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Singapore’s medical standards are among the highest in Asia and the health care system was ranked sixth in the WHO’s ranking of world health systems in 2000. Health care in Singapore is a combination of both private and government institutions offering primary, secondary and tertiary health care provision. The public system is managed by the Ministry of Health, which is also responsible for regulating health standards and formulating national health policies for the provision of preventive, curative and rehabilitative health services. The private system is composed of hospitals and general practitioners, which provide 80% of primary health care services. The public sector, however, provides 80% of hospital care. There are 18 government-run outpatient polyclinics, about 1,500 private medical practitioners’ clinics, and several public and private hospitals and specialty centres.
There is a large and successful pharmaceutical industry in Singapore, with more than 10 leading pharmaceutical and biotechnology companies having regional headquarters in the country. The pharmaceutical sector is self-regulated through the Singapore Pharmacy Council.
Singapore finances health care using government subsidies, insurance and a mandatory saving system called Medisave, into which employers and employees contribute a percentage of their salary each month. There are still out-of-pocket payments to be made, however, that can be difficult for low-income families to afford.
In the early days of independence, the government established a network of satellite outpatient dispensaries, and maternal and child health clinics to bring primary care services closer to people and take pressure off hospitals. The so-called polyclinics offer a one-stop-shop for immunisation, health screening, family planning services, nutritional advice, psychiatric counselling, dental care, pharmaceutical dispensary, x-rays, clinical laboratory and even home visits.
Those living in Singapore who are not citizens or permanent residents generally have to pay the full cost of their health care. Having a baby, for example, costs in the region of S$9,000 (US$6,650).
Non-communicable diseases (NCDs) in Singapore accounted for an estimated 76% of all mortality in 2012. The most prevalent NCDs in Singapore are cardiovascular diseases, which accounted for 31% of total deaths across all age groups in 2012, and cancer, accounting for 30% of all deaths. Non-communicable variants of respiratory diseases and diabetes contributed 3% and 1% to total mortality, respectively (2012). Communicable diseases along with maternal, perinatal and nutritional conditions in Singapore accounted for an estimated 19% of all mortality in 2012. The prevalence of HIV in Singapore, as a percentage of people aged 15–49 years, is less than 0.1% (2012). Despite being in a region endemic for malaria, Singapore has maintained its malaria-free status from the World Health Organization since 1982. Estimated incidence of and estimated mortality (when mortality data excludes cases comorbid with HIV) from tuberculosis (TB) fell overall in the period 1990–2013, although estimated incidence has shown a gradual increase in the period 2007–13.
Singapore has a life expectancy of 82 years, showing a sustained increase – up from 78 years in 2000 and 76 years in 1990. Gains have been primarily due to reduced child and maternal mortality, and improved longevity for other age groups, particularly for older people with chronic diseases.
Singapore suffers from few physical hazards, but has one of the world’s most open economies which, coupled with a high population density, makes the country particularly vulnerable to outbreaks of infectious diseases, such as the severe acute respiratory syndrome (SARS) outbreak in 2003 and the influenza A (H1N1) pandemic in 2009. In response to this vulnerability, the Ministry of Health maintains a comprehensive and well-established system of disease surveillance and control under the Infectious Diseases Act. The Ministry of Health has access to a surveillance system capable of allowing early detection of potential infectious disease threats. This, combined with close links with the World Health Organization, allows the Ministry of Health to detect and track outbreaks worldwide, allowing for a quick response to infectious disease outbreaks. Health care institutions and medical workers are also kept informed of potential threats in a bid to ensure that they are prepared.
NCDs, particularly cancer and heart disease, remain the leading causes of mortality – in contrast to the 1950s, when infectious diseases like TB were among the leading causes. Cancer incidence rates, which accounted for 30% of all deaths in 2012, have been declining slowly since the early 1980s for men. However, incidence rates for women have increased, due mainly to increases in breast and colorectal cancers. The prevalence of chronic diseases in Singapore, such as diabetes and hypertension, declined between 1992 and 2010, as well as risk factors including smoking, physical inactivity, obesity and high cholesterol.
In 2013 government expenditure on health was 1.8% of GDP, equivalent to US$912 per capita. In the most recent survey, conducted between 1997 and 2010, there were 192 doctors, and 639 nurses and midwives per 100,000 people. In 2013, 95% of one-year-olds were immunised with a dose of measles and in 2011, 100% of births were attended by qualified health attendants. In 2014, 100% of Singapore’s population had access to improved water sources and adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Singapore has 39 pharmaceutical personnel per 100,000 people.
Just over a third of health care in Singapore (38%) was government funded in 2012. The remaining 62% was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 4.2% of GDP in 2012. Expenditure by government amounts to US$912 per capita.
Singapore is not a signatory to the International Covenant on Economic, Social and Cultural Rights, the covenant that commits signees to the ensuring ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’.
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|Mahkota Medical Centre||