Political

Singapore is one of the most politically stable countries in SouthEast Asia. According to the Political And Economic Risk Consultancy, political risk in Singapore is quite low. With a high score of 85, Singapore is the third least corrupt country in the world since 2018 and the only Asian country ranked in the top ten. A corruption free environment supports the business sector.

Corporate tax is charged at a flat rate of 17%. Many analysts see Singapore as a tax heaven as it offers low taxes and other incentives to foreign investors. Hence, it is one of the largest recipients of foreign direct investment (FDI) in the world. Goods and services tax would be raised from 7% to 9%, sometime in the period from 2021 to 2025, to support expanded health care spending as the country’s population ages.

Singapore’s healthcare system is ranked 6th worldwide in 2021. Singapore’s public healthcare is funded by taxes, which usually cover about one-fourth of Singapore’s total health costs, but basic care at government hospitals is heavily subsidized. Singapore imposes user fees for all healthcare services – a policy designed to reduce overuse of non-necessary medical services. Singapore’s employees inject around 37 percent of their salaries in mandated savings accounts that may be used to spend on healthcare, with part of this being contributed by their employers. The government has introduced various policies which will transform the pharmaceutical and medical device industry of the country in the near future. Subsidies & financing schemes such as MediShield Life, CareShield Life, ElderShield, MediSave, MediFund, Community Health Assist Scheme, Pioneer Generation and Merdeka Generation subsidy schemes benefit the healthcare landscape of the country.

In recognition that the fight against COVID-19 is likely to be long-drawn, the Government has also taken steps to encourage the development of telemedicine to reduce unnecessary travel and prevent another wave of infection. Among the various initiatives, the Government has expanded the scope of the Productivity Solutions Grant (PSG) to support healthcare providers in providing teleconsultation solutions to patients. All eligible healthcare providers will be able to receive up to 80% PSG support to incorporate these solutions into their existing business and can apply for it through the Business Grants Portal.

Environmental

Healthcare firms have been trying to reduce carbon footprint by being more efficient and adopting new practices and technology such as going paperless. Many firms aim to reduce the consumption of papers by initiating paperless billing, medical reports, expense and payroll related claims and other internal processes. Apart from promoting sustainability, it also helps to improve efficiency and reduce costs.

Firms have also strived to ensure that cleaning products and consumables are environmentally friendly. These companies also aim to reduce power and water consumption through installing more energy and water saving devices. For example, some hospitals installed water dispensers to prevent the overuse of plastic water bottles. Due to severe space constraints in Singapore, healthcare firms are beginning to build rooftop solar systems to generate electricity.

Biohazard waste has, however, increased in 2020 mainly due to the pandemic situation and healthcare sector’s contribution to national efforts in swabbing and operating community care facilities which resulted in higher consumption of PPE.

Social

Singapore has a population of 5,905,276, the third most densely populated country in the world and faces severe space constraints. The literacy rate is 97.1% of the population in 2021. The high literacy rate is due to the government’s free education policy and making primary schooling compulsory. A high literacy rate is associated with a healthier population, greater economic growth, higher employment rates and implies that the workforce is qualitative. Majority of Singaporeans are bilingual, have a good command of English and their respective ethnic mother tongues and this advantage helps to attract international trade and foreign investment.

Like many other countries, Singapore faces the demographic challenges of an ageing population and low birth rates. Fertility rate reached a record low of 1.1 in 2020. Singapore has one of the most rapidly ageing populations in the world, and it is estimated that by 2030, one in four people will be aged over 65 years, and this will rise to almost one in two by 2050. The aging population will definitely have an impact on healthcare. The prevalence of chronic diseases such as diabetes, stroke and heart disease increases with ageing, as does the proportion of elderly people developing multiple chronic conditions. Subsequently, many older people typically have complex healthcare needs and are higher users of healthcare services. In light of its ageing population, Singapore therefore, needs to meet the challenge of ensuring that healthcare services remain accessible and affordable for the increasing number of people living longer with complex conditions.

