Digital health ecosystem in Singapore

Introduction

Singapore’s strategic geographical location coupled with its strong information technology infrastructure and favourable climate for innovation due to strong government support makes it an ideal destination for a digital healthcare hub in the Asia-Pacific region. The country has seen increasing interest from global multinationals, accelerators and startups to establish the country as a base for addressing the emerging digital healthcare needs of people across several countries in the entire region.

The strong R&D infrastructure, favourable government policies and abundance of growth opportunities make Singapore an ideal destination for exploring digital health growth in the South Asian region.

Basics on the healthcare system in Singapore

Singapore’s healthcare system is designed to ensure that everyone has access to different levels of healthcare in a timely, cost-effective and seamless manner. The country offers universal healthcare coverage through a mixed financing system. Singapore’s government controls and pays for much of the medical system itself. More than 80% of the hospital beds in Singapore are in public hospitals, and those hospitals are divided into wards with different levels of amenity. The high-end single-room air-conditioned A-ward patients and the dorm-style C-ward patients are paying for their own care, but at different price points, because the government is absorbing the direct cost of care in the C-wards. The government’s subsidies shape patient and provider decisions and influence pricing.

The basic structure of Singapore’s insurance system is built around the three Ms – Medisave, Medishield and Medifund.

Medisave is a mandatory health savings account. Every employee contributes 8% to 10.5%, depending on age group, of monthly salary to a personal Medisave account. Patients can use their Medisave accounts only to purchase pre-approved drugs, and the government subsidises many medical bills directly.

Medishield is a nationwide catastrophic insurance program with higher deductibles. Together, Medishield and Medisave form the core of Singapore’s more market-oriented health insurance system.

Medifund, which is based on a $3bn endowment, helps Singaporeans unable to afford medical help even with Medishield and Medisave.

Attractiveness of Singapore

Singapore has established itself as a medical hub in the region and is considered a favourable destination for medical tourism as well. The country’s government is working hard to improve the nation’s medical infrastructure and services by fostering innovation with a strong focus on operational efficiency, cost-effectiveness and optimisation of healthcare operations.

Many leading global organisations are attracted to Singapore due to its favourable business climate supported by an efficient operating milieu, reliable legal framework and an environment favourable  to R&D and intellectual property protection. The country’s internet and technology infrastructure is also very strong.

Healthcare spend and growth expectations

The Singaporean government spends only 2% of its GDP on healthcare. However, increased spending is anticipated. One in five residents in Singapore will be over 65 by 2030 and close to two-thirds of the elderly will have at least one chronic disease. 

As Singapore’s population has aged, the government’s annual healthcare spending has doubled over the past five years, with enhanced subsidies and expanded services bringing the total to S$10bn ($7.4bn) last year. Healthcare expenditure is projected to rise by S$90m – 9.6% – mainly to cater for higher patient subsidies as capacity, patient numbers and services expand, according to Heng Swee Keat, Singapore’s finance minister.

The projected increase in spending bodes well for the future of healthcare companies.

(Source: https://sias.org.sg/)

Digital healthcare system

The National Electronic Health Record (EHR) System was started in 2011 and the government spends about $15m a year on maintenance.

The country is now approaching a new digital healthcare model by moving healthcare information to the cloud. The project – hCloud – will cost $37m in the first 10 years of operations. There are also plans to use data and analytics to assist in decision-making at point of care as well as by the Ministry of Health for national planning.

A 2016 survey by consultancy Accenture found that around 90% of residents in Singapore believe that doctors can provide better care by accessing their EHR. Around 78% of consumers and 81% of doctors believe wearables have a positive impact on a patient’s engagement with his or her health. However, only 22% say doctors have recommended wearable technology to track vital signs or fitness.

