Establishment Strategy For A Super Specialty Hospital Economics Essay

The Republic of Singapore is a Southeasterly Asiatic island state off the southern tip of the Malay Peninsula. Singapore is the universes 4th taking fiscal Centre with a major interest in the international trade and finance. The port of Singapore figures in the list of top five busiest ports in the universe.

Singapore has a diverse population of close to 5 million people made up of Chinese, Malays, Indians, Asians of assorted descents, and Caucasians with about 42 % of the population being aliens who work and study at that place. Foreign workers make up about half of the service sector. The state is the 2nd most dumbly populated in the universe after Monaco. Harmonizing to A.T. Kearney Singapore is the most globalised state in the universe – Globalization Index 2006.

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Singapore ranks No 1 in the Economist Intelligence Unit ‘s “ Quality-Of-Life Index ” in Asia and eleventh overall in the universe. Singapore possesses the universe ‘s 9th largest foreign militias.

Before independency in 1965, Singapore had a antic trading port with a GDP per capita of $ 511, which was the 3rd highest in East Asia at that clip. After independency, foreign direct investing and a state-led thrust for industrialisation based on programs by former Deputy Prime Minister Dr. Goh Keng Swee created a modern economic system. After a contraction of -6.8 % in the fourth one-fourth of 2009, Singapore claimed the rubric of fastest-growing economic system in the universe, with GDP growing of 17.9 % in the first half of 2010.

Below we give our appraisal of the grounds why Singapore is a premier investible location:

Economic Growth

If we take China as a benchmark..Is it turning fast? Over 2010, Singapore boasted the universe ‘s fastest-growing economic system, with a instead alert GDP growing rate of 17.9 % . It seems even better given the 6.8 % contraction during the 4th one-fourth of 2009.

Singapore is a developed economic system, which has historically revolved around drawn-out entrecote trade. Hong Kong, South Korea and Taiwan & A ; Singapore are known as the Four Asiatic Tigers. The economic system is to a great extent dependent on exports and the industries involved in polishing imported goods, esp the fabrication sector which is 26 % of Singapore ‘s GDP. The World Bank considers Singapore as the universe ‘s top logistics hub.

Singapore ‘s economic system has been ranked amongst the universe ‘s 10 most unfastened competitory and advanced.

Rated as the most business-friendly economic system in the universe, Hundreds of 1000s of foreign exiles work in Singapore in multi-national corporations. There are besides 100s of 1000s of foreign manual workers.

Singapore introduced a Goods and Services Tax ( GST ) with an initial rate of 3 % on 1 April 1994 well increasing authorities gross by S $ 1.6 billion ( US $ 1b, a‚¬800m ) and bracing authorities fundss. The nonexempt GST was increased to 4 % in 2003, to 5 % in 2004, and to 7 % on 1 July 2007.

Resilient Economy:

Inspite of merely holding 1.6 % of its land being agri-suitable a heavy dependance on imports for about everything, including H2O, Singapore still manages to hold a trade excess coupled with a balanced budget and a stable currency.

The currency of Singapore is the Singapore dollar, represented by the symbol S $ or the ISO abbreviation SGD. The cardinal bank is the Monetary Authority of Singapore, responsible for publishing currency.


Quite different to South Korea and Taiwan, which are to a great extent coupled with the cyclical electronics industry, Singapore has a reasonably much ; a well-diversified economic system, with finance and services accounting to about 70 % of its GDP.

Global Transportation Hub

Hong Kong and Shanghai might differ, but Singapore has the busiest transportation port in Asia and is next to the Straits of Malacca: a critical trade channel.

Government & A ; Politicss

A parliamentary signifier of authorities with a freer political clime development, and the ability to show positions freely anyplace, with the exclusion of two sensitive subjects: race and faith.

Singapore has a Westminster system of parliamentary authorities with the Constitution set uping representative democracy. The People ‘s Action Party ( PAP ) has won control of Parliament since 1959. Freedom House in its “ Freedom in the World study ” ranks Singapore as “ partially free ” and as a “ intercrossed government ” , the 3rd rank out of four, in its “ Democracy Index ” by the Economist. Besides, Singapore is one of the least corrupt states harmonizing to Transparency International.

