ANNALS ACADEMY OF MEDICINE SINGAPORE · Published 2026-06-25 · DOI 10.47102/annals-acadmedsg.202626
Joshua Kuan Tan, Yun Zhao, Zoey Hui Xian Lim, Boon Hwee Ang, Julian Thumboo, Ivan En-Howe Tan, Lian Leng Low, Marianne Kit Har Au
Introduction: Despite rising healthcare expenditure in Singapore, detailed utilisation patterns are not well characterised. We analyse utilisation within SingHealth, the country’s largest public healthcare cluster. Methods: We conducted a retrospective observational study using patient-level data from 2019 to 2024, across inpatient, outpatient specialist, and primary care settings. Patients were categorised using the Modified British Columbia (ModBC) Population Segmentation Framework, and inpatient diagnoses were classified using a locally adapted version of the Clinical Classifications Software Refined (CCSR). Healthcare costs were reported in inflation-adjusted 2024 Singapore dollars (SGD). Descriptive statistics and temporal trend analyses were performed. Results: The patient population increased from 1.21 million in 2019 to 1.37 million in 2024, while total healthcare expenditure rose from SGD 4.37 billion to SGD 6.05 billion. Inpatient care remained the dominant cost driver, accounting for 63.8% of total expenditure in 2024, with a stable relative share over time. Expenditure increased disproportionately among older adults, with the steepest per-user growth in those aged ≥80 years, consistent with age-related acceleration in healthcare spending. Absolute utilisation increased among adults aged ≥60 years, while utilisation rates within age groups remained stable, suggesting that growth was associated with changes in population composition rather than utilisation intensity. Patients in the ModBC high-complex chronic conditions and cancer segments accounted for 46.7% of total expenditure. Diagnosis-level analyses using CCSR revealed age-related differences in utilisation patterns within these segments. Conclusion: Rising healthcare expenditure appears consistent with population ageing and the increasing complexity of chronic diseases. Addressing these challenges will require a sustained shift towards preventive, community-based, and value-driven models of care to ensure long-term system sustainability.
Abstract from DOAJ. Public domain (CC0 1.0).
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Tan, J., Zhao, Y., Lim, Z., et al. (2026). Trends in healthcare costs and utilisation in SingHealth 2019–2024: The effects of an ageing population. ANNALS ACADEMY OF MEDICINE SINGAPORE. https://doi.org/10.47102/annals-acadmedsg.202626