九略—中山市人民医院总体发展战略咨询—新加坡医疗体系

1、SingaporeHEALTH CARE SERVICESTITLE: HEALTH CARE SERVICESSUBJECT COUNTRY(IES):SINGAPOREPOST OF ORIGIN:SINGAPORESERIES:INDUSTRY SECTOR ANALYSIS (ISA)ITA INDUSTRY CODE:HCSDATE OF REPORT (YYMMDD): 990401DELETION DATE (YYMMDD): 020401AUTHOR:TONG MEE MIENAPPROVING OFFICER:STEPHAN J. HELGESENOFFICER'S

2、TITLE:DEPUTY SENIOR COMMERCIAL OFFICERNUMBER OF PAGES: 22INTERNATIONAL COPYRIGHT, U.S. & FOREIGN COMMERCIAL SERVICE ANDU.S. DEPARTMENT OF STATE, 1999.ALL RIGHTS RESERVED OUTSIDE OFTHE UNITED STATES 目录：SUMMARY 1Singapore has 23 hospitals, of which 10 are operated by the MOH 2A. MARKET PROFILE 市场情

3、况 3Health Care Reforms 6Hospital Services 7Health Care Expenditure 8B. COMPETITIVE ANAL YSIS (竞争态势) 12Mount Elizabeth Hospital is the best known hospital in the 13C. END-USER ANAL YSIS 14D. MARKET ACCESS 14SUMMARYSingapore has built a sound healthcare infrastructure since its independence in 1965. D

4、espite this success, the Singapore Government continues to face many challenges. These include:- a rapidly ageing population- changing health needs of the population- increasing cost of providing healthcare- rising expectations/demand for better and more sophisticated health servicesSingapore's

5、health care service is comparable to those of developed countries. With a populationof 3.1 million (1997), the per capita government health care expenditure in 1997 was US$300. In 1996, the per capita total health care expenditure (public and private) was US$745.This isabove the average for countrie

6、s in the surrounding region. Singapore's high standard of health care service is renowned in Asia. Patients from the region have used Singapore's facilities although the current economic downturn has affected the inflow by 10%. Names like Singapore General Hospital, National University Hospi

7、tal, Mount Elizabeth Hospital, and Gleneagles Hospital are well known in the region.The Ministry of Health (MOH) plays a dominant role in developing the health care service in Singapore. It is instrumental in establishing standards and ensuring that the industry is financially sound. Singapore hospi

8、tals, both public and private, are assured of healthy balance sheets due to the MOH's prudent planning for health care financing.Because of rising medical costs and an ageing population, the Singapore government drew up guidelines on health care to address the increasing burden. Based on the &qu

9、ot;1993 White Paper on Affordable Health Care", the MOH has implemented several policies on health care financing over the past few years. One of the policies (known as CASEMIX), announced in November 1998, was a system of monitoring subsidies for public hospitals and private hospital fees.Sing

10、apore has 23 hospitals, of which 10 are operated by the MOH and 13 by the private sector. The total number of beds as of July 31, 1998 was 11,276, of which 9,091 were under the MOH and 2,185 under the private sector.新加坡 60% 的公立医院为企业化运作，但是100% 公有。Six of the MOH's tertiary hospitals have been '

11、;restructured' and run like private hospitals. Ownership of these hospitals is under the Health Care Corporation of Singapore which is 100%-owned by the MOH.Parkway Healthcare Group, owner of Mount Elizabeth Hospital, Gleneagles Hospital and East Shore Hospital, accounts for two-thirds of the pr

12、ivate hospital beds in Singapore.Parkway 医疗集团占私立市场的 2/3Other major healthcare providers are:- Raffles Medical Group- Shenton Medical Group- Beng & Ooi- Healthway Medical Group- Vista HealthcareThe most common diseases affecting Singaporeans are cancer and cardiovascular diseases. Diagnostic and

13、treatment services for these diseases are advanced and are being continually upgraded. 最常见的疾病是心脏病和癌症。To improve their expertise, both government and private hospitals are eager to link up with reputable health care management companies, foreign hospitals and medical centers. Over the past years, var