A study by Political and Economic Risk Consultancy ( PERC ) of exile concern leaders found that Hong Kong and Singapore had the best judicial systems in Asia, with Indonesia and Vietnam being the worst:

Hong Kong ‘s judicial system scored 1.45 on the graduated table ( zero stand foring the best public presentation and 10 the worst ) ; Singapore with a class of 1.92, followed by Japan ( 3.50 ) , South Korea ( 4.62 ) , Taiwan ( 4.93 ) , the Philippines ( 6.10 ) , Malaysia ( 6.47 ) , India ( 6.50 ) , Thailand ( 7.00 ) , China ( 7.25 ) , Vietnam ( 8.10 ) and Indonesia ( 8.26 ) .

Conservative Regulation

Rules on stock list accounting and the expensing are more conservative than those in the United States.

Additionally, Singapore ‘s educational public presentation is exceeding.

It has twice every bit many Internet users as telecasting sets and its citizens are a diverse blend of 77 % Chinese, 14 % Malay and 8 % Indian & A ; 42 % of its population are aliens working chiefly in services. The state has a path record of being corruptness and drug-free.


Healthcare sector in Singapore

Healthcare sector in Singapore is chiefly under the duty of the Singapore Government ‘s Ministry of Health. Singapore has a cosmopolitan health care system where the authorities ensures affordability. Overall disbursement is approximately 3 % out of which 66 % comes from private beginnings ( 1 ) . The effectivity of the health care system has given consequences such as lowest infant mortality rate and highest life anticipation. Singapore ‘s system uses a combination of mandatory nest eggs from paysheet tax write-offs, a nationalized ruinous wellness insurance program, and authorities subsidies, every bit good as modulating supply demand of health care services to maintain monetary values in cheque ( 1 ) .

Performance of Healthcare sector

Even though the planetary economic system was shrouded with economic instability Singapore health care sector has performed exceptionally good. It recorded a addition of 40.7 % YTD on the FTSE ST Health Care Index ( 2 ) . This has been chiefly due to the floaty economic recovery in the first two quarters of 2010 and due to abroad patients. Medical touristry is supported by a state-of-the art substructure therefore pulling more and more patients for complex surgical processs which are expensive interventions in other developed states such as USA ( 2 ) . Besides the recent coup d’etat of Parkway kindles strong involvement for sector. This has besides led to a re-rating of most healthcare related stocks.

Competitive Landscape

Companies in health care sector provide a assortment of services, runing from pharmaceutical companies to medical engineerings company and health care suppliers. Primary health care is provided chiefly by private sector suppliers which make up to 80 % of the market. However, for the more acute sector public infirmaries ain 80 % of the market. Singapore has 12 forte centres. They take attention of alveolar consonant, tegument, malignant neoplastic disease, bosom, blood, oculus and other diseases. Majority of Asia ‘s specializer centres are located in Singapore. Some of the celebrated specializer centres in Singapore include the Thongchai Charity Medical Institution, Tan Tock Seng Hospital, and St. Luke ‘s Hospital for the Elderly, St. Andrew ‘s Community Hospital, St. Andrew ‘s Community Hospital, Singapore National Eye Center, Singapore Health Services, Singapore General Hospital, National University Hospital and the Gleneagles Singapore. The National University Hospital houses a specializer centre, which deals with orthopaedic instances and it is deemed to be the best orthopaedic clinic in the full South-East Asia ( 3 ) .

Public sector dominates third health care

By entire admittances, authorities infirmaries accounted for 76 % of the sum in 2008. The figure shows the split between private and public portion ( 4 ) .


Public infirmaries are much cheaper. If we compare the mean measure charges we see that the public infirmaries are 71 % cheaper for surgical fortes and 76 % cheaper for medical fortes ( 4 ) .


Bettering economic conditions and new tendencies such as insurance are doing it easier for citizens to afford private health care. At least 40 % Singaporeans can afford private health care. Singapore ‘s health care finance system is based on the 3Ms: Medisave, Medishield, and Medifund. Medisave is a mandatory medical nest eggs strategy, wherein working Singaporeans contribute 6.5-9 % of their wages into a savings history. The Medisave part is portion of the 20 % part that employees make from their income into their Cardinal Provident Fund ( CPF ) histories. Medisave financess can so be used to pay for medical intervention, with certain limitations. Medishield is a medical insurance strategy that is designed to be low-priced, but cover the fiscal hazards of major unwellnesss. The basic coverage is for public infirmaries, but 50 % of Singaporeans have supplemented the strategy with a “ private incorporate shield ” which besides covers private infirmaries. Last, Medifund is a medical gift fund which acts as a concluding safety cyberspace for Singaporeans who can non afford to pay for their health care costs ( 4 ) .

