THE STATE OF HEALTH: SINGAPORE

Healthcare policy changes and what they mean for Singaporeans and the healthcare ecosystem

CONTENTS
1. Executive Summary

2.
3. 4. 5.

Healthcare in Singapore
Healthcare 2020 Master Plan What Are the Changes to the Healthcare System? How Will This Impact Industry Subsectors? Patients Healthcare Providers, Hospitals & Clinics Pharma and Medical Device Industries Conclusion

6.

1. EXECUTIVE SUMMARY

Starting January 2014, Singapore has begun instituting changes to existing healthcare policies.
While older Singaporeans, low-income families and those who require outpatient treatments will benefit most from these modifications, all stakeholders in the health ecosystem will be affected in some way. Outlined in this document is an overview of the health policy changes in Singapore and suggestions for how various stakeholders can update their communications strategies based on the changing priorities and needs of the market.

2. HEALTHCARE IN SINGAPORE

Singapore has established strong fundamentals in healthcare excellence, providing strong infrastructure and universal coverage for its citizens, while dedicating a relatively small portion of its GDP (4%) on healthcare.1 As a result of the emphasis on quality care, Singaporeans have experienced positive effects, including high life expectancy (#4 in the world2) and the lowest infant mortality rate in the world.3 However, as one of the fastest-aging populations in Asia, Singapore faces challenges ahead in the form of greater demand for specialised elderly care, constraints on healthcare infrastructure and rising costs.

1World Competitiveness Yearbook 2010,

IMD. 2World Health Organisation 2008. 3UN Interagency Group for Child Mortality Estimation 2012.

3. HEALTHCARE 2020

To address these challenges, in 2012, the Ministry of Health introduced Healthcare 2020, a master plan to ensure Singapores healthcare system better meets the needs of the people. The plan focuses on using the three pillars of Accessibility, Affordability and Quality to measure the effectiveness of healthcare in the country.

Image reprinted from HealthScope June-July 2012 issue.

HEALTHCARE 2020 (CONTINUED)

In the next few years, improvements to healthcare in Singapore will revolve around these strategies:

Working more closely with community clinics and general practitioners (GPs)

Healthcare subsidies for a wider range of Singaporeans

Subsidies for high cost drugs and treatment

Improvements to MediShield, the national health insurance system

Efforts and financial aid to be allocated to raising health workforce productivity and capacity

4. SPECIFIC CHANGES

Healthcare Item1

Former System

System as of Jan 2014

Community Health Assist Scheme (CHAS)

Beneficiaries need to be at least 40 years old to qualify for CHAS

Age restriction removed and is now open to those below 40

Subsidy for Specialist Outpatient Clinics

50% subsidy for patients who fall under the lower middle income bracket

An increase of 10-20% for outpatient treatment subsidies; means testing will be applied

Medisave for outpatient treatment

Medisave can only be used for chemotherapy and major outpatient operations

Increased coverage for Medisave, which now covers vaccinations such as pneumococcal and influenza for high-risk groups

MediShield now MediShield Life

Coverage only applicable for people under 90 and is an optional scheme

Age ceiling lifted; those with pre-existing illnesses are covered; MediShield Life is mandatory and premiums will be higher

1http://www.straitstimes.com/breaking-news/singapore/story/budget-2014-relief-the-

elderly-cpf-boost-all-workers-20140221

5. HOW WILL THIS IMPACT INDUSTRY SUBSECTORS?

Patients

Healthcare Providers, Hospitals & Clinics

Pharma and Medical Device Industries

HOW WILL THIS IMPACT PATIENTS?

After revision of the Community Health Assist Scheme, young people who belong to the lower income group now qualify for subsidised healthcare (previously available only to individuals above the age of 40) and increased healthcare options.

More young people will qualify for subsidies

More operations and procedures will be covered

The Ministry of Health (MOH) has dramatically increased the number of surgical procedures paid for through MediShield and Medisave. Previously, 1,600 procedures were covered; as of January 2014, MediShield Life and Medisave cover about 2,350 procedures.

