Health and medical to Singapore

Trends and opportunities

The market

There is a dual system of healthcare delivery in Singapore. Both public and private providers of healthcare are regulated by the Ministry of Health and its statutory boards, and the standard of medical practice ranks among the best in the world. The international healthcare accreditation body, Joint Commission International (JCI) has accredited 11 hospitals and three medical centres in Singapore. JCI as an entity, works to improve patient safety and quality of health care in the international community through education, publications, advisory services, and international accreditation and certification.

Singapore’s healthcare system is designed on an integrated care model platform which provides holistic and integrated care. The public healthcare system comprises three integrated healthcare clusters, anchored by a regional Hospital working with a variety of Primary, Intermediate and Long-Term care sector and support services to deliver patient-centric care. The healthcare clusters are the National Healthcare Group (NHG), Singhealth, and National University Health System (NUHS). All heathcare clusters are supported by an  integrated care agency, the Agency for Integrated Care (AIC), which has been set up to smooth the transition of patients from one care setting to another.

National healthcare expenditure on healthcare is about 4 per cent of GDP, which is low among developed countries, but expected to grow as the population ages. There are four schemes to help citizens ‘co-pay’ for healthcare services in the public healthcare system:

1. Medisave
2. Medishield
3. Eldershield
4. Medifund

Around 70-80 per cent of Singaporeans obtain their medical care within the public health system via the the above public healthcare finance schemes. Private healthcare demand is also high, and is paid for by private insurance schemes.

There are more than 50 companies undertaking biomedical sciences R&D, including drug discovery, translational and clinical research, in collaboration with key research institutes in Singapore.

Singapore is also a growing medical technology (medtech) manufacturing hub for global original equipment manufacturers (OEMs) and specialist medtech equipment R&D, designers and manufacturers, registering an industry output of about A$5 billion - and set to grow at a compounded rate of 5 per cent per year until 2020. There are about 30 medtech devices manufacturers (mid to large) based in Singapore, with manufacturing activities geared towards global and regional exports markets, all of whom must meet strict regulatory compliance, e.g. ISO 13485 quality management standards, in design and manufacture of medical devices.

As Singapore is a small market and adopts international regulatory medical standards from established countries, Australia’s respected Therapeutic Goods Association (TGA) is often one of the key bodies where the Singapore regulatory authorities make reference to for internationally recognised guidelines and standards.

Opportunities

• advanced and cost-effective medical devices and equipment
• disposables
• generic drugs for expiring patented drugs (asthma and high cholesterol)
• home care products.

As this is an advanced market, health and medical products with international accreditation are highly sought after. There are also opportunities for biomedical sciences organisations to consider foreign direct investment into Singapore, especially in the area of:

• pharmaceutical manufacturing
• drug discovery
• clinical trials
• biotechnology research.

In the medtech segment, Singapore looks to TGA’s global standing as one of its benchmarks. This has implications for Australian medtech businesses as they can be positioned to tap into the growth of the Singapore medtech R&D and design and manufacturing sector.

Competitive environment

Singapore faces competition from neighbouring countries, Thailand, Malaysia and India. Each have been aggressive in promoting medical capabilities in their countries. For example, Thailand, a popular tourist destination, has leveraged its traditional spa and massage facilities to improve the attraction of its wellness tourism industry, moving beyond providing health-screening and oncology treatments. India focuses on cardiac treatment, transplants, orthopaedics, issuing medical visas and has special lanes in its main airports for those seeking medical treatment.

Australia can learn from Singapore, and its (Singapore’s) competitors and seek to highlight its world class standing in scientific discoveries and commitment to medical research. It also has a vibrant and knowledge-intensive health and medtech industry with a long history of globally recognised breakthroughs in biomedical devices and diagnostics, making it an ideal partner in for collaboration and partnership in market expansion and R&D.

Tariffs, regulations and customs

Singapore is a free trade country, with taxes applicable to the import of alcohol, cigarettes and cars. Generally, goods imported attract a 7 per cent goods and services tax.

