We all don’t want to be in that situation: a sudden moment when our loved ones need hospital attention.
In Singapore, the top reason for hospital admission is accident, poisoning and violence. This means that for most people, the most common route to being hospitalised is through the Accident & Emergency (A&E) department. Another route is through patient referral whereby you are admitted as a patient via doctor’s referral or as a follow-up treatment. This article will focus on A&E admission at public hospitals.
Here’s what you need to know when you or your loved ones need to be hospitalised in Singapore.
Note: do not seek treatment at the A&E for non-emergency medical conditions. You can also gain access to subsidised public hospital services by seeking consultation at the polyclinics. General Practitioners (GPs) participating in Community Health Assist Scheme (CHAS) can also refer you to a Specialist Outpatient Clinic (SOC) as a subsidised patient.
Call An Ambulance Only For Emergencies
A good gauge of whether you (or your loved ones) need to seek treatment at the hospital is Singapore Civil Defence Force (SCDF)’s Tiered Response Framework. The SCDF classifies cases into life-threatening emergencies, emergencies, minor emergencies and non-emergencies.
While for us, seeing a pool of blood is an immediate emergency, it may not be as severe we think.
In some cases, you may require the emergency medical services of SCDF and ambulance support to get to the hospital. The charges will differ depending on whether your case is an emergency and the type of transport service you require. While SCDF ambulance services are free for genuine emergencies, they refuse to convey your case and/ or charge a hefty $274 for non-emergency cases.
You Can Seek Treatment At The Accident & Emergency (A&E) Department As A Walk-In Patient
For walk-in patients, the process is typically similar for all the public restructured hospitals. Taking the example of the National University Hospital (NUH), the process starts with 1. temperature screening, followed by 2. registration, 3. triage, 4. consultation, 5. pharmacy and discharge or admission to hospital.
At any stage of the waiting process before the consultation (i.e. stage 1 to 3), it is possible that you will be expedited to see a doctor if your condition deteriorates or is deemed as a medical emergency.
You Pay Similar Fees For Accident & Emergency (A&E) Charges Across All The Public Restructured Hospitals
Currently, our public hospitals charge a flat fee for Accident & Emergency consultations, for Singaporeans and non-Singaporeans. This fee includes basic laboratory investigations (e.g. urine test, blood sugar test, ECG), basic procedures (e.g. plaster cast, simple suturing and wound dressing), x-ray services and standard drugs.
|Public Hospitals||Accident & Emergency (A&E) Charges|
|Alexandra Hospital (AH)||$110.00|
|Changi General Hospital (CGH)||$126.00|
|Khoo Teck Puat Hospital (KTPH)||$122.00|
|KK Women’s And Children’s Hospital (KKH)||$120.00|
|Sengkang General Hospital (SKGH)||$121.00|
|Singapore General Hospital (SGH)||$121.00|
|Tan Tock Seng Hospital (TTSH)||$128.00|
|National University Hospital (NUH)||$121.00|
|Ng Teng Fong General Hospital (NTFGH)||$120.00|
This flat fee would not include the charges for complex investigations, such as CT or MRI scans. Additionally, if you require complex procedures such as emergency surgery, this is not included in the initial flat fee for A&E consultation. Instead, these additional charges will be billed to you at discharge. Along the way, you and/ or your family member will be advised if you require additional treatment and the estimated cost of treatment.
For children, do note that not all hospitals are equipped to handle severe paediatric cases. Critical cases involving children may be transferred to NUH or KKH which have full paediatric facilities.
You May Be Placed In A Observation Ward Instead Of A Full Hospital Admission
Depending on your medical condition you may be placed in an observation ward that is attached to the A&E department, instead of or prior to a full ward admission. This is a transitionary ward unit that is intended for observation and extended diagnostic testing. For some patients, this observational ward stay is sufficient to manage the treatment without being admitted for a full ward stay.
Depending on the hospital, there may be different names/ terms for these observational wards and their layouts and number of beds will differ. At NUH, this is the 16-bedded Extended Diagnostic Treatment Unit, SGH has a 24-bedded Emergency Observation Ward, which includes a 7-bedded Emergency Cardiac Care Unit (ECCU). While the prices for ward stays in these units are not listed, they are typically priced at subsidised ward rates.
If you are warded at these units, you will have to go through the hospital admissions process. At this stage, you will also be asked to decide on your choice of ward class, in the case you are admitted for a full ward stay. You will also be asked to provide your insurance or medical benefits number, if applicable.
You May Have To Wait (A Long Time) Before You Are Admitted
Assuming that your medical condition is not resolved upon consultation and the doctor decides to admit you for inpatient ward stay, you will have to go through the hospital admissions process.
The waiting time for admission to ward fluctuates on a daily basis and is monitored by MOH. Between 14 March 2021 to 20 March 2021, the waiting times varied from as fast as less than an hour to almost 14 hours. This is the time taken from the moment the doctor decided that you need to be admitted as an inpatient patient to the time that you exit A&E and enter an inpatient ward. The large difference in waiting time is due to many factors including the number of discharges that day, the number of admissions, the number of available ward beds and the time of discharge vs the time of the decision to admit you as a patient.
You Decide Your Ward Choice At The Point Of Admission
At the point of admission, you will also have to decide your choice of ward class which will determine the ward subsidies you are eligible for during your hospital stay. Currently, B2 wards are subsidised at 50% to 65% of the hospitalisation bill while C wards are subsidised at 65% to 80%. Currently, your ward choice also affects the future subsidies you will receive on follow-up outpatient treatment upon discharge. This means that patients who choose A class wards will be treated as private patients when returning for follow-up treatments at Specialist Outpatient Clinics (SOCs).
This is set to change with the latest changes to the Healthcare Subsidy Framework in mid-2022. Private patients will be allowed to opt for subsidised follow-up care at SOCs, with the subsidies determined by their Per Capita Household Income, as part of the mean-testing framework.
During admissions, this is the time to alert your admissions officer if you require financial assistance. The public hospitals are all equipped with financial counselling resources and they can assist you further.
Discharge Documents Are Important If You Intend To Make Insurance Claims
Aside from the follow-up referrals, medication, medical certificate and payment, you may need to check with your insurer on the required documents, especially if you are claiming for inpatient stay.
Do note that while your discharge documents may include a doctor’s memo or referral letter for SOC follow-up treatment, these may not suffice for insurance claims. A formal medical report usually costs about $100 with specialist medical reports costing more. You will have to request for these separately at the admissions office or submit the required forms online.
For inpatient hospitalisation, you are allowed to withdraw up to $550 per day from your MediSave for the first two days of hospitalisation. You will need to inform the hospital during billing that you wish to claim from MediSave and you will need to sign the Medical Claims Authorisation Form (MCAF), which authorises the institution to use your MediSave monies to pay the bill.
Being hospitalised is never a good experience but being aware of the process and what to expect can help alleviate some of the anxiety surrounding that experience.
As a final pointer, here’s a checklist of the items you should bring to the hospital:
|Checklist of Items You Should Bring To The Hospital|
|Patient’s NRIC/ Passport|
|Employment Pass/ S Pass/ Work Permit for foreign residents|
|Insurance and Medical Benefit Identification Documents:
– Policy Number of Integrated Shield Plan (for insurance claims, if any)
– Civil Service Card or Medical Benefit Identification Memorandum for Civil Servants
– Hospital Identity Card or Letter of Guarantee for Employees of Companies
|Personal Items (if admitted for observation or ward stay)|
|Toiletries (such as toothbrush, toothpaste, soap, personal towel, slippers)|
|Pyjamas and change of clothes to wear on the day of discharge|