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Category: Singapore Healthcare

A guide to the healthcare system for children in Singapore

What percentage of our healthcare costs are spent on our children?

This page is to gather all available data on healthcare spending on children in Singapore. New information will be added, here so please leave a comment or email us at info@margaretjane.org with more data.

Hospital admissions for 2010

In 2010, tadalafil children (0-19) made up 20% total of hospital admissions. Surprisingly, while adults went overwhelmingly to public hospitals vs private (85% vs 14%), parents chose to send their children to private hospitals far more, with public hospital admissions dropping to 68% vs 32% for private hospital care.

Source: http://www.moh.gov.sg/content/moh_web/home/statistics/healthcare_institutionstatistics/
hospital_admissionratesbyageandsex/Hospital_Admission_Rates_by_Age_and_Sex_2010.html

Neonatal Intensive Care Units (NICUs) in Singapore

A healthy baby delivered at term will go to a hospital nursery where nurses will look after them when they’re not with their mothers in the mother’s ward or room. These babies are usually swaddled in open plastic cots, with nothing attached to them other than their hospital ID tags. ¬†They’ll be brought to their mother for nursing or bottlefed. Occasionally, a newborn may be placed under “blue lights” to treat jaundice, a fairly common and easily treated condition. They will be screened for common disorders which usually includes a tiny bit of blood being drawn for testing. These babies will go home with their mothers within a few days at most from the hospital.

The NICUs are very different. The babies in the NICUs are usually much smaller and quieter. Some will be cradled within an incubator, trailing lines and beeping machines from a big plastic box. Others will be lying in a cot under heat lamps with bubbling ventilators taped to their tiny faces. At one end of the NICU, there will be open cots with small but healthy looking babies – the “feeders and growers” who are getting ready to graduate to the regular nursery or even be discharged to go home.

Why do babies need to go to an NICU?

Most infants end up in an NICU due to prematurity. Premature births are 8-12% globally. Very young and older mothers, mothers of multiples and women with previous premature births are higher risk, but sometimes premature births simply happen. A premature birth is usually classified as before 37 weeks. Babies at 23 weeks have survived, but the earlier the birth the higher the risk of longterm physical and mental challenges. In Singapore, the guidelines to start medical treatment are for infants above 24 weeks and 500g, although parents can ask for medical treatment in any case.

Other babies come to the NICU because they have congenital problems or suffered trauma during their delivery. Newborns that need surgery will be admitted to the NICU. After discharge and then re-admittance for further treatment or very rarely when a chronically ill baby is several months old, babies will go into the Pediatric Intensive Care Units (PICUs).

Adjusted age
Babies born before their due date often have two ages, their adjusted age and their actual or chronological age. For example, a baby born at 32 weeks on the first of January is eight weeks early because the baby should have been born on the first of March. When the first of March comes round, the baby’s actual age is two months, but her adjusted age is zero. On the first of April, that baby has been out in the world for three months, but her adjusted age is only one month.

A premature baby can’t be compared directly to full-term babies born on the same date. By using an adjusted date, you can account for the extra time the baby should have been in the womb. That premature first of January baby can be expected to start rolling over by August when she’s four months adjusted age, while a full-term first of January baby would be expected to start rolling over by May.

By two years of age, premature babies don’t need to use their adjusted age and can be assessed using their actual or chronological age.

NICUs in Singapore

There are 9 neonatal intensive care units in Singapore.

Public:

  • National University Hospital
  • KK Women’s and Children’s Hospital
  • Singapore General Hospital

Private:

  • Gleneagles Hospital
  • Mt Elizabeth Hospital
  • Parkway East Hospital
  • Mount Alvernia Hospital
  • Raffles Hospital
  • Thomson Medical Centre

NICUs are usually ranked by the complexity of cases they can handle. A Level 3 NICU can handle the most complex cases. Singapore’s public hospital NICUs are all Level 3, and some private hospitals such as Gleneagles Hospital also have Level 3 NICUs. A Level 2 NICU may also be called a special care nursery. KK Hospital has probably the biggest and busiest NICU in Singapore.

Singaporean NICUs generally encourage breastfeeding and will help loan breastpumps and offer breastfeeding help. Donated breastmilk is not available. Kangaroo care is encouraged and most NICUs have reasonable visiting hours, although usually visitors are limited to parents and grandparents only.

What’s the difference between the NICUs?

The biggest difference is cost. NICU charges in public hospitals are tied to the category charges of the mother. If you checked in as a Class A mother for a private room, your child’s stay in the NICU will also be charged under Class A. The quality of care given is exactly the same – all NICU babies receive the same high nurse:child ratio of care and are treated by a team of specialists – but the bills can be very different.

NICU charges range from $58/day for a Class C-subsidized at KK Hospital to $562/day for Gleneagles’ Level 3 NICU. This is just the room charge – NICU babies will often have many medical treatments and possibly surgery charges as well. It is fairly common to have NICU bills of $20,000 for a straightforward premature birth, up to hundreds of thousands for early multiples.

Financial tips
  • Ask to be downgraded. Usually the hospital will downgrade you on the same day you request, and all charges from then on will be under the subsidized rate.
  • If you know your baby will spend time in an NICU, plan for a public hospital. You won’t be able to choose your own doctors, but if you are a high-risk pregnancy likely to wind up in an NICU, you will be assigned a specialist in high-risk pregnancies anyway.
  • All public hospitals have medical social workers who can help you apply for financial aid and appealing your charges. Private hospitals will often work out a payment plan as well.
  • Medisave from both parents can be used. The government has allowed grandparents’ medisave to be used in exceptional cases. Medisave covers up to $450/day per baby, which will still leave you with at least several thousand in a cash payment for an NICU stay.
  • Medishield does not cover any NICU charges, although the government is now considering whether babies with serious birth defects will be included.
  • Some insurance policies will cover NICU charges, depending on the package. In general, you can only qualify if you bought the insurance at least a year before you became pregnant.
photo by: tamakisono