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Medical tourism—the Singaporean story

by Matthew Holt
Here’s the transcript of my interview at WHCC with Dr. Joseph Yap from Singapore on medical tourism, and why Singapore cares.

Matthew Holt: For the World Healthcare Blog, this is Matthew Holt. I am taking advantage of cocktail hour in the exhibit hall to talk to a couple more people.One of the interesting things about the World Health Care Congress this year is that it really is a World Healthcare Congress. There was a little bit about global tourism last year. But this year, I have seen people from India, Singapore; I believe there are some folks from Thailand, and a lot of the Europeans.The Singapore Medicine Association, which is part of the Singapore tourism Board, has made a big splash here and they have handed me a nice glass of champagne. While that’s going on, I would like to introduce you to Dr. Jason Yap. Dr. Yap is the Director of Information Services at the Singapore Medicine at the Singapore Tourism Board. I hope I got that right.So the first question, Dr. Yap is why does Singapore have a Tourism Board that is promoting medicine?

Dr. Jason Yap: Singapore has the problem of a small population. We don’t have enough sick people of particular sorts to maintain the services that we have built up through the years. So for that we need to have a larger patient volume and a larger range of patients coming to Singapore. In order to do that, it is a whole government approach. We have got multiple government agencies working on it. The Economic Development Board brings in investment. They brought in Johns Hopkins and the Mayo Clinic into Singapore from the United States. We have other agencies working on this. The idea of bringing international patients to Singapore is about people moving. That is what the tourism infrastructure does. So the Singapore Tourism Board has created a Healthcare Services Division just to look after this. We are not saying that patients coming to Singapore inspired tourism. But because they use the tourism infrastructure, that is the best place for it. That is why I am brought by them to do this.

Matthew: That makes a lot of sense. Let’s talk about Singapore’s place as a regional hub in Asia, for now, and what you are doing to try and extend this to other parts of the world. Then I will ask you questions about cost and issues later.As you correctly mentioned, you have four and a half-million people in Singapore, is that about right? Those of you on the blog may not know that my grandfather lived in Singapore for many years, which is completely irrelevant. So I know a little bit about it.The issue there, I guess is that we know very well the high-volume centers do better in terms of their treating patients. With four half-million people, you may not have enough volume in certain specialties. A lot of Singaporean doctors are very highly trained. A lot of them come over to the US and Europe to get their training and then go back to Singapore. But also Singapore itself has great medical facilities. How many of the current patients coming to Singapore come from elsewhere in Southeast Asia and Asia?

Jason: In 2006 we got something like over 400,000 patients coming to Singapore just for healthcare; this is counting the number of visits to the country. Within that 400,000, a bulk of them, more than 50 percent come from Indonesia, Malaysia, and the immediate surrounding regions. We get patients from the Middle East, from the United States, from Canada, from Europe, Russia, and the Ukraine. So basically, people come to Singapore from all around the world.

Matthew: Now, 400,000 visits, give me a sense to put that in - how many encounters or surgeries? Compared to what you have at home, what is the scale of medical tourism as a share of the overall healthcare services provided?

Jason: It’s generally small compared to the local services. For some of our hospitals like Mount Elizabeth and Gleneagles something like 50 to 60 percent of their total clientele. But the public sector hospitals, which are actually private hospitals owned by the government, are operated at arms length. They are part of the government infrastructure; they will see something like less than five percent of foreign patients.

Matthew: Right. Primarily, here we are talking about surgeries and elective types or are we talking about more complex care as well?

Jason: This is where Singapore is a little bit different. When you hear about medical tourism and medical travel people are talking about going for knee replacements, very defined procedures and so on. Singapore is a service hub for the whole region. So people come to Singapore for high-end things like pediatric leukemia, for bone marrow transplants, for cancer treatments, very high-end quaternary stuff. They also come for stuff as simple as cough and cold. Indonesians will take a ferry over to Singapore to see a GP.

Matthew: Right, well, it’s just a half hour trip, right between Singapore and Indonesia?

Jason: That’s right.

Matthew: That’s like somebody in America driving across town to see their doctor.

Jason: Exactly.