14、ious major hospitals have teamed up with well-known institutions such as Johns Hopkins University Hospital, Pennsylvania University Medical Center, Stanford University Hospital, Massachusetts General Hospital and Kaiser Permanente.为了提供自己的品牌形象，所有医院都在试图与医疗管理公司、国外著名的医疗机构合作A. MARKET PROFILE 市场情况The MOH

15、competes with private healthcare operators to provide for Singapore's healthcare service. However, the MOH plays a pivotal role in planning and developing the framework of Singapore's healthcare service.Role of Ministry of Health 卫生部的角色The MOH regulates the standard and practice of health ca

16、re services. It works closely with the Ministry of Environment in the maintenance of environmental hygiene and control of communicable diseases. It also works with the Ministry of Labor in improving the industrial and occupational health of workers.The MOH is in charge of the following five professi

17、onal boards:1. Singapore Medical Council This is a corporate body established under the Medical Registration Act. The Council registers qualified medical practitioners for practice and maintains a Register of Medical Practitioners. It also determines and regulates the conduct and ethics of medical p

18、ractitioners.2. Singapore Nursing BoardThis was established under the Nurses and Midwives Act 1975. The Board registers qualified nurses, midwives and enrolled nurses for practice and is responsible for regulating and improving their standard of practice and conduct. It is also responsible for the s

19、tandards of training for nurses and midwives.3. Singapore Dental BoardThe Board regulates the practice of dentistry and oversees the professional conduct of dentists.4. Pharmacy BoardThe Board maintains the Register of Registered Pharmacists and oversees the professional conduct and practices of pha

20、rmacists.5. Laboratory BoardThe Board is responsible for regulating and improving the standards of clinical laboratory practice. It maintains a register of laboratory technologists and advises the Medical Audit & Accreditation Unit on the licensing and accreditation of clinical laboratories.The

21、MOH provides preventive, curative and rehabilitative health services. Preventive health care comprises health education, mass vaccination/immunization against infectious diseases and selective health screening. The curative and rehabilitative services are provided through the Government hospitals an

22、d a network of Government polyclinics for general outpatient care.Primary Health Care ServicesPrimary health clinics run by the MOH provide about 20% of primary health care in Singapore. About 1,250 private general practitioners provide the rest of the 80% in the form of private clinics spread over

23、the country.Parkway has formed a consortium with the Guardian Pharmacy chain and Shenton Medical Group in March 1999 to set up 40 neighborhood clinics in Singapore and more in the region.The clinics, eachhaving an area of 300 sq ft instead of the normal 1,000 sq ft, will be set up adjacent to Guardi

24、an's pharmacies.40 家社区诊所，平均面积 300 平方英尺 Beng & Ooi Holdings owns 13 medical clinics, two dental surgeries and a diagnostics center in Singapore while Healthway Medical Group owns 14 clinics, in conjunction withVista Healthcare Asia (Vista). Vista owns three clinical laboratories and provides

25、integrated healthcare services through partnerships with physicians, clinics, hospitals and diagnostic centers.The MOH has a network of 16 polyclinics, four outpatient dispensaries and two maternal and child health clinics. Polyclinics are one-stop health centers providing a wide range of services.

26、These include medical treatment of patients with acute/chronic illnesses, follow-up management of patients discharged from hospitals, maternal/child health care, health screening, health education, patient counseling and diagnostic services such as laboratory/ X-ray services. Dental care and rehabil

27、itation services for the elderly are also provided.About 21% of women who give birth in Singapore receive pre-natal care in the MOH clinics. A shared pre-natal care program is carried out by KK Women & Children Hospital and Toa Payoh/Ang Mo Kio polyclinics and between Singapore General Hospital

28、and Bukit Merah /Jurong polyclinics. This program allowed pre-natal patients to see the polyclinic doctors as well as hospital obstetricians at different times during the pregnancy, for improved and better-coordinated pre-natal care.Children are immunized against tuberculosis, diphtheria, pertussis,

