider within the dual healthcare delivery system for services and
can walk in for a consultation at any private clinic or any government polyclinic. For
emergency services, patients can go at any time to the 24-hour Accident &
Emergency Departments located in the government hospitals. The Singapore Civil
Defence Force also runs an Emergency Ambulance Service to transport accident and
trauma cases and medical emergencies to the general hospitals.
Health Status in Singapore
The state of health in Singapore is good by international standards. The infant
mortality rate in 1999 stood at 3.2 per 1000 live births while the average life
expectancy rate was 77.6 years. Rising standards of living, high standards of
education, good housing, safe water supply and sanitation, a high level of
medical services and the active promotion of preventive medicine, have all
helped to significantly boost the health of Singaporeans. The leading causes of
morbidity and mortality are currently the major non-communicable diseases such
as cancer, coronary heart diseases, strokes, diabetes, hypertension and injuries.
Cancer and cardiovascular diseases together accounted for approximately 62% of
the total causes of death.
Singapore today has about 5,154 doctors for its healthcare delivery system. This gives a
doctor to population ratio of 1:730. Slightly less than half of the doctors
(48%) are in the private sector. About 42% of the doctors are trained specialists
with postgraduate medical degrees and advanced speciality training.
There are 942 dentists, giving a ratio of 1 dentist to 4,130 population. About 77% of
the dentists are in private practice.
The nurse to population ratio is 1:244, with a total of about 15,947 nurses. 55% of
the nurses work in the public sector.
National Healthcare Expenditure
In 1999, Singapore spent about S$4.3 billion or 3.0% of GDP on healthcare. Per
capita healthcare spending was S$1,347. Government subsidy on the public
healthcare services was S$1,089 million or 0.8% of GDP in 1998.