The Health Products Regulation Group, under Health Sciences Authority (HSA), ensures that drugs, innovative therapeutics, medical devices and health-related products are regulated to meet appropriate standards of safety, quality and efficacy. The Group comprises:

• Therapeutic Products Division
• Complementary Health Products Division
• Manufacturing and Quality Audit Division
• Pharmacovigilance and Compliance Division
• Enforcement Division

The HSA and TGA have an enhanced technical cooperation and information exchange through the Memorandum of Intent for cooperation on scientific and regulatory affairs. However, local distributors of Australian health and medical products will still need to ensure that the products they wish to represent comply with HSA’s regulatory requirements.

Industry standards

The Health Products Act (HPA) was introduced in 2007 with the aim to consolidate and streamline the regulatory controls of health products under one single Act. The consolidation is done in phases to cover a range of health products.

Pharmaceutical products, commonly known as chemical or biologic drugs, will be regulated as “therapeutic products” in the HPA. Thereafter, the existing controls under the Medicines Act (MA) and Poisons Act (PA) will no longer be applicable to pharmaceutical products.

The following six pieces of legislation, effective since 1 November 2016, have been introduced in the HPA for the regulation of therapeutic products:

• Health Products Act (Amendment of First Schedule) Order 2016
• Health Products (Therapeutic Products) Regulations 2016
• Health Products (Clinical Trials) Regulations 2016
• Health Products (Therapeutic Products as Clinical Research Materials) Regulations 2016
• Health Products (Advertisement of Therapeutic Products) Regulations 2016
• Health Products (Licensing of Retail Pharmacies) Regulations 2016

Correspondingly, the following are legislation for the controls of medicinal products (MP) under MA and medical devices (MD) under HPA, used in clinical trials/clinical research:

• Medicines (Clinical Trials) Regulations 2016
• Medicines (Medicinal Products as Clinical Research Materials) Regulations 2016
• Health Products (Medical Devices) (Amendment) Regulations 2016

Marketing your products and services

Market entry

In the public healthcare system, commonly used health and medical products are collated by a central procurement office and purchases are put up for tender. Government tenders are posted on the Singapore government’s one-stop procurement portal Government Electronic Business (GeBiz). The public healthcare facilities can separately call for tenders for items that may be unique to their requirements.

Relationship and personal selling are important to both private and public healthcare providers as most tend to prefer liaising with distributors that they are familiar with.

When introducing new products to the health and medical sector, it is important to engage key opinion leaders and associations, organise seminars and forums or even take part in conferences to raise awareness. Most importantly the product must satisfy all claims and be safe for use.

For the medtech devices sector, the strategy to drive market access for Australian organisations is the ability to value-add at each stage of the medtech value chain. Each stage of the value chain essentially revolves around patient care (including striving for cost efficiencies) and collaboration across the broad spectrum of stakeholders would be important

• Clinical needs development (considered as R&D stage e.g. clinician-researcher collaboration to develop new medical devices to improve patient care and lower cost. Potential partners include research institutions and universities)
• Device conceptualisation (design stage e.g. accelerators/design firms/ incubators/pre-clinical testing services)
• Clinical research and regulatory approvals (design/niche manufacturing stage e.g. clinical institutes/research organisations/HSA)
• Production and manufacturing (niche manufacturing stage e.g. contract manufacturers/multinational companies (MNCs) or small and medium enterprises)

In Singapore, key entities for potential collaboration include:

• Research communities (A*STAR: Agency for Science, Technology & Research), National University of Singapore (NUS), Duke-NUS Graduate Medical School
• Clinical groups (hospitals within Singhealth or National Health Group, where there are Medical Devices Development Offices (MDDOs) including Tan Tock Seng Hospital, NUH, Singapore General Hospital
• Industry partnerships (with MNCs such as Johnson & Johnson, Becton Dickinson, Medtronics)
• Government entities supporting the medtech sector, e.g. Economic Development Board and Enterprise Singapore.

In addition to registration of health and medical products, local distributors usually undertake the entire sales, marketing and distribution process, and will also involve the principal firm as needed.

Links and industry contacts

Government, business and trade

• Health Promotion Board
• Health Sciences Authority 
• Ministry of Health
• Singapore Economic Development Board

Healthcare groups

• Agency for Integrated Care
• National Healthcare Group
• Singapore Health Services
• National University Health System
• Parkway Group Healthcare
• Raffles Medical Group 
• Government Electronic Business

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