Technological

Covid-19 has accelerated healthcare sectors’ push for digital adoption and precipitated greater acceptance of new technology. Healthcare firms have gradually launched e-healthcare platforms where patients can book medical appointments, access personal health records, take a queue number and register prior to arrival at the clinic, book Covid-19 Polymerase Chain Reaction test and even make cashless payment. When Covid-19 hit, social distancing became the new normal and people around the world turned online for most activities. In response to this and to reduce the risk and exposure to Covid-19 infection, many healthcare firms have launched telemedicine services that allow patients to remotely consult a doctor via text, phone call or video-conferencing, and have their prescribed medication and issued medicine certificates conveniently delivered to their doorstep. To minimise the disruption of essential services during the circuit breaker period, firms have also rolled out Tele-Rehabilitation. This initiative allows patients to continue receiving treatment in the safety and comfort of their homes, without compromising the care required to facilitate their recovery.

The advancement of technology has prompted healthcare sectors to store large volumes of data on the cloud. Firms need to ensure that data needs to be stored in a secure environment and maintained by IT professionals, to avoid cyber threats and data breaches.

Singapore’s rapid ageing population creates a greater demand for healthcare services and hence, the government plans to build more smart hospitals to deal with this issue using robotics. In recent years, firms have evolved to integrate robots into healthcare. For example, Raffles hospital has acquired and deployed the latest da Vinci Robotic Assisted Surgery System. It utilises robotic technology to assist surgeons in performing complex surgeries. Changi General Hospital has also begun to automate logistics by deploying transport robots in the hospital, moving documents, drugs, specimens and linen. It even plans to use robots to move heavier objects, like patient beds. It is expected that robots will gradually take over some healthcare jobs and workers will need to be retrained.

Economic

Singapore exported an estimated $372.9 billion worth of products and services in 2021, making it the 13th largest export economy in the world. It is one of the four Asian Tigers that are so named as they have highly developed economies with highly educated and productive workforces. It has the 36th largest economy in the world with a Gross Domestic Product (GDP) of $391.88 billion and a very low unemployment rate of 2.7% in 2021. However, this unemployment rate may be regarded as overemployment in some countries whereby employers may have been forced to recruit anyone as there were not enough workers in the market.

To meet the growing demand for labour, Singapore began importing large numbers of foreign workers since the 1980s and currently, 20% of its population is made up of foreign workers totalling over 1.2 million. It is heavily dependent on foreign labour from neighbouring countries for essential services jobs that are labour intensive and offers low wages. It is Singapore’s attempt to fill manpower shortage, maintain competitiveness and for economic growth. However, the reliance on cheap foreign labour has been frequently highlighted by analysts to be unsustainable in the long run. For instance, as other countries slowly start to develop, foreign workers would be less inclined to come to Singapore for jobs. Also, the closure of country borders due to pandemic, as seen during Covid19, would result in insufficient workers to continue providing essential services in Singapore and in turn, might negatively impact its economy.

Inflation reached a 7 year high at 2.5% in Jul 2021. In normal inflationary cycles, industries counter higher costs by raising prices. Consumers, in turn, pay more for just about everything, from fuel and food to transportation and healthcare.

Healthcare expenditure is 2.1% of GDP since 2016. The total health expenditure in 2021 is projected to be $18.84 billion, which is 13.2% higher than 2020’s expenditure. It is expected to grow to $49.4 billion and reach 9% of GDP by 2029. The increase is largely attributed to rising government spending on healthcare, as well as the local population’s increasing consumption of healthcare services, given the aging population and a trend towards earlier diagnosis of chronic conditions, close monitoring and follow-up. It is also due to increased public subsidies, which are intended to help reduce out-of-pocket costs.

Legal

In 2020, MOH has proposed new regulations which will govern telemedicine in Singapore. The objective of the new regulations is to mitigate the risks of teleconsultation in the interests of patient safety. In particular, MOH has stipulated that all medical practitioners seeking to offer teleconsultation are required to obtain a license in the future. This requirement will come into force in 2022 under the new Healthcare Services Act (HCSA). HCSA modifies the regulatory regime for healthcare services from a “premises-based” to a “services-based” form of licensing, expanded to cover non-premises based providers such as the ambulance and telemedicine service providers.. HCSA will also allow for a more flexible and modular services-based licensing regime that caters to the licensing of different healthcare services, while enabling the development of new and innovative services. This form of healthcare licensing is similar to that practiced by Malaysia and the UK. For instance, nursing homes will now be able to provide dementia care and geriatric clinical services at one location. Hospitals or medical clinics can provide telemedicine beyond services at their premises, offering more convenience and cost savings to patients, especially the aged sick with minor ailments or who are following up on chronic conditions.