The authorities is besides willing to promote displacement. Although the bulk of Singaporeans choose public infirmaries for their world-class health care services and to a great extent subsidised monetary values, the costs have been increasing for the authorities. The authorities had indicated in the past its want to incorporate subsidies to 1 % of GDP ( as noted in a Healthcare Strategic Working Group paper ) . The current subsidies have already exceeded this and a limitation to 1 % is non executable, in our position. But as health care costs continue to turn, the authorities will necessitate to postpone some costs to private persons ( 4 ) .

Local Competition

Singapore infirmary experience

The tendency of increasing gross strength and demand of sophisticated services is an apparent factor in the public presentation of the Singapore infirmaries.

Parkway CAGR 6 %

From 2003 to 2009, Parkway ‘s mean gross per admittance ( uniting both in-patient admittances and twenty-four hours instances ) increased from SGD3,919 in 2003 to SGD5,660, a CAGR of 6 % . However, this growing has already been diluted by the group ‘s displacement towards twenty-four hours surgeries, which direction advises has lower grosss per instance. From 2003 to 2009, Parkway ‘s in-patient admittances really declined, while day-cases rose treble. Despite the dilutive consequence of daycases, Parkway ‘s mean gross per patient still grew, from which we can reason that mean gross per inpatient admittance must hold increased ( 4 ) .

Thomson CAGR 2 %

From 2003 to 2009, Thomson ‘s mean gross per admittance increased from SGD2,046 to SGD2,295, a CAGR of 2 % . Thomson ‘s growing in mean gross per admittance should be lower as Thomson focuses on supplying bringings, a more standardised and less complex service. But note that in the past three old ages, Thomson ‘s mean gross per admittance has grown at a CAGR of 6 % ; in our position, due to the group traveling up the value concatenation in footings of services ( 4 ) .

Raffles CAGR estimated 9 %

Raffles does non unwrap patient admittance Numberss, but we expect its mean gross per admittance to hold stronger growing. Based on direction counsel on historical operating bed Numberss, we estimate that admittances could hold grown at a CAGR of 13 % from 2003 to 2009. But, during this period, Raffles ‘ infirmary service grosss grew at a CAGR of 23 % . If we take Raffles ‘ infirmary services gross over our estimation of admittance Numberss, Raffles ‘ mean gross per admittance would hold grown from SGD5,208 to SGD8,751, a CAGR of 9 % . Raffles captures specializer fees Based on that estimation, Raffles ‘ mean gross per admittance of SGD8,751 in 2009 was 55 % higher than Parkway ‘s SGD5,660. The ground is that Raffles ‘ infirmary services gross includes specialist fees as Raffles employs its physicians. In contrast, Parkway and Thomson ‘s grosss are net of physician fees as their physicians operate independently. We believe Raffles ‘ ability to capture specializer fees is an of import driver of Raffles ‘ gross strength. Specialists are the first line of contact to patients ( they see a specializer before they are admitted to a infirmary ) and have considerable pricing power. As patients consult specializers for progressively sophisticated countries, specializer fees are likely to lift faster than infirmary fees ( 4 ) .

International Competition

When it comes to foreign patients the state faces competition from neighboring states such as Thailand and Malaysia. Although the costs in Malaysia and Thailand are reasonably less than Singapore this is non a menace because these states target different income sections ( 4 ) .


Opportunities and Scope

There are many factors that are altering non merely in Singapore but all over the universe. As Singapore forte infirmaries extract a immense per centum of their gross from foreign patients the tendencies in states such as USA and UK besides affect the gross of forte infirmary in Singapore. All over the universe ( particularly the developed states ) are seeing a addition in the per centum of old people in the population. This means that there are more people who need specialised intervention.