Digital health startup scene

Some prominent and well-funded digital health spinouts and startups in Singapore include:

• Attune Technologies: One of the best-funded startups with over $15m raised across several rounds, Attune is a cloud-based software provider for healthcare delivery organisations.
• Biorithm is a medical signal processing spinout from Nanyang Technological University that provides cutting-edge signal analysis to the medical community. Working with doctors, Biorithm is dedicated to providing solutions for current and future medical problems especially in the field of wearables and monitoring sensors.
• Cardiatrics is an innovative heart disease prevention program pioneered by leading doctors.
• Clearbridge Biomedics, a spinout based on research conducted at National University of Singapore, manufactures devices for cancer diagnostics.
• Connexions Asia (CXA Group) is billed as “Asia’s first insurance and wellness marketplace” and raised $25m in series B funding in April co-led by EDBI, the investment arm of the government’s economic development board, and with the participation of NSI Ventures, a VC firm backed by government-owned investment firm Temasek.
• Cornea Biosciences was founded in 2011 to exploit research undertaken at University of Ottawa and Linköping University. The spinout is focused on bio-engineered corneas and has also established the corneal transplant foundation. It has raised $500,000 from US-based eye tissue transplant provider Indiana Lions Eye Tissue Bank.
• DocDoc is an online health appointment and medical information portal that has raised around $9m.
• EndoMaster is a medical device spinout from Nanyang Technological University and National University that is developing a novel robot-assisted surgical system that will advance current endoscopic surgeries. T
  his will enable surgeons to perform incisionless surgery that could be performed before only by open and laparoscopic surgery. The company closed a $14.6m series B round in March.
• Healint is the startup behind Migraine Buddy, a migraine-tracking app available on Google Play. Migraine Buddy has access to huge datasets that enable patients, doctors and researchers to diagnose the real-world causes and effects of neurological disorders.
• I3 Precision is a spinout from the Advanced Digital Science Centre, a research centre owned by University of Illinois Urbana-Champaign and funded by Singapore’s Agency for Science, Technology and Research. Its co-founders include Chueh Loo, assistant professor at Nanyang Technological University’s school of chemical and biomedical engineering. The company develops systems that address medication safety and productivity issues from the time the medication is prepared to the time it is consumed by the patient.
• Klinify provides a document management system, helping private specialist clinics manage patient records while preserving workflow.
• MyDoc, another Nanyang Technological University spinout, operates a digital platform that integrates various healthcare players and gives users access to different healthcare services, including doctor consultations, online prescriptions and long-term disease management programs. The company raised a $5.2m series A round led by IT services firm UST Global in September, with past investors including government-sponsored fund Spring Seeds.
• Ospicon offers a slumbering mat that can monitor a baby’s breathing sequence via optic fibre sensors.
• OurHealthMate has developed a platform for online medical appointment reservations.
• Privi Medical provides relief from grade I and grade II internal haemorrhoid bleeding and pain.
• Px Plate prescribes personalised meals designed precisely for a body’s health condition. 
• RingMD is an online directory for therapists, wellness experts and doctors.
• Smartmissimo Technologies provides connected wearable muscle stimulators. It offers PowerDot, a wearable personal training device that allows athletes to focus on their workout. 
• uHoo is a smart indoor air-quality sensor, about the size of a soda can, that detects allergens and toxins in the air to help prevent asthma, rhinitis and allergies through alerts, insights and recommendations delivered to a smartphone.
• Vault Dragon Healthcare aims to provide a cloud-based patient-centric platform to give users secure real-time access to their health records.The company has digitised more than 700,000 patient records and is the first vertically integrated record company in Southeast Asia, offering end-to-end medical record solutions for doctors.

Progressive government support and strong initiatives to drive digital healthcare

Singapore’s government unveiled a $13bn five-year R&D plan in 2016 with a major emphasis on innovation in health and biomedical sciences. Health technology innovation is also promoted strongly by government agencies in close partnership with private sector organisations. EDBI has a strong portfolio of health tech firms.

The government has undertaken extensive efforts to promote a thriving startup ecosystem in Singapore, be it investing citizens’ entrepreneurship skills or fostering legal, patent and regulatory systems trusted by investors and entrepreneurs.

Incubators, accelerators and investors

International research organisations such as Johns Hopkins University, Duke University and American Association for Cancer Research have made Singapore their base for accelerating drug discovery and exploring novel therapies for unmet health needs.

EDBI and electronics company Philips announced a joint investment partnership early in 2016 to drive the creation and commercialisation of connected health solutions aimed at Asian markets. The program focuses on mid to late-stage digital health companies.

