Moving to a new country is both exciting and daunting! There can be information overload as you try to find out how things work in your new home. Healthcare is usually the last thing on your mind.
Most people only engage with healthcare when they develop health issues, and to be honest when you first start trying to navigate the Singapore healthcare landscape it can be VERY confusing! In this article I aim to explain the Singapore healthcare system for expats, and give clear advice on how to find the right doctor for you!
- Overview
- About me
- Introduction to healthcare in Singapore
- Do you need health insurance?
- What if you have pre-existing conditions?
- Maternity cover
- Once you have cover how do you find a doctor if you need one?
- General (GP) and family practitioners
- Where do you get your medication?
- How to find a specialist
- Where are private specialists located?
- Hospitals
- Are there standardized costs for in-patient treatments?
- What do you do in an Emergency?
- Dental care
- Second opinions
- Screening tests
- Summary
Overview
Moving to a new country is both exciting and daunting! There can be information overload as you try to find out how things work in your new home. Healthcare is usually the last thing on your mind. Most people only engage with healthcare when they develop health issues, and to be honest when you first start trying to navigate the Singapore healthcare landscape it can be VERY confusing! In this article I aim to explain the Singapore healthcare system for expats, and give clear advice on how to find the right doctor for you!
About me
I came to Singapore in 2015 to work as a cardiologist in Changi General Hospital, one of the public hospitals. I worked there until 2019 until I started in private practice at the Harley Street Heart & Vascular Centre in Orchard. When I first arrived I had medical insurance included in my job package up to the value of $10000 inpatient cover…. Coming from the UK I had zero knowledge of true healthcare costs and I thought this was a grand sum, until I found out how much healthcare truly cost! I then had to seek out medical insurance of my own and have used it on a number of occasions since I arrived.
Introduction to healthcare in Singapore
You are in luck! Singapore constantly ranks as one of the world’s top healthcare systems both for efficiency and quality. As evidence of this, people in Singapore have the longest life expectancy in the world! In addition, you can pretty much walk in to a lot of doctor’s practices and be seen almost immediately. There are lots of GPs available that can be seen on the same day, at a relatively low cost. Secondary (hospital) care, can be divided into public and private. With public hospitals serving both locals at a subsidized rate and foreigners at a private rate. Many specialists can also be accessed on the same day.
Do you need health insurance?
Yes! You definitely need some form of healthcare insurance if you are resident in Singapore. It can be an extremely expensive problem if you don’t! A quick example… If you or a member of your family has an accident and you have a facial scar that requires stitches, the call out fee for the plastic surgeon alone, is a minimum of $5000SGD. If you have a heart attack and require a stent, your inpatient bill could easily be $60000SGD. You get the picture…
There are many insurance providers. They will have varying levels of cover for international travel, out-patient bills and inpatient bills. Generally, your biggest bills will be in-patient costs, so this is the most important cover to get. Often CT and MRI scans that can be expensive will be covered under “in-patient” cover.
There are 3 main types of insurance plan:
1) Integrated shield – a local plan often bought by Singaporeans
2) International health insurance (local provider)
3) International health insurance (global provider).
I am not an insurance expert. I went to expatinsurance.com.sg who are a broker and they provided me with the correct cover for my personal needs. My policy is with AXA and it costs over 20K a year for myself and my family. I am probably a little over-insured, as I am covered internationally and have not been doing a lot of travelling lately due to COVID. However, I have never had an issue with them paying out on healthcare claims. Some of my friends are on local policies, that cost around 5K for the family.
What if you have pre-existing conditions?
If you have a pre-existing illness before you come to Singapore, you will need to declare it on your insurance application. Unfortunately, there is a high chance you will not be covered for that condition here, or you will have an annual limit for the amount you can claim for that illness.
Maternity cover
If you are planning to get pregnant when living in Singapore, then you can either pay for it all yourself or get insurance to cover it. A C-section costs around 10 – 20K. The C-section rate for pregnancy is very high in Singapore in comparison to other countries because it is a doctor rather than a midwife lead service. If you want insurance to cover it, then usually you need to purchase the policy for a pre-defined period before you conceive or you will not be covered. This is often around 9-12 months.
Once you have cover how do you find a doctor if you need one?
You can go to any doctor of your choice and pay out your pocket with your own money, but if you want to claim on your, you will need to follow their instructions. Some policies like mine, allow you to go to any doctor for out-patient treatment and reclaim later. Some of the doctors may even have direct billing with the insurance so you don’t need to pay out of pocket.
Other insurers require you to go to one of their panel GPs first, they have a list of their doctors if you call them up or on their website/portal that are approved for you to visit. If you require a specialist then again you may need to go to one of the specialists on their panel as not all specialists are on all insurance panels. If your doctor says you will need an operation or in-patient treatment, then you will need to pre-inform your insurance company and they will provide an LOG (Letter of Guarantee). The specialist will council you about the potential costs and will often submit the application to your insurer on your behalf.
So, in short – before you go to see a doctor – check with your insurance provider what their process is, otherwise you can be out of pocket.
General (GP) and family practitioners
Polyclinics are government run primary care clinics, that are for the local population and permanent residents, who receive subsidized rates. As of January 2020 there are 20 polyclinics. You don’t usually need to make an appointment, you get a queue ticket when you arrive, and wait for your number to come up. Don’t expect to have a long consult though. You will probably be in an out the doctors room in under 5 minutes!