Healthcare as a whole and specialized intervention specifically is traveling through the procedure of consumerism. Peoples now make medical determination similar to other purchase determination. They follow a elaborate consumer determination doing procedure, where the procedure starts from demand acknowledgment and information hunt is an of import portion of it. Internet is playing an of import function in this information hunt. Any patient has entree to all the information on medical intervention worldwide. There are excessively many options to take from. The insurance has besides made important alterations in the mentality of people. Now, people can afford more expensive interventions than few old ages back.

Any selling attempt in the concern of forte infirmaries is to be go arounding around the patients. Unlike other industries medical intervention is really serious as it ‘s related to the wellness and good being straight. Besides, in the procedure of determination doing the feelings and sentiments of the relations become really of import. In such instance we need to convert non merely the patient but his/her household every bit good. This means that in our promotional activities we would wish to underscore on highest quality evaluations, internationally celebrated physicians and international criterions of research and development.

In our stigmatization attempts we will hold to implant the patients experience in it. Patient experience is the cardinal to make a particular topographic point in everybody ‘s head. Emphasis on a universe category experience would be a cardinal manner to bring forth involvement in a patients head. Convenience would besides be a manner to do patients believe positively of us.

Another of import thing to take attention of is the cleavage and aiming. We need to place the right client and invest in aiming them. To aim them we need to utilize the right communicating channels. The right communicating channel for local occupants is telecasting and print, whereas for international patients cyberspace could be used extensively.


The human resource and organisational direction plays a strategic function in the success of an organisation, particularly in today ‘s dynamic planetary environment. Organizations with strategic employment of their resources can easy outplay the rivals who put less accent on HRM patterns.

In a state as culturally diverse as Singapore, the challenge of pull offing workplace diverseness is huge. However it can besides be turned into an plus if managed decently, as it can enable organisations to respond to the concern chances in a originative and rapid manner.

With a little population of around 5 million, and the enormous growing over the last 2-3 decennaries based on high-end engineering and knowledge-based economic system, Singapore has been able to pull foreign endowment in great Numberss. This has made the local directors understand the demand for culture-based HRM preparations that would heighten their ability to actuate the extremely skilled, but diverse work force. Besides it is necessary to guarantee that foreign endowment is now looked upon as a menace to the calling chances by the local employees ( Toh, 1993 ) . For MNCs, it needfully requires believing globally and moving locally.

Cox ( 1993 ) has suggested the acceptance of a ‘culturally comparative position ‘ instead than an ethnocentric position to pull off workforce diverseness. The managerial model including planning, commanding and forming the resources, should be built around such a position.

In the context of service organisations like infirmaries, HRM patterns are of important importance. Several surveies have found internal organisation and employee perceptual experience to be of great possible to impact client satisfaction. Emprical surveies done on health care sector have provided findings that suggest HRM patterns are straight related to service quality ( Clark 1999, Weech-Maldonado, Dreachslin, Dansky, De Souza & A ; Gatto 2002 ) .

Working patterns in Singapore

The concern civilization of Singapore is a mix of Chinese, Malay and Indian imposts and traditions. It is by and large accepted that a thorough apprehension of the cultural background of your concern spouse or the host state where one is puting up their concern is really critical to the success of the concern. Some arrows in this way for Singapore are:

Punctuality is of import so attempt should be made to get on clip.

Normal concern hours are between 9 a.m. and 5 p.m. with one hr for tiffin, Monday to Friday.

Some offices will open for a half-day on Saturdays, typically in the forenoon.

Structure and hierarchy in Singapore companies

Singaporean concerns largely have a top down hierarchal construction where position becomes really of import. Decisions are about ever taken by the senior direction and subordinates avoid oppugning or knocking their higher-ups.

When come ining a room, senior members of a group are supposed to be introduced foremost.

Peoples tend to wait until told where to sit as this is determined by position.

Women play an built-in portion in the professional environment and keep managerial place.

Working relationships in Singapore

Peoples of Singapore frequently adhere to the Asiatic doctrine of making good resonance before making concern. Accordingly, many Singaporeans frequently consider personal relationships really of import.

Singaporeans are frequently really cautious and would wish to do certain they are making concern with the right individual before perpetrating to any important partnership. Therefore, it is of import to set up a relationship based on trust and common regard.

