Are you for or against inbound Singapore medical tourism?

A debate on why Singapore should or should not promote medical tourism has raised questions in the local media. In 2003, the Singapore government launched SingaporeMedicine, a national initiative to establish and enhance Singapore’s position as the medical destination in Asia.

The ambitions were bold: one million foreign patients a year by 2012, the creation of 13,000 jobs and a contribution of $3 billion to the economy, or roughly 1% of GDP. Within a decade SingaporeMedicine quietly disappeared.

The government claimed that the medical tourism initiative would help contain healthcare costs but political opponents voiced concerns about distracting or diluting the public hospital core mission of serving Singaporeans. They argued that foreign patients want better and faster treatment so get priority over locals and that the country had a shortage of doctors, nurses and other health professionals.

Dr Jeremy Lim of management consultants Oliver Wyman argues that medical tourism is not about economic benefits and attracting rich foreigners,

“Foreign patients are vital to our healthcare system’s continued ability to provide quality healthcare for Singaporeans. High patient volumes deepen clinical acumen, sharpen surgical skills and enable higher quality for all patients, foreign and local. Attracting foreign patients is no longer a “nice-to-have” but a “must-have”. We may not have enough patient volumes in some specialities to even maintain competence and safety. Singapore has 43 cardiac surgeons and the latest numbers work out to only about a dozen operations per year per surgeon, this is not enough to maintain and improve skills. We need more patients.”

Lim also argues “We need more foreign patients for biomedical innovation. For biomedical research and innovation ambitions to be realised, Singapore needs medical scientists and clinicians to sub-specialise and focus on specific diseases or even sub-types of specific diseases. For this we need far more patients with certain selected diseases than Singapore’s modest domestic population could ever provide.”

Basically, Lim wants to reignite SingaporeMedicine, but not in the old blunderbuss pursuit of all manner of foreign patients, but precisely targeted.

Lim wants to start a discussion on –

Where are Singapore’s strategic priorities in healthcare and where are the gaps?
Which types of foreign patients with diseases of interest and value to Singapore are needed to help plug these gaps?
The best way to encourage foreign patients with these conditions to choose Singapore?
Better coordination between public and private healthcare sectors?
Special visa arrangements?
Subsidies for expensive technologies?
Lim concludes, “Forget about foreign patients crowding out locals; that is a red herring and hurts Singaporeans. We must discuss how some types of foreign patients can benefit from the excellent care Singapore is able to offer and help us to help ourselves.”

Several critics argue that Lim is wrong in principle and on detail. They argue that even if medical tourism is revived, it should not be considered in government hospitals, as the present healthcare infrastructure already has trouble meeting demand. Government hospitals, community hospitals and national specialist centres are struggling to cope with increasing demand for specialist care and in-patient care, with occupancy rates almost at full capacity.

Critics argue that there simply is no spare bed space in government hospitals, while recent and upcoming changes to the local MediShield health insurance system will see people switching from private hospitals to government hospitals, and increased demand for beds in government hospitals.

Critics point out that government and community hospitals receive annual financial grants from the Ministry of Health to offset part of their operating costs. So all government hospitals must stay committed to giving priority to citizens seeking in-patient care, and not pursue profits from medical tourism.

Even critics agree that foreign patients are welcome to seek care in private hospitals. So to develop and train the next generation of specialists, rules should change to allow doctors who wish to specialise to practise in private and government hospitals concurrently.

Singapore has a more basic problem that the will or interest in promoting medical tourism, after Hong Kong, it is the most expensive Asian country for private hospital treatment. As other countries have caught up and can now offer treatment that was once only available within Asia in Singapore, at a lower cost, Singapore continues to see falling numbers of medical tourists as it has lost its point of difference.