Singapore's Healthcare System: A Model of Excellence or a Systemic Flaw?
Introduction
In 2023, Singapore was ranked first amongst 104 countries in the "health component" category of the Legatum Prosperity Index, which measures the extent to which people are healthy and have access to healthcare services. Singapore has been globally recognised for its quality and cost efficient healthcare, but beneath this veneer of excellence, cracks exist, namely the high pressure environment for healthcare professionals and long waiting times in public healthcare facilities. This essay seeks to delve deeper into these shortcomings and discuss some of the solutions that are in place or could be in place to address them.
High pressure environment for healthcare professionals
Singapore is already a country well known for its workaholic culture. The situation is worse for the front liners of the country— the healthcare personnels. According to the World Bank, in 2021, there are 2.7 doctors looking after 1000 people in Singapore, an overwhelming number that would bring immense fatigue and even burnout for the doctors. A 2022 survey by the Singapore Medical Association revealed that 54% of doctors reported symptoms of burnout. Being exposed to such high levels of stress for prolonged periods would inevitably lower the quality of care received by the patients, which in some unfortunate cases, could be fatal. A study by the National University of Singapore found that burnout increases the likelihood of medical errors by 23%. This figure highlights the severe impact that Singapore's pressure-cooker healthcare system can have.
To further exacerbate the situation, by 2030, it is projected that 25% of Singaporeans would be aged 65 and above according to the Strategy Group. And this is a bad news because compared to individuals younger than 65 years, the risk of hospitalisation for those aged 65 years and older is higher (337.8 cases per 1000 residents vs 85.0 cases per 1000 residents) and is associated with a longer average length of stay, according to the Ministry of Health and BMC Health Services Research.This trend clearly illustrates the significant strain it would place on existing doctors, who are already fully stretched. Therefore, this worrying trend injects a sense of urgency to address the shortage of healthcare professionals especially in public hospitals.
To tackle the shortage of healthcare professionals in public hospitals, the government has to raise the attractiveness of having a profession in public hospitals, by taking actions to alleviate the mental, physical and emotional burden on physicians in public hospitals. This can be done by offering free counselling and psychotherapy services for physicians, and even allocating time slots periodically for mandatory consultations. Oftentimes, even amongst doctors, there is a stigma associated with receiving psychotherapy, which may make one averse to it despite needing it. Simultaneously, the intake for medical schools in Singapore has been gradually on the rise throughout the years. Over the past decade, Singapore has seen a significant increase in its medical student intake. The combined admissions of local medical schools rose by approximately 60%, from around 320 students in 2010 to 510 in 2019, according to statistics from Channel News Asia. In addition to the increasing number of medical students, with time, the universities have increasingly rigorous admission criterias, and the intention behind these higher standards is to carefully select individuals who would stay in Singapore’s public healthcare system and contribute in the long run despite the hardships.
Long waiting times in public healthcare facilities
According to the Ministry of Health, patients in public hospitals waited an average of 3-4 hours in emergency departments in 2023, while the median waiting time for a non-urgent consultation in a public specialist outpatient clinic was 25 days. These numbers are concerning particularly in the healthcare field as it not only builds up frustration amongst patients, it is also tied to fatal and irreversible circumstances. A waiting time of 3-4 hours in an emergency ward is alarming, as patients in the emergency department require urgent and timely care. Often, their conditions can be critical, with outcomes hinging on prompt medical attention. 25 days for a non-urgent consultation is also not negligible, as that is not the end of the story. After the consultation with the public specialist, it is often accompanied by follow up checks, relevant scans, that also has a long interval, ranging from weeks to months, and these may add up to be sufficient time for initially benign lumps to develop into cancerous ones. Data from Philips APAC showed that 60% of leaders reported delays in patient care due to staffing issues, while 79% cited financial difficulties as a barrier to providing quick and efficient healthcare services. As explored in the previous point, the shortage of healthcare professionals inevitably adds on to the waiting time. Financial constraints could undermine the efficiency of healthcare services such as requiring receptionists for every patient registration instead of being able to automate it using electronic kiosks.
The Singapore government has recognised this issue and has invested heavily into public hospitals to transition towards smart healthcare with the utilisation of Artificial Intelligence (AI) in multiple areas, including radiology. In October 2024, the Ministry of Health (MOH) had declared an investment of $200 million into implementing AI-powered new technologies across public hospitals islandwide. AI can be used to assist radiologists in analysing medical images such as X-rays, CT scans, MRIs and ultrasounds. AI helps to detect abnormalities such as tumours, fractures and cancerous lumps. National University Hospital (NUH) reported that AI tools had reduced the time taken to diagnose brain haemorrhages from 30 minutes to under 10 minutes. Changi General Hospital (CGH)’s use of AI for the analysis of chest X-ray has shortened the duration to identify disease by 40%, from an average of 4 hours to 2.5 hours.
And an important point to highlight is that accuracy is not compromised for speed. Artificial intelligence tools currently are as accurate or even more accurate than human doctors in detecting abnormalities. In the book Complications: A Surgeon’s Notes on an Imperfect Science, it cites a study conducted by Lars Edenbrandt, who spent five years perfecting the detecting system in his computer electrocardiogram (ECG) by feeding it more than ten thousand patients, telling which ones represented heart attacks and which ones did not, until the machine became an expert at reading the most ambiguous ECGs. Then he approached Ohlin, who is one of the top cardiologists in Sweden and a man who on average reads ten thousand ECGs a year. The computer and Ohlin were made to compete and see who can most accurately pick up which ECG would indicate heart attacks. The results were shocking, as the machine beat man by 20 percent. From this example, we can see that increasing reliance on AI tools does not mean that the radiologists are compromising on the accuracy, but instead, it is in fact more accurate than humans.
Conclusion
All in all, while Singapore's healthcare system is undeniably a global model of excellence, as evidenced by its top ranking in the Legatum Prosperity Index, it is not without its flaws. The challenges are complex and multifaceted but they are not unsolvable. By continuing down the path of innovation and investment, the quality of healthcare is bound to improve to more comprehensively meet the needs of our patients, and solidify Singapore’s position as a leader in healthcare.
Additional citation
Tan, C. C., Lam, C. S. P., Matchar, D. B., Zee, Y. K., & Wong, J. E. L. (2021). Singapore's health-care system: key features, challenges, and shifts. The Lancet, 398(10305), 1091-1104.