Healthcare – Singapore

Sector Report

Healthcare

Singapore

Produced by:

Ms Valsa Panicker, Senior Trade & Investment Attache, British High Commission, Singapore

Last revised: July 2009

Whereas every effort has been made to ensure that the information given herein is accurate, UK Trade & Investment or its sponsoring Departments, the Department for Business, Innovation & Skills and Foreign & Commonwealth Office, accept no responsibility for any errors, omissions or misleading statements in that information and no warranty is given or responsibility is accepted as to the standing of any firm, company or individual mentioned.

Table of Contents

OVERVIEW3

CHARACTERISTICS OF THE MARKET4

OPPORTUNITIES6

KEY METHODS OF DOING BUSINESS12

PUBLICATIONS13

EVENTS14

CONTACT LISTS17

Page 1 of 20

Healthcare – Singapore

Overview

Since Singapore’s independence in 1965, its concerted and farsighted efforts in economic development have resulted in almost uninterrupted growth of nearly 8% per annum for over three decades. Despite its small size (707km²), population base (4.7 million), and its lack of natural resources, Singapore’s business friendly environment, significant foreign investment, and constant efforts to maintain a competitive edge, have resulted in consistent economic growth over the years, and a per capita GDP of S$52,994 (2007) [approximately £24,400]. The economy grew by 7.9% in 2006, 7.5% in 2007 and but grew by 1.2% in 2008. Growth in 2009 is predicted to be between –5% to –2% due to sharp, protracted recession envisaged due to the global economic downturn. Singapore’s strategic location has historically made it a major trading hub, and annual trade is valued at 3 times its GDP.

Singapore is the UK’s ninth largest export market outside of Europe. In 2006, UK product exports to Singapore exceeded £2.3 billion and imports from Singapore totalled £3.8 billion. The UK is the largest overseas investor in Singapore. The cumulative stock of UK foreign direct investment in Singapore stood at £19.5 billion in 2006.

Biomedical Sciences, comprising pharmaceuticals, biotechnology and medical technology, has grown to be the third largest manufacturing cluster after electronics and chemicals, following investment of nearly $3 billion since 2000. It now accounts for over 20% of the sector’s value add, contributing 6% to the GDP. The BMS industry has grown rapidly at a compounded annual growth of 23% since 2000, and reached S$24 billion in manufacturing output in 2007, well on track to reach the earlier target of $25 billion, and employment of 15,000 by 2015. Singapore’s aim is to develop the sector to reach world class standards, and to encompass the entire value chain, from basic research to clinical trials, product/process development, full-scale manufacturing and health care delivery.

Singapore’s medical standards are among the highest in Asia and it is widely acknowledged as a regional centre for medical excellence. It currently holds one percent of the total healthcare market in Asia. The Healthcare Services Workgroup, under the Economic Review Committee, plan to raise this to 3% and develop Singapore into the leading healthcare services centre in Asia, by promoting medical tourism under the SingaporeMedicine initiative. In 2005, 374,000 foreign patients sought medical treatment in Singapore, of which 27,766 received hospital care. 80% of foreign in-patients seek treatment in private hospitals. Both the public and private sectors have announced an increase in foreign patients, who make up 30-40% of the patient base in the private sector. In view of the rising competition from the region, healthcare operators are aware that they need to constantly innovate on their service delivery, invest in the latest technology, upgrade skills, and undertake regular training.

The Government has announced the target of attracting 1 million patients by 2012, generating $3 billion, by developing Singapore as a hub for clinical medical specialities as well as for ‘economic medical’ services.

Singaporeans enjoy a high standard of health. There are 7,384 registered doctors with a doctor-population ratio at 1:620, one of the highest in the region (2007). 3991 are in the public sector and 3004 in the private sector. 35% of the doctors are specialists with advanced training. 2500 are in General Practice. There are 1,354 registered dentists with 287 in the public sector and 881 in the private sector, with a dentist-population ratio of 1:3,390. The total number of registered nurses/midwives is 22,332, with 12,294 and 6,112 in the public and private sectors respectively. The nurse-population stands at 1:210.