Matthew: So let’s talk a bit about medical tourism as a whole. Has it become trendy in the US to talk about it? It’s unclear as to how much it actually is getting done, but certainly, we’ve heard a lot about people going to India and Thailand, but less so about going to Singapore. A lot of it has to do with that we see this remarkable pricing where a $57,000 surgery here equates to a $4000 surgery in India. Give us a sense of whether you are competing with those players in that market. What is the relative pricing of things between the US, Singapore, and India?

Jason: Singapore is marginally more expensive than India, partly because we do put in a lot more infrastructure. For example, we have one third of Asia’s GCI institutions, where India has two or three. If you were looking at more serious surgeries, for example a knee replacement, in the US it would cost $40,000. In Singapore, it would be about $9,000. So it is maybe about one quarter of the price. In India, it would probably be down to $6,000.

Matthew: OK. So there is some differential there, but off the US base is huge. And obviously, Singapore has got other advantages. Anybody that has Singapore would know nothing in the least developing about it. It is one of the most developed countries you will ever see for a small island.

Jason: An American I know describes Singapore as Honolulu, with humidity.

Matthew: [laughs]. Yes, those of you don’t like humidity should know that Singapore is right on the equator, and it is about 95 degrees the whole time, with humidity. But it’s not that bad. Not that bad. But it’s quite interesting. Those of you coming from the UK might be interested to know that they have English soccer on TV on a regular basis. [laughs]

Jason: That’s right.

Matthew: So you are obviously promoting that. I understand the concept of the Singapore government wanting to keep the skills in check of its physicians. I suspect that revenue is the main matter to some extent, but are you regarding this as being a major market for the country itself? Or is it more about keeping positions of hospitals with steady patients to try to keep their skills up?

Jason: Our bottom line is that we are seeing international patients in order to see our own people. If you’re talking in terms of the government putting in investment in order to make international medical travel something for Singapore, we would actually be better off putting the money elsewhere. We make more money through wealth management, manufacturing, IT services, and everything else. But this is because we want to look after our own people.

Matthew: Interesting. We are running out of time in this interview. But Singapore itself has a very interesting Universal cash-based account system for its own healthcare, which I have written about on the blog now and again and is interesting in and of itself. But we don’t have time for that. So that’s great. How has the show been for you?

Jason: It’s been very interesting. I’ve met lots of interesting people. I couldn’t get into some of the talks I wanted to, but that’s OK. It just means that it is well attended.

Matthew: It means that they are too busy. They have too many different talks. I’ve had that same problem with talks.Dr. Yap, thank you very much for talking with me. It was very interesting and I look forward to getting to Singapore and seeing you one day.

Jason: Sure, thank you.


  Medical Tourism portal wrote @ May 13th, 2007 at 3:12 am

Dear Mathew,

Interesting interview. Alot of the developing/Asian countries are trying to garner a larger share of the growing medical tourism industry.

Singapore, Malaysia, Thailand, Philippines and India are among the ones running the race. Lets see which country works fastest to address the needs of this industry and supports private enterprise to build a brand image that is both safe and reassuring to the travelling patient.


  Rains wrote @ May 17th, 2007 at 7:47 am

Singapore has a lot to offer in terms of tourism. Apart from the high-end things mentioned in your interview, people also go to Singapore for cosmetic treatments and vacation on the tropical island at the same time.

  Sam Hibrawi, M.S. wrote @ June 18th, 2007 at 4:12 am

Arab patient education is invaluable for attracting Arab patients to medical tourism programs in Asia. In fact, there is a serious deficiency in Arabic cancer information because cancer in general is a taboo topic in Arab countries. For example, the web site provide cancer information about 44 different types of cancer in Arabic language. This information have requested repeatdly by European hospitals to help Arab cancer patients and their families.

  Najid Pasha wrote @ June 28th, 2007 at 5:59 pm

Please visit www.arabmedicaltourist.com for more info on medical tourism industry in the arab world.

  Andrew wrote @ July 1st, 2007 at 2:15 am

Interesting article.

I think Singapore is well placed to grow with the medical tourism business. Its infrastructure is excellent and Singapore can deal with a very large range of medical procedures. Also, the Singapore brand is very carefully cultivated and very valuable. Singapore has a well deserved reputation for medical care.


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