|Implemented in this survey?|
With effect from 1 March 2010, Singaporean citizens and permanent residents are, under certain conditions, able to use their compulsory medical savings, Medisave, to help pay for non-emergency hospitalisation in approved hospitals overseas. Previously, outside Singapore they could only use Medisave for emergency hospitalisation.
Aim of this policy is to enable Singaporean patients to take advantage of the lower cost of hospitalisation available in neighbouring countries.
Singapore and its closest neighbour, Malaysia, are connected by a causeway that is only three-quarter miles long, or about an hour's drive by car, taking into consideration the need for passport clearance at the border. Indeed, the two countries were united as one political entity for two years between 1963 to 1965, when Singapore was part of Malaysia in a federal union of fourteen states. For Singapore, however, the political union failed and so it alone became ejected as an independent, sovereign island-state. Largely owing to differences in cost structures that have increasingly widened since separation, the cost of healthcare in Malaysia is generally much lower than in Singapore, as illustrated in Table 1.
Table 1: Price comparison of selected procedures done in Singapore and in Johor (the state that is closest to Singapore), Malaysia
Procedure Specialist Hospital in Johor Specialist Hospital in Singapore
Removal of Haemorrhoids S$1,667 S$3,142
Total knee replacement S$8,333 S$16,765
Stent for blocked heart vessels S$7,500 S$19,730
(Source: Straits Times, figures cited are from from Health Management International and Ministry of Health, Singapore)
The idea of crossing the border for cheaper healthcare (and indeed, for a whole range of produce and services) has certainly not been lost on Singaporeans, and indeed, many do. Over the years, the government of Singapore has received requests from many Singaporeans to allow them to tap on their Medisave accounts for elective hospitalisation overseas, particularly in neighbouring Malaysia.
The main concern, however, has been that Singapore's Ministry of Health has no regulatory jurisdiction over overseas hospitals, and cannot be sure of their standards. It would also be difficult to audit the hospitals when problems, such as fraudulent Medisave claims, arise.
Thus, in announcing the relaxation of the policy, the MoH noted that a commonly expressed fear, whether founded or unfounded, is that potential patients are unsure of the standard of healthcare in Malaysia, and stipulated the following conditions:
a. Medisave usage will only be limited to hospitalizations and day surgeries, i.e. it cannot be used for outpatient treatment;
b. The overseas hospital must have an approved working arrangement with a Medisave-accredited institution/referral centre in Singapore;
c. The patient must be referred through a Medisave-accredited institution/referral centre in Singapore;
d. The accredited local institution/referral centre must provide pre-admission clinical assessment and financial counselling to the interested patient; satisfaction and clinical outcome.
e. The local centre will be accountable for patient satisfaction and clinical outcome.
The scheme has started off with two healthcare providers that are headquartered in Singapore, namely: Health Management International (HMI) which has two hospitals in neighbouring Malaysia, and Parkway Holdings Pte Ltd., which has 10 hospitals in Malaysia. Both groups are also listed companies on the Singapore Exchange.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Implemented in this survey?|
|Ministry of Health||very supportive||strongly opposed|
|Private providers||very supportive||strongly opposed|
|Patients||very supportive||strongly opposed|
|Ministry of Health||very strong||none|
|Private providers||very strong||none|
According to a check conducted by a Singaporean newspaper about six months after implementation, many of the patients who used Medisave across the border did so for obstetrics treatment.
To date, HMI has had 23 Medisave patients seeking medical treatment at its two hospitals in Malaysia - the Regency Specialist Hospital in Johor Baru and Mahkota Medical Centre in Malacca. 15 of these have sought obstetrics treatment. Nine have already given birth and six are waiting to deliver. While only four out of the 16 cases referred to Parkway Holdings' hospitals are related to births, the majority of the queries received were about obstetrics procedures, a spokesman said.
Others sought treatment for procedures such as coronary angiogram, cataracts, total knee replacement and total hip replacement.
The liberalization of Medisave for overseas treatment is expected to be an important driving factor for an influx of Singaporean residents to accredited hospitals in Malaysia.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Between 2008 and 2009, the increase in the average bill sizes in Singapore's public sector hospitals ranged from three per cent for Class B1 to 10 per cent for Class B2. Extending the usage of Medisave to overseas therefore is increasingly seen as a viable option for receiving affordable healthcare.
Lim Meng Kin
National University of Singapore