Business patterns

Each cultural group normally has a different manner of utilizing names so it is advisable to inquire a Singaporean what he/she would wish to be called. To be on the safer side, when run intoing a individual for the first clip, it might be prudent to utilize the appropriate rubric and last name until told otherwise.

A light handshaking is the common signifier of recognizing in concern state of affairss.

Normal concern garb consists of dark pants, long-sleeved shirts and ties for work forces, and blouses, skirts or pants for adult females. Due to the hot and humid conditions, jackets are non normally required. Although Singapore is a broad state, adult females should do certain they do non have on apparels that are excessively telling.

In concern meetings, Singaporeans tend to be unagitated and composed and do non openly show their emotions. Talking excessively aloud is hence considered rude.

Negotiations are frequently conducted at a slow gait and Singaporeans are likely to dicker difficult.

Business Etiquette ( Do ‘s and Don’ts )

Make guarantee that you carefully inspect the concern cards from your Singaporean opposite numbers before seting them off.

DO talk in a quiet and soft tone with your Singaporean opposite numbers.

DO be careful giving gifts, particularly to authorities employees, as this may be considered graft which is prohibited by rigorous Torahs in Singapore.

DO N’T take ‘yes ‘ from your Singaporean opposite numbers literally. Singaporeans will seldom reply a inquiry with a blunt ‘no ‘ . ‘Yes ‘ can intend possibly and even ‘no ‘ .

DO N’T do intense oculus contact with a senior or older individual as this will be seen as a mark of discourtesy.

DO N’T be impatient in concern dialogues as this will be seen as a failing by your Singaporean opposite numbers.

Listed below is a sum-up of the ordinance of employment in this economic system, specifically as it affects the hiring and redundancy of workers and the rigidness of working hours. The information has been collected from the Doing Business undertaking 2010, which measures and compares ordinances relevant to the life rhythm of a small- to moderate-sized domestic concern in 183 economic systems.

Trouble of engaging

Fixed-term contracts prohibited for lasting undertakings?


( * ) Maximum length of a individual fixed-term contract ( months )

No bound

Maximal length of fixed-term contracts, including reclamations ( months )

No bound

( * ) Minimum pay for a 19-year old worker or an learner ( US $ /month )


Ratio of lower limit pay to average value added per worker


Rigidity of hours

( * ) Standard working day in fabrication ( hours )


( * ) Minimum day-to-day remainder required by jurisprudence ( hours )


( * ) Maximum overtime bound in normal fortunes ( hours )


( * ) Maximum overtime bound in exceeding fortunes ( hours )

72 hours a month

( * ) Premium for overtime work ( % of hourly wage )


50-hour workweek allowed for 2 months a twelvemonth in instance of addition in production?


Maximal on the job yearss per hebdomad


( * ) Premium for dark work ( % of hourly wage )


( * ) Premium for work on hebdomadal remainder twenty-four hours ( % of hourly wage )


Major limitations on dark work in instance of uninterrupted operations?


Major limitations on hebdomadal vacation in instance of uninterrupted operations?


( * ) Paid one-year leave for a worker with 9 months of term of office ( in working yearss )


( * ) Paid one-year leave for a worker with 1 twelvemonth of term of office ( in working yearss )


( * ) Paid one-year leave for a worker with 5 old ages of term of office ( in working yearss )


( * ) Paid one-year leave for a worker with 10 old ages of term of office ( in working yearss )


Paid one-year leave for a worker with 20 old ages of term of office ( in working yearss )


( * ) Paid one-year leave ( mean for workers with 1, 5 and 10 old ages of term of office, in working yearss )


Trouble of redundancy

Dismissal due to redundancy allowed by jurisprudence?


Presentment of a 3rd party required if 1 worker is dismissed?


Approval of a 3rd party required if 1 worker is dismissed?


Presentment of a 3rd party required if 9 workers are dismissed?


Approval of a 3rd party required if 9 workers are dismissed?


Retraining or reassignment duty before redundancy?


Precedence regulations for redundancies?


Precedence regulations for reemployment?