The average life expectancy is 78.9 years, with 77.4 years for men, and 81.3 years for women. Infant mortality rate is 2.2 per 1000 births, while maternal mortality rate is 1.2 per 10,000 births. The leading causes of mortality are cancer, coronary heart disease, stroke, pneumonia, diabetes, hypertension and injuries. Singapore ranks first globally for the lowest infant mortality rate and the fourth for life expectancy. A recent WHO report ranked the Singapore healthcare system to be the sixth most effective among the 191 countries surveyed.

Frost & Sullivan valued the Asian healthcare market at US$240 billion in 2008, with pharmaceuticals accounting for 66% of the market and medical devices at 21%.

Characteristics of Market

In Singapore, healthcare is offered by both the public and private sectors. The former accounts for 80% tertiary care and 20% primary care, with the private sector accounting for the rest. There are a total of 29 hospitals and speciality centres to provide both general secondary and specialist services, with 1,900 primary care clinics and 18 government polyclinics.

The public sector is organised into two clusters, National Healthcare Group (NHG) and Singapore Health Services (SingHealth), which cater to the western and eastern parts of the country respectively. They aim to provide seamless and patient-centred care through the 18 polyclinics, 7 hospitals and 6 speciality centres. A third cluster, Alexandra Health was set up in 2008, which will include the new Khoo Teck Puat Hospital. The government encourages personal responsibility through a system of co-payment for healthcare services.

The private sector comprises around 1,900 clinics and 16 hospitals, and includes Parkway Group Healthcare which offers primary, tertiary, dental, diagnostic and contract research services in Singapore and the region. Several private operators offer their clinical and management expertise overseas, mainly through joint ventures.

Total health spend is estimated at around 3.7% of GDP, low when compared with OECD countries. This figure is likely to increase significantly in the next twenty years because of Singapore’s ageing population profile. The ultimate challenge for the government lies in providing good quality medical care to Singaporeans, while ensuring increases in health care costs are affordable to the nation and maintaining Singapore’s edge as the leading provider of high technology medicine in the region.

The Ministry of Health’s five priority programmes are: to improve the health of the elderly; strengthening the management of the main killer diseases; enhancing child health services; improving mental health care; and health promotion and disease prevention. Major challenges include rising healthcare costs, increasing demand for improved services, an ageing population and manpower shortages from doctors to nurses and ancillary personnel.

In February 08, MOH announced an investment of $1.9 billion over the following 5 years to upgrade public hospitals and build a new hospital ($900 million), and raise the quality of healthcare professionals ($1 billion).

Under the 2009 Budget, $4 billion was committed over 5 years to expand the healthcare infrastructure to include:

  • Redevelopment of older hospitals, medical centres and a new hospital in the west, and current projects like the Khoo Teck Puat Hospital in the north; the new National Heart Centre and a Pathology Lab at the Singapore General Hospital.
  • Building new community hospitals and boosting capabilities in treating chronic diseases (e.g. stroke, heart and kidney failure) and other age-related conditions (e.g. dementia);
  • Training healthcare professionals from doctors and nurses to physiotherapists and pharmacists ($500 million)
  • Enhancing capabilities for long-term care (including rehabilitation, home care and palliative services after patients have been discharged from hospitals); and
  • Developing an electronic health records system that will be accessible by authorised medical practitioners at hospitals and polyclinics, and eventually extending to the community care sector.
  • Research and public health initiatives.

The significant investment in the biomedical sciences sector has led to major international companies setting up base in Singapore for manufacturing and R&D, besides their regional sales and marketing operations. GSK for instance, is a major investor in Singapore and continues to expand with a new R&D centre and a new S$600 million vaccine plant. Other significant investors include Merck, Pfizer, Schering Plough, Novartis, Wyeth, Lonza, Genentech and Sanofi-Aventis. International medical devices companies include Baxter, Becton Dickinson, Ciba Vision, Fisher Scientific, Biosensors, and Hoya Healthcare among others. New investments in plants and R&D centres continue to flow in, and renowned scientists advise and steer Singapore’s biomedical strategy and helm the major research institutes. The Johns Hopkins International Medical Centre, the US Hospital’s first venture overseas, operates as a private hospital within the Tan Tock Seng Hospital, offering local and international patients the latest cancer care and research under the management and standards of Johns Hopkins.