MediShield Life may overlap with existing health insurance coverage

As MediShield transitions to MediShield Life, enrolment will become compulsory for everyone Those who are already enjoying personal or company insurance will be doubly covered by insurance, providing them with the option to withdraw from private schemes and save money on premiums.

HOW WILL THIS IMPACT PATIENTS?

For Singaporeans aged 65 and older as of 2014, MediShield Life will now cover medical bills regardless of pre-existing conditions and will offer a further 50% off specialist outpatient clinic fees. They will also receive a further Medisave top-up of S$200 to S$800, depending on their age group.

Pioneer Generation to receive greater support for medical bills

Higher premiums for specialised plans

If a Singaporean requires healthcare beyond the limits of current plans, additional coverage may require higher premiums. Insurance providers may overhaul their offerings to cater to more specialised groups and may levy higher charges to go with it.

Communication Opportunities

As more Singaporeans gain access to a wider variety of treatments, there is a need for large-scale education efforts to determine who qualifies for increased financial support and the benefits and drawbacks of specialised plans. Increased access to testing creates more opportunities for preventative health campaigns.

10

HOW WILL THIS IMPACT HEALTHCARE PROVIDERS, HOSPITALS & CLINICS?

Increased eligibility may stretch healthcare resources

A greater pool of individuals is now eligible for coverage. Assuming the number of healthcare providers remains about the same, existing resources may be strained by increased demand. However, this may also present market entry opportunities for healthcare providers.

Innovations in health technology

Adoption of innovative health information technology can increase efficiency by effectively managing complex patient records and outfitting patients with more information so that they can make informed decisions about their treatments.

Greater need hospitals may for clinical data and become more information sharing crowded

Clinics and

As data sharing between hospitals, providers and clinics improves, providers will carry some of the burden to explain and to help provide fixes for any deficiencies identified in the healthcare system.

Clinics and hospitals Communication may become more Opportunities crowded

Providers can become part of proactive disease awareness initiatives, prevention campaigns, educational sessions and roundtables to identify best practices for addressing new and evolving challenges. Opportunities include partnerships with pharma and medical device industries and community outreach programs, such as educational sessions in the heartlands. Digital extensions like web resources and apps can expand campaigns reach and influence.

11

HOW WILL THIS IMPACT PHARMA AND MEDICAL DEVICE INDUSTRIES?

Lower out-of pocket costs for medications Out-of pocket costs for patients will be lower as coverage increases for medications. More patients may start seeking treatments for chronic conditions like anxiety, osteoarthritis and Parkinson's disease.

Wider availability of surgical operations

The number of covered surgical procedures rose almost 50% from about 1,600 to 2,350 to include operations for abnormal heart rhythm and piles. Procedures have been reclassified to better reflect improvements in technology and their relative complexity.

Pharmacist as gatekeeper

As a key touchpoint in the medical service process, pharmacists are usually the last point of contact for patients. This is significant as educational programs and initiatives for these important yet overlooked stakeholders can bolster a campaign at an additional point of contact with patients.

Communication Opportunities

Public health campaigns, building disease awareness and drives for early detection and treatment remain strong communication opportunities for pharma and medical device industries. Companies may also consider partnership opportunities with governmental organisations to improve patient compliance and to address unmet needs.

12

6. CONCLUSION

Singaporeans are just beginning to understand the implications of new healthcare policies.
The fast-changing health landscape provides a slew of opportunities for the private and public sector to lead large-scale education efforts, upgrade digital capabilities, drive disease awareness and prevention campaigns as well as provide platforms to discuss and shape the future of healthcare in Singapore. As the Singapore governments approach evolves and as 2020 healthcare goals come into view, it is important for all subsectors healthcare providers, hospitals and companies in the pharmaceutical, medical device and biotech industriesto continue growing and tailoring their communication efforts to match the changing nuances and needs of the local communities.

13

Edelman Health Phone: +65 6733 1110 E-mail: singapore@edelman.com