Close up of doctor and patient sitting at the desk near the window in hospital (Photo by Andrei_R from Shutterstock).

Healthcare is a major point of concern for Singaporeans. It’s a universal issue that is constantly debated by citizens and politicians alike. The Ministry of Health (MOH) has consistently maintained that healthcare is affordable thanks for the 3Ms – MediSave, MediShield and MediFund – which helps keep out-of-pocket medical costs low for individuals.

However, recent years have seen plenty of talk about strategies and approaches to deal with the spiralling increase of healthcare costs.

The Singapore Business Review noted in a 2018 article, “Singapore’s staggering healthcare costs may be pushing medical tourists away” that “The rising cost of healthcare in Singapore is increasingly diminishing the city’s attractiveness as a medical tourism hub with patients opting to turn to neighbouring countries for their medical needs.”

In recent months, we’ve written several articles about this issue, specifically about how the cost of public healthcare is rising to points beyond that of private healthcare.

Let’s look at three new examples.

Ward charges

Two bills from Changi General Hospital (shown below) shared with TOC recently clearly shows that a Class B2 ward (4-bed) costs about S$265 a day while a Class C ward (open ward) costs about S$217 a day, both are prices before subsidies.

If you look at the hospital’s website, the price listed for a B2 ward is S$83 (citizen) or S$151 (permanent resident or PR) while the price for a C ward is S$43 or S$96, respectively. It says these are prices inclusive of GST and based on maximum subsidy level.

Hospital room charges at Changi General Hospital

So the math does tally there.

But if you compare room rates at private hospitals, you’ll realise that the charges for rooms in CHG, a public hospital, is actually really high.

Room rates for Mount Elizabeth Hospital (left) and Raffles Hospital (right).

A 4-bed room at Raffles Hospital costs S$288 with GST, while a similar 4-bed ward at Mount Elizabeth Hospital costs S$258 with GST. Surprisingly, a 6-bed ward (B2) in CGH costs S$265 before subsidy, while an open ward (C) costs S$217.

So a 6-bed, un-airconditioned ward in a public hospital, costs as much as a 4-bed ward in a private hospital?

Of course, after subsidies are deducted, the amount due is much less but why is the original cost for a public hospital so high in the first place?

Many have also argued to remove the class system for public hospitals as it creates a class system for those who can pay for better medical treatment and those who can’t.

As Dr Paul Tambyah, chairman of the Singapore Democratic Party (SDP) rightly points out that no one – whether rich or poor – chooses to get sick, get cancer. And earlier in the re-launch of SDP’s healthcare proposal, Dr Tambyah emphasised that healthcare access should be seen as a right of citizen and not something that should be left to the spending ability of an individual.

Cost of medication

Another concern is the inflated the cost of certain medications prescribed at polyclinics and hospitals.

Back in June 2019, prominent blogger Phillip Ang shared an email on his website which he had sent to Health Minister Gan Kim Yong to highlight this issue of over-inflated medication costs.

In a hospital bill Mr Ang received, the full cost of paracetamol was listed as S$6.29. However, he highlighted that a box of 20’s of the same medication at a retail pharmacy costs only S$2.50.

Mr Ang asked the minister why this medication which is purchased in bulk by MOH costs 250% more than retail price.

Now if we look at the bill from a polyclinic, we can see that the prices of medication from the polyclinic are actually very cheap, especially when compared to the prices we sought from a private clinic.

For example, the full price of 90 tabs of Amlodipine Besilate 5mg at a polyclinic is S$18 while at a private clinic is S$130.5.

For 170 tabs of Simvastatin 10mg, a polyclinic charges a full price of S$10.80 compared to S$63 at a private clinic.

Also, 84 tabs of Telmisartan 40mg is S$33.60 compared to S$147 while 340 tabs of Metformin HCL 500mg is only S$40.80 compared to S$51.

The large difference in prices is due to the fact that pharmaceutical companies sell to government hospitals at below-market rates. These purchases are done via an open tender process.

Often, pharmaceutical companies are willing to sell below market rates because they will be able to make a profit from the sheer volume of orders coming from government hospitals and polyclinics.

Private clinics, on the other hand – like the ones where TOC sought the retail prices of those medications mentioned above – sell medication at variable prices depending on the volume of their purchase. And since they’re never ordering as much as hospitals would, so the prices are naturally higher.

Now in the SDP’s healthcare proposal, they argued that general practitioners should be allowed to purchase the cheaper drugs from the Group Purchasing Office (GPO) tenders, as private clinics also contribute to the overall healthcare system in the country. This would allow them to charge their patients a much lower rate for medications.

Consultation fee

Finally, that same polyclinic bill shows a consultation fee of S$48 before subsidy. This bill, dated 2020, shows a consultation fee that is more than double the price of a visit to a general practitioner at a private clinic, which would only be about S$20.

This is something we’ve highlighted before in a previous article (Why does a private clinic charge less for consultation than the unsubsidised cost of the same at a public polyclinic?).

A visit to a National Healthcare Group Polyclinic charged a consultation fee of S$48.10 before subsidy while a visit to a private clinic costs only S$29.90.

Again, the subsidy brought the final cost down to S$13.20, but the question remains as to why the original, pre-subsidy cost of public healthcare so much higher than that of private healthcare?

The high price of public healthcare

In general, you would expect private healthcare to cost much more than public healthcare. But from the bills here and in our previous articles, we would argue that public healthcare costs in the country are heavily inflated, especially since it has an advantage in the volume of patients.

Sure, with subsidies, Singaporeans ultimately pay less out of pocket than if they go to a private clinic or hospital, but the massive difference in the initial, pre-subsidy cost is surprising.

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