There is also indigenous manufacture of generic pharmaceuticals and medical devices, and a strong supporting industry. The increase in R&D funds to the 3 key sectors of biomedical sciences, water and environment, and creative and media, of $13 billion over 5 years, is likely to spur commercialisation of new biomedical products and processes, and further establish Singapore as a major base for the full spectrum of activities in the sector.

Opportunities

Singapore is committed to remaining at the forefront of health care provision as the regional centre of medical excellence. Both the public and private sectors are well funded and are continually seeking to upgrade their services and facilities. The Government has reaffirmed Singapore’s interest in staying ahead in high tech medicine, and has called on the private sector to keep abreast of latest developments and to invest in the emerging technology, to maintain Singapore’s edge in providing quality medical care.

New technology: Doctors in Singapore have developed capabilities in complex procedures such as organ transplant, assisted reproduction, limb reattachment, joint replacement, separation of conjoined twins, and the world’s first umbilical cord transplant. New methods of medical treatment are constantly being tested and introduced, and the universities work together with the hospitals to research and develop new medical devices, implants, etc. Translational medicine from the bench to the bedside is the focus of the second phase of the biomedical sciences initiative. Companies with innovative products could seek to work with hospitals, to research and test the products, which would be a good reference for their eventual marketing in Asia. One example is UK-based pSiMedica working with Singapore General Hospital on their novel cancer fighting technology.

Information Technology: There is increasing use of IT in training, administration and service provision. Both large and small hospitals are exploring full computerisation of their inventory systems, patient data records and link up of all activities from admission to discharge. Electronic Medical Record Exchange (EMRX), was initiated by the Ministry of Health to enable both public sector clusters to fully exchange and share patient information across primary and tertiary care institutions.

A national electronic health record system will be implemented by 2010, when patients can move seamlessly from their polyclinics or GPs to public, private or community hospitals, as all the patient’s data will be in a consolidated file, encompassing notes on the medical condition, drug allergies, treatment and test results.

Singapore is also keenly exploring RFID technology, and the Agency for Science, Technology & Research (A*STAR) partnered 4 local companies in Sept 07, to develop it for the healthcare and other sectors. Singapore is also enhancing its telemedicine links, and is set to be a tele-radiology hub for the electronic transfer to medical radiographic images for off shore consultation, by going filmless. This will enable quick transmission for overseas consultations, as well as for other countries to send films for consultation and interpretation in Singapore.

New Medical Universities

A new graduate medical school in collaboration with Duke University, USA, will be built at the Outram Campus, a joint venture with the National University of Singapore. The Duke-NUS Medical School will be ready by 2009. In the meantime, it has started at an interim campus in August 2007 with an annual intake of 50 students on a 5 year course, which will be very research led, to produce clinician-scientists. The Outram Campus Master Plan also includes plans for schools for nurses, and other professionals such as physiotherapists.

A third medical school is planned to be set up at Nanyang Technological University (NTU). Imperial College London that draws on its strengths in engineering and science is cited as a model for the NTU medical school and a collaboration is now explored.

Two New General Hospitals

  1. The Khoo Teck Puat Hospital is a $500 million, 550-bedded hospital to be completed by 2010. Located in a 3 ha plot in Yishun Central, in the north of Singapore, it will have general and specialist services, with a strong focus on day surgery and will be located next to Yishun Polyclinic for primary care. A community hospital, nursing home and rehabilitation centre are planned around for full step down care. The hospital site would also have room for further expansion. It will increase the public sector beds to 6,500.
  1. A second new hospital, the Jurong General Hospital, will be built in the west, to be completed by 2014. A community hospital and a nursing home are also planned alongside.