Redundancy costs ( hebdomads of wage )

( * ) Notice period for redundancy dismissal ( for a worker with 9 months of term of office, in salary hebdomads )


( * ) Notice period for redundancy dismissal ( for a worker with 1 twelvemonth of term of office, in salary hebdomads )


( * ) Notice period for redundancy dismissal ( for a worker with 5 old ages of term of office, in salary hebdomads )


( * ) Notice period for redundancy dismissal ( for a worker with 10 old ages of term of office, in salary hebdomads )


Notice period for redundancy dismissal ( for a worker with 20 old ages of term of office, in salary hebdomads )


( * ) Notice period for redundancy dismissal ( mean for workers with 1, 5 and 10 old ages of term of office, in salary hebdomads )


( * ) Severance wage for redundancy dismissal ( for a worker with 9 months of term of office, in salary hebdomads )


( * ) Severance wage for redundancy dismissal ( for a worker with 1 twelvemonth of term of office, in salary hebdomads )


( * ) Severance wage for redundancy dismissal ( for a worker with 5 old ages of term of office, in salary hebdomads )


( * ) Severance wage for redundancy dismissal ( for a worker with 10 old ages of term of office, in salary hebdomads )


Rupture wage for redundancy dismissal ( for a worker with 20 old ages of term of office, in salary hebdomads )


( * ) Severance wage for redundancy dismissal ( mean for workers with 1, 5 and 10 old ages of term of office, in salary hebdomads )


Hofstede Cultural Dimensions


Value Chain

In order to understand the operations and service bringing theoretical accounts in the health care industry and so invent a value proposition for patients, it is critical to understand the value concatenation of the health care industry overall.


The health care industry has evolved to a extremely convoluted sector with suppliers such as infirmaries holding integrated both frontward and rearward. Besides outgrowth of IT/ITeS has led to new bringing theoretical accounts and greater inter-hospital interaction.


As a new entrant into the super-speciality infirmary section, the focal point for our infirmary should be developing ties with the Payers and Administrators which could be the insurance companies or 3rd party sellers and the Distributors, which will provide medical equipment and Drugs.


Based on our appraisal of the value concatenation, including our possible place within the concatenation, and understanding the infirmary industry the undermentioned cardinal stakeholders may be identified:


We need to measure the availabiilty and preparation demands of the staff every bit good as set uping long term dealingss with the providers, trade recognition policy, design internal procedures and regulative conformity norms for our new ace forte infirmary.

While proficient and administrative staff forms the most of import stakeholders from an organisations internal position, it is critical to prosecute with the regulators and the authorities to guarantee smooth operations.

Technical Staff

The Singapore Ministry of Health lists 8323 registered physicians as of 2009, which translates to about 1.7 physicians per thousand population. The Doctor to population ratio in Sinagapore is one of the best in the part. Singapore has 16 JCI accredited infirmaries and several universe category universities and medical colleges which attract the best heads in the field of medical specialty to its shores.


Figure: Doctors and Nurses Density/Thousand of Population, Source: MOH, Singapore

Besides there are 26,792 nurses and accoucheuses in Singapore which comes to about 5.4 per 1000 of population. This is lower than the nurse denseness in many other ASEAN states. This implies that while there are a good figure of qualified physicians and sawboness, there is some deficit in the nursing and caring section.




No. of Medical alumnuss




No. of Nursing alumnuss





As can be seen from the above tabular array, the figure of alumnuss in both Medicine and Nursing has been reasonably dead over the last three old ages. Therefore, there might be a demand for qualified professionals from other states who can come and work in Singapore. The Ministry of Health has passes a authorization in October 2006 saying that all foreign allied wellness professionals ( AHP ) are to beA employed on the S-Pass or Employment Pass ( EP ) onlyA as skilled foreign work force. As of 2007, about 30 % of entire physicians in Singapore were International Graduates.

A instead upseting tendency in the wellness attention professionals is the low degree of occupation satisfaction which is doing high abrasion rates the universe over. In order to advance employee friendly image any new constitution must hold clearly laid out HR policies and competitory compensation strategies.

To get the better of the above job Singapore authorities has committed S $ 400mn for development of preparation installations and enlisting of foreign medical professionals in the 2010 budget. Traveling frontward this will guarantee equal staffing and a larger pool of better skilled professionals. While this is traveling to chiefly profit the populace sector infirmaries in the short term, the investing in developing substructure is traveling to hold spillover effects even for the private sector.



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