29、 tetanus, poliomyelitis, measles, mumps, rubella and hepatitis B. Diphtheria and measles immunizations are compulsory by law. The Central Immunization Registry monitors the immunization status of children. On average, two-thirds of immunizations were carried out by MOH clinics and one-third by priva

30、te clinics.The School Health Service provides periodic health screening to about half a million school children. The general health of students is good. The most common health problems among school children are defective vision, obesity and spinal problems.Health education seminars and workshops rea

31、ch out to about a quarter of a million students annually.Health Care ReformsThe MOH has been instrumental in structuring health care services over the years. Since 1980, the MOH has made the following reforms to improve the standard of healthcare services:National Health PlanCompulsory Savings Schem

32、e (Medisave) Catastrophic Illness Insurance (Medishield) Medical Endowment Fund (Medifund) Public Hospital Restructuring19831984199019931985 onwardsReview Committee on National Health Policies 1991-1992White Paper on "Affordable Healthcare"CASEMIX19931998In November 1998, the MOH announced

33、 that hospital subsidies would be based on a new financing mechanism, known as CASEMIX funding, similar to the Australian model. It will be implemented in all public hospitals by the year 2000 and extended to private hospitals in three to five years' time. Public hospitals will be funded accordi

34、ng to the type and difficulty of medical conditions treated and the number of patients seen with each condition. At present, government funding is based on the number of days a patient stays in a hospital; so the longer the stay, the more the hospital receives. With the new system, patients can expe

35、ct a better quality of health care and, as a result, will not be subjected to unnecessary treatment or longer-than-necessary stays which increases their medical bills.Each hospital will have its own CASEMIX, depending on the type of specialties that it has and the types of patients it serves. The co

36、nsistency across the board is in the treatment given by doctors for similar conditions. By working out the amount of resources used, treatment costs can be determined.With the new system, all hospitals will receive the same amount of subsidy for the same condition. This will encourage hospitals to s

37、earch for more cost-effective treatment while maintaining a benchmarked quality. The MOH assured that the system would have enough flexibility to cater for conditions which require more than the recommended treatment.The MOH is currently collecting information from all hospitals to draw up a set of

38、"best treatment" guidelines for 667 conditions, from childbirth to brain surgery. Comparisons will then be made between hospitals and doctors on the treatment given and the resources used. This is not possible at the present moment.Hospital ServicesSingapore has 23 hospitals with a bed com

39、plement of 11,276. Hospital admissions total approximately 369,456 in 1997.The MOH operates five hospitals for acute health care, and four hospitals with special functions. The hospitals are as follows:Acute Care:Alexandra HospitalChangi General HospitalNational University HospitalSingapore General

40、HospitalTan Tock Seng HospitalSpecial Functions:KK Women & Children Hospital - maternityWoodbridge Hospital - mentalView Road Hospital - mentalCommunicable Disease Centre - infectious diseaseAng Mo Kio Community Hospital - sub-acute careSingapore General Hospital, Tan Tock Seng Hospital, KK Wome

41、n & Children Hospital, Ang Mo Kio Community Hospital, National Skin Centre and Singapore National Eye Centre were privatized by the MOH under the umbrella of Health Corporation of Singapore (HCS) to give these hospitals management autonomy. This enables the hospitals to compete effectively again

42、st private hospitals.These hospitals are also commonly referred to as "restructured hospitals", and they account for about 74% of public specialist outpatient consultations in Singapore.The National University Hospital is also an autonomous hospital directly reporting to the MOH instead of

43、 the HCS. It is also a teaching hospital for the National University of Singapore.There are 13 private hospitals in Singapore with a bed complement of 2185. The largest private health care operator in Singapore is Parkway Group Healthcare, the health care division of Parkway Holdings Limited which i

44、s listed on the Singapore Stock Exchange. Parkway, which owns Gleneagles Hospital, Mount Elizabeth Hospital and East Shore Hospital, accounts for two-thirds of private hospital beds. Gleneagles and Mount Elizabeth are the two largest private hospitals providing acute care.Raffles Medical Group (RMG)