Other GPs either work for a medical group or are solo practitioners. Medical groups can be large like Raffles or smaller and just be 2 or 3 practices under one brand. There are 1000s of GPs spread across the island so you will easily find a clinic if you need one. The customer service varies between clinics, so ask around for quality recommendations.
Where do you get your medication?
One thing that is done slightly differently to other countries, is that most GPs and specialists dispense their own medicine from within the clinic. This allows them to control the quality and brand, but also allows the consult costs to be offset by profit on the medicines. If the required medicine is not stocked, then the doctor will give you a prescription that can be filled at a pharmacy. The big chain pharmacies are Watson’s and Guardian.
How to find a specialist
If you need to see a specialist there several options. Singapore has an incredibly efficient healthcare system. If you want to see a specialist you can just call them up and make an appointment with them, even on the same day! However, insurance policies vary. Some policies have a “panel” of specialists that you need to pick from. Other policies require you to see one of their specified panel GPs to get a referral letter prior to seeing a specialist. Best to call your agent or insurance provider to check before you do anything. Most of them have a 24-hour line you can call for advice.
The ability, availability and affability of specialists can vary, just like in any profession. Luckily, Singapore is well regulated so most doctors will be well trained. It is very difficult for the public to discern the ability of a doctor, as websites are largely marketing exercises, and just because a doctor went to a famous hospital does not mean he is skilled. Recommendations can be useful. Recommendations from friends are good particularly to assess a doctor’s character, but it is very difficult for a lay person to assess the skill of a doctor. Recommendations from doctors probably carry more weight regarding the skill of the doctor, but even then, doctors will often refer to people they know.
Simplest process is probably to ask your friends, ask your GP, and have a look online at their website. If you meet a doctor that you do not “gel” with you can always go and see someone else.
Where are private specialists located?
Private specialists will usually be located in purpose built medical centres that are often nearby an in-patient facility. Examples of medical centres are – Mount Elizabeth Medical Centre, Paragon Medical Centre, Camden Medical Centre etc…. Private Doctors will usually rent or buy a unit in these centers. There are often day surgery facilities in some of these centres for simple procedures to be done.
Hospitals
There are a lot of hospitals in Singapore and they can be divided into public and private. Public hospitals can be used by both locals and foreigners. Singaporeans and permanent residents receive subsidized rates, however foreigners will pay private rates. Anyone can use private hospitals, and everyone pays private rates.
There are 16 public hospitals in Singapore. Main ones by region would be:
- Khoo Teck Phuat (North),
- Changi General (East),
- Singapore Genetral (Central),
- National University Hospital (West),
- Ng Teng Fong General (West)
The key private hospitals are:
- Mount Elizabeth Orchard
- Mount Elizabeth Novena
- Gleneagles
- Raffles hospital
- Parkway East hospital.
Hospitals are often owned/run by larger medical groups ie Parkway owns Mt E Orchard and Novena, Parkway East and Gleneagles hospital. Raffles is owned by Raffles group.
Are there standardized costs for in-patient treatments?
The cost of in-patient treatment is made up of doctor/surgeon’s attendance and procedure fees in addition to the hospital charges. The Ministry of Health sets a benchmark range for doctors’ fees these can be accessed online here. In addition, if you are under an insurer, they may set their own fee levels for specialists on their panel which are often lower. This is the price for a doctor being on the panel and having access to that insurers patients.
What do you do in an Emergency?
If you have an emergency that requires an ambulance call 995. You will probably be taken to a public hospital but be charged private rates. There are lots of accident and emergency units in Singapore. The larger A and E units are generally at the public hospitals where there will be longer waiting times. Most private hospitals have an A and E unit where you will be seen quickly. If you need to see a specialist, then you’re A and E doctor will let you choose one from your insurance panel, or choose the one that is on call for that week if you have no preference.
Dental care
Many insurance policies will include some dental cover, often just in an emergency. Others will have full cover but will probably be more expensive. There are many dentists in Singapore to choose from.
Second opinions
As a foreigner you will often be seeing doctors you have never heard of, and you may be in a vulnerable position because you are unwell. It is worth noting that you ALWAYS have the right to a second opinion. If you ever feel like you are being rushed into a procedure that you are not sure of, there is no harm asking for a second opinion for peace of mind. It is extremely easy to get another opinion and because the healthcare system here is so efficient you can get one very quickly. I am always available if you want to drop me an email with questions and I am happy to recommend specialists that I know and trust personally.
Screening tests
Screening is very popular in Singapore, some insurance policies include an amount annually that can be used for screening, and some employers include it as part of their package. It is important to understand that doing lots of tests not only has the potential to pick up disease early BUT, on the flipside, can often through up some spurious results called false positives. So, don’t be surprised if you get an unexpected result in your screening that then leads to further investigations to clarify if it is a real finding or a false positive.
Summary
Healthcare in Singapore is advanced, efficient and good quality. In comparison to the USA it is also cheap, but if you come from a country with universal public health you will find the prices eye-watering! I think the most important thing is to make sure you are adequately insured for in-patient cover, and if you become ill then first port of call should be your agent or insurer to guide you on how best to find a doctor. I am always available for questions and I am glad to help if I can! Hopefully, you won’t need it
Related article: Ultimate guide to seeing a cardiologist in Singapore
