In Singapore, patients can opt to get medical treatment in either public or private healthcare institutions. Costs are generally lower in the public sector, but due to heavy workload, wait times can be long. On the other hand, the private sector wait times tend to be considerably shorter, but the costs of treatment are higher.
Based on data from the Singapore Department of Statistics for the period between 2020 and 2024, there was an 18% increase in the number of acute public hospital admissions, and a 23% increase in the number of patients at public hospital specialist outpatient clinics.1 In comparison, there was only a 6% increase in the number of acute private hospital admissions over the same period. While there is no data available for private specialist outpatient clinics, it is likely that the number of attendances has likewise not increased significantly.
Active collaboration
Recent changes to private health insurance that reduce the coverage of riders will lead to reduced insurance payouts for private hospital admissions,2 and this could steer even more patients to the public sector. The public sector would be under further strain, while the private sector would be underutilised. It would be logical for the Government to collaborate with the private sector to optimise the use of healthcare resources.
The COVID-19 pandemic provided an extraordinary impetus for such collaboration. During the pandemic, private hospitals contributed medical staff, nurses and operational support towards the running of COVID-19 treatment facilities across the island. Stable non-COVID-19 patients were diverted to private hospitals for management of their chronic conditions. Over 970 private GP clinics were designated as Public Health Preparedness Clinics to provide COVID-19 testing and treatment.
Outside of the pandemic, the most sustainable government collaboration with the private sector has been at the primary healthcare level. Since 2012, the Community Health Assist Scheme (CHAS) has allowed some 1.2 million patients to obtain subsidised primary care at participating GP clinics.3 More recently, the Healthier SG initiative has allowed 1.3 million enrollees to potentially receive health screenings and selected common chronic medications at subsidised rates.4
However, collaborations at the hospital level have been few and far between. The Ministry of Health and Raffles Hospital have had an ongoing collaboration since 2015, whereby Singapore Civil Defence Force ambulances may send patients with non-life-threatening conditions to Raffles Hospital for emergency treatment at subsidised rates. There were also collaborations with a few private hospitals to receive dengue patients, but I am not sure if they are still ongoing.
As for private specialist outpatient clinics, there is no such collaboration to date. When I first started private practice, I thought that since benign prostatic hyperplasia (BPH) was among the 23 chronic conditions covered under CHAS, some of my patients would be able to get subsidies for BPH treatment. However, I soon realised that the CHAS scheme did not extend to specialist outpatient clinics.
There are advantages to having government collaboration with private specialists and hospitals – on the whole, wait times for patients would shorten and workloads would be more evenly distributed between the public and private sector. Doctors' fee expectations will need to be moderated for such a scheme to be viable. Costs of implementation may come down if plans for a new not-for-profit private hospital come to fruition.5
The COVID-19 pandemic has clearly shown that government collaboration with the private sector is possible and beneficial. Why not have a similar collaboration in "peacetime"? It would optimise the utilization of the public and private healthcare sector and improve the delivery of healthcare to Singaporeans.