45、 which owns Raffles SurgiCentre is in the process of building a 428-bed hospital in the central business district. It will be completed by end of 1999 and will be the second largest private hospital after Mount Elizabeth. RMG also manages medical service centers at the Singapore Changi International

46、 Airport and Hong Kong's Chek Lap Kok Airport.The other seven private hospitals are:Adam Road HospitalHMI Balestier Medical CentreKwong Wai Shiu HospitalMount Alvernia HospitalRaffles SurgiCentreRen Ci HospitalSt. Andrew's Community HospitalThomson Medical CentreWestpoint Family Hospital You

47、ngberg HospitalWards in the MOH hospitals are segregated into single-bed rooms, two-bed rooms, four-bed rooms, six-bed rooms and ten-bed rooms. Non-resident patients are not eligible to stay in the six-bed and ten-bed wards as these wards are subsidized by the MOH. Private hospital wards offer singl

48、e-bed rooms, two-bed rooms and four-bed rooms.Health Care ExpenditureGovernment health care expenditure in 1997 was US$1.196 billion or about US$300 per capita. The per capita total health care expenditure (public and private) was US$745 in 1996 or 3.0% of Singapore's Gross Domestic Product (GDP

49、).Health Care FinancingThe financing philosophy of Singapore's health care delivery system is based on individual responsibility, coupled with government subsidies to keep basic health care affordable. To help Singaporeans in the co-payment for hospitalization expenses, the Singapore Government

50、introduced the following health care financing plans:MEDISA VE: a compulsory savings plan to help individuals save and pay for their health care expenditure.MEDISHIELD: a catastrophic insurance plan to help meet the cost of large medical bills; andMEDIFUND: a health endowment fund which provides a s

51、afety net for the poor and needy.Under Medisave, Singaporeans pay between 6.0-8.0% of their salaries into a medical savings account managed by the Central Provident Fund (CPF, a Government trustee pension fund). This percentage is part of the mandatory 40% of income which all resident Singaporeans c

52、ontribute to the CPF. Medisave is used for hospitalization expenses including day and convalescent hospitals as well as hospices. Certain expensive outpatient treatments are included such as day surgery, radiotherapy/chemotherapy, renal dialysis, in-vitro fertilization and hepatitis B vaccination.Me

53、disave withdrawal is subject to the following limits:- S$300 (about US$170) per day for daily hospitalization charges; and- a fixed limit for the various surgical procedures listed under Medisave's guidebook "Using Your Medisave".Medisave also allows payments to approved health insuran

54、ce schemes such as MediShield Plus, Incomeshield and Managed Healthcare System.As of December 31, 1996, there were 2.6 million Medisave accounts totalling US$9.3 billion. The amount of Medisave withdrawn was US$204 million for 1996. The average Medisave balance per account was US$3,612.MediShield wa

55、s implemented in 1990 as a supplement to Medisave, to cover expenditure for any serious or major illness. Medisave was designed to cover average medical expenditures. As a catastrophic insurance plan, MediShield reimbursements are only for expenditures that exceed a "deductible" (technical

56、 term used by MediShield). MediShield will pay only 80% of the excess. Amounts which are not reimbursed by MediShield are deducted from MediSave or the patients' health insurance plans.MediShield Plus, an extension of MediShield since July 1994, includes a second tier optional plan to cover hosp

57、italization expenses in higher-class wards. This plan is targeted at patients using private hospitals or Class A and B1 wards in the public sector.Medifund is an endowment fund set up specially to help poor and needy Singaporeans pay for their medical care. Medifund was started in April 1993 with an

58、 initial endowment of US$140 million from the Singapore Government. Only interest income from the endowment fund which is distributed by the MOH hospitals is used to pay hospital bills for the needy. Every MOH hospital has a Hospital Medifund Committee appointed by the Government to consider applica

59、tions and allocate funds.BEST PROSPECTSDiagnostic and surgical services for cancer and cardiovascular diseases are the main areas of treatment provided by government and public hospitals. Programs for good management and control of diabetic patients are also of priority importance.Cancer remained the leading cause of death in 1997, contributing to 27% of deaths in Singapore. Lung cancer was the leading cancer followed by colorectal ca