The Digital Health Accelerator by insurance provider AIA and technology group Konica Minolta runs a 12-week program in Singapore where the two corporates select up to eight startups. This accelerator is powered by venture capital firm Nest.

Galen Growth Asia is an association building an integrated innovation network focused on healthtech startups. Some other prominent accelerators investing in the healthcare sector include Rockstart, FocusTech Ventures, Clearbridge, TheBioFactory and TNF Ventures.

Technology firm IBM is working with Parkway Pantai, one of Asia’s largest integrated healthcare groups, to enhance patient care quality. IBM is a major player in the region.

Prominent venture capital and private equity firms investing in the healthcare sector in Singapore include BioVeda Capital, OWW Capital Partners, Venturra Capital and Qualgro Asean Fund. Many prominent global VC and private equity funds such as state-owned Temasek, 500 Startups, Sequoia Capital, TA Associates, Walden International, Silver Lake are also active in the region.

World-class healthcare research infrastructure

The research and innovation ecosystem in Singapore consists of various government departments such as the Ministry of Health, R&D funding providers such as the National Medical Research Council, and R&D performers such as hospitals, universities and research institutes. The Ministry of Health oversees policies and provides financing support to the academic medical centres and hospitals and runs the National Innovation Challenge on Active and Confident Ageing.

The National Medical Research Council was established in 1994 and oversees development of medical research in the country.

The Singapore Clinical Research Institute is a national academic research organisation that works with clinicians to develop disease and practice focused clinical research networks.

The Signature Program in Health Services and Systems Research, one of five signature research programs of the Duke-NUS Medical School, a collaboration between Duke University and National University of Singapore, focuses on areas such as modelling, health economics, survey research and implementation and evaluation.  

Market map

Future of digital health in Singapore

The digital health ecosystem in Singapore will be driven further by a common theme – to make healthcare affordable and accessible with improved quality. Some of the most promising areas of growth would be in telehealth, remote patient monitoring, mobile health, data and analytics. Singapore is already focused on creating remote healthcare monitoring rooms, so telehealth will be of major focus in future. Data and analytics will play a pivotal role in understanding the population’s health requirements as well as offering targeted services to patients.

Further, the strong regulatory environment encompassing digital health initiatives in Singapore will also pave the way to success in deep technologies such as precision medicine where regulations play a major role in ensuring patient safety.

The Ministry of Health has identified five therapeutic areas based on factors such as impact of disease, Singapore’s scientific prowess and the needs of the country. These are:

1. Cancers.
2. Cardiovascular diseases.
3. Diabetes mellitus and other metabolic or endocrine conditions.
4. Infectious diseases.
5. Neurological and sense disorders.

The island offers tremendous growth, research and development and strategic benefits to digital health companies eyeing the attractive Asian
market.

References

_{https://www.moh.gov.sg/content/moh_web/home/our_healthcare_system.html
https://www.vox.com/policy-and-politics/2017/4/25/15356118/singapore-health-care-system-explained
http://apps.who.int/nha/database
https://sias.org.sg/files/SGXMarketUpdates/23022017-Rising-Government-Spending-Bodes-Well-for-Healthcare-Sector.html
https://www.pwc.com/gx/en/issues/high-growth-markets/assets/the-digital-healthcare-leap.pdf
https://www.accenture.com/t20160627T034015Z__w__/sg-en/_acnmedia/PDF-22/Accenture-Digital-Health-Consumer-Survey-Research-Brief-Singapore.pdf
http://techonomy.com/2016/04/health-tech-innovation-blooms-in-singapore/
https://www.duke-nus.edu.sg/research/signature-research-programmes/health-services-systems-research
https://www.singaporebusiness.com/2016/singapore-a-gateway-to-southeast-asias-digital-healthcare-market.html
https://www.eiu.com/graphics/assets/images/public/Digital-Health-Report/Digital-Health-Breakfast-Briefing-in-Asia-2017-V2.pdf
https://www.nrf.gov.sg/rie2020/health-and-biomedical-science
https://www.techinasia.com/directory-of-early-stage-venture-capital-seed-funds-and-angel-investors-for-startups-in-singapore}

– This article first appeared on LinkedIn. It has been edited for style and republished with permission from the author.