Other projects

  • New $300-500 million, 350-bedded private hospital to be developed by Parkway Group Healthcare, at a total cost of S$1.5 billion for the 1.7 ha site at Novena, to be completed by 2011. The Communicable Disease Centre in the area is being rebuilt, as well as a private medical centre, and a hotel, to support medical tourists.
  • Farrer Park Mediplex, comprising 200 specialist medical suites, a functionally interlaced 230 bedded hospital and the 260-room four star hotel located above the Farrer Park MRT station. It will comprise a 6 storey podium, rising to 19 storeys via 2 connected high rise wings. Total estimated cost for the project is $400 million. To be operational by 2011.
  • Redevelopment of the National Heart Centre by 2011. It will have a floor area of 30,000 sq m compared to the current NHC’s 5,200 sq m. Work started in early 2008. NHC will offer outpatient care with in patient services at SGH.
  • Extension of the National University Hospital.
  • Two new speciality centres at NUH for cancer and heart disease to complement the national cancer and heart centres in the SingHealth cluster.
  • Two new community hospitals linked to the upcoming Khoo Teck Puat Hospital and the planned Jurong General Hospital by 2016.
  • New pathology laboratory at Singapore General Hospital at $200 million by 2010.
  • A new S$9 million cell therapy facility was opened in August 09 by the Health Sciences Authority to conduct trials and develop cell based therapies.
  • Institute of Investigational Medicine housing clinician scientists, to transform research results to new drugs and treatment methods by 2010.
  • A new complex to integrate tracking and treating of infectious diseases, research and training of health care workers at the Communicable Disease Centre (CDC) premises.
  • $256 million investment in the Cancer Research Centre of Excellence over 7 years, to accelerate cancer research and develop cures in cancers prevalent among Asians.
  • New $42 million 24-hour private cancer centre to be built at the former Adam Road hospital, by Pacific Healthcare. To be ready by early 2011, it will be headed by US cancer specialist Dr Steven Tucker.
  • Expansion of the second dental centre within the National University Health System.
  • MOH to support Voluntary Welfare Organisations (VWOs) to expand nursing home capacity from 9,200 to 14,000 beds over the next decade (May 09). 2,000 more nursing home beds are planned in the next five years, and five new nursing homes in the next two years. These will include:

-a 300-bed nursing home for patients with psychiatric problems by 2012

-two 250-bed nursing homes for patients suffering from dementia

(currently there are 20,000 dementia patients which will rise to 45,000 by 2020)

-Release of plots for two private nursing homes

-New and larger facilities for two nursing homes run by Voluntary Welfare Organisations (VWOs).

  • Manpower expansion and training in healthcare.

The MOH plans to set up a committee to study new specialty centres Singapore will need in the future, taking into account the emerging disease trends, projected demand and clinical capabilities, including geriatric medicine and infectious diseases. Specialist centres, bigger labs, new research and teaching facilities and centres are in the pipeline.

Care of the Elderly: Singapore has one of the most rapidly ageing populations in Asia and will have the world’s 4th oldest population by 2050. The Government’s policy is to encourage family and home based care over institutionalised care, with access to community based services, for the estimated 800,000 elderly Singaporeans by the year 2030. The Government strategy to reduce the burden on acute care hospitals is to build community hospitals and nursing homes around three regional hospitals to provide high quality, low cost ‘step down facilities’ for non-acute medical care and rehabilitation services.

The Government is also keen to increase the current share of the private sector nursing homes from 25% to 40% of the total by 2010. It has earmarked 15 sites for private nursing homes, each targeted for homes with 200 beds.

Apart from comprehensive training of health care workers, additional services to provide a seamless, integrated long term care infrastructure for the elderly include home aids, transport services, community care, and modifying homes to suit the needs of the frail and disabled elderly.

The Housing and Development Board (HDB), the agency responsible for the construction of government subsidised housing, introduced studio apartments for the elderly in 1998, equipped with several elderly friendly features. There are a total of 936 studio flats in 6 new towns that incorporate elderly friendly features, such as non-slip floors and emergency cords in bathrooms. HDB is also exploring the idea of studio flats integrated into regular HDB blocks and homes with removable walls and partitions to allow ageing in place, and to build more such flats. Under the Project to Improve the Living Conditions of the Elderly, HDB will continue to upgrade several blocks with elderly friendly equipment and devices. Consequently, there areopportunities for products ranging from IT enabled assistive technology, mobility and self-help aids, medical kits and alarms to a wide array of elderly-friendly products.