The price of pregnancy and choosing a hospital in Singapore

Singapore is a very expensive country to have a baby. Especially if you are a foreigner without international insurance. At the time of writing this, I am 38 weeks pregnant. Here is my experience of the healthcare system in Singapore, a breakdown of prenatal costs, and a summary of insurance options. Ultimately, I have chosen to deliver at NUH due to the great service and some financial considerations.

Great news – you’re pregnant!

Falling pregnant is exciting! In my last blog, I shared how being pregnant this year has been a breeze.

In Singapore, we have world-class medical facilities for expectant mothers but they aren’t cheap. Call it a tradeoff to living under a low-tax regime. It could also be why Singapore has nearly the lowest birth rate in Asia. According to World Bank data, in 2018 Singapore had a fertility rate of 1.1 compared to 1.4 for Japan, 1.7 for Australia, China and New Zealand, and 2.0 for Malaysia.

There are incentives for citizens such as tax breaks, discounts on infant care, and baby bonuses to offset high delivery and prenatal costs. Unfortunately for us foreign residents, we are not eligible for any financial support.

Prenatal Costs

When you are pregnant you need to see the doctor a lot. All those prenatal visits in addition to various tests and scans can really add up. Assuming you have a healthy 40 week pregnancy these are the prenatal costs you can expect:

  • 12 doctors consultations (once per month from 8 weeks gestation increasing to once per fortnight from 32 weeks and once per week from 38 weeks)
  • First trimester blood screening at 6 to 10 weeks
  • NIPT test at 10 to 14 weeks (optional)
  • Anatomy scan at 20 weeks
  • Glucose test between 24 and 28 weeks
  • Growth scan at 30 weeks
  • Whooping cough vaccine at 29 to 32 weeks (optional)
  • Streptococcus Group B screening at 34 weeks

And this is just for a normal pregnancy! If you have a high-risk pregnancy, history of miscarriages, or pregnancy-related health issues such as preeclampsia, carpal tunnel, or gestational diabetes, there could be additional consultations and tests as well.

At 38 weeks, I have spent a staggering $3,639.27 already! I have incurred further costs because of investigations on how my previous back injury might impact delivery. But more on costs as we go on. You can also skip ahead to see the cost comparison table.

Private versus Public Hospitals in Singapore

If you have an existing gynaecologist then where you deliver your baby will be influenced by which hospitals they are affiliated with. If you don’t have a preferred gynaecologist then I recommend you choose the hospital first as I did.

There is a world of difference between private and public hospitals in Singapore. A private hospital offers more personalised care but the costs are 2-3 times higher. A public hospital is subsidised by the government. The service is more routine but the level of medical expertise remains high.

I started my pregnancy by going to Raffles Hospital. I then changed to KK Women’s & Children’s Hospital, before making a final switch to National University Hospital (NUH).

Raffles Hospital

Raffles Hospital was my first choice as it was a panel clinic under my old insurer. Service was top-notch and I was provided with direct contact details for my doctor as well as the reception staff. Booking appointments was easy and based on my own availability.

Nonetheless, waiting times were not great. On average I waited 40-minutes to see my doctor for a scheduled appointment. There was then a further 15-minute wait after the consultation to settle the bill and schedule a follow-up appointment.

prenatal costs

One thing I did not like about my experience at Raffles was the lack of privacy. The Fertility Clinic at Raffles Hospital, where all maternity-related consultations are held, is small. Yet the reception staff speak loudly about your condition and reiterate any advice given by the doctor in front of other waiting patients. This made me uncomfortable.

RAFFLES HOSPITAL COSTS

For each prenatal visit at Raffles Hospital I was charged for the following:

  • Consultation: $150.00 (+7% GST)
  • Practice Costs: $16.00 (+7% GST)
  • Ultrasound: $126.00 (+7% GST)

The first trimester blood screening at Raffles set me back $176.00 (+7% GST).

At 14 weeks of pregnancy, I was given financial counselling. This is when they provide you with a breakdown of expected delivery costs. I was quoted $9,309.00 (incl. GST) for regular delivery with 2 nights hospital stay and $12,711.60 (incl. GST) for a c-section with 3 nights hospital stay.

My doctor and the nurses I interacted with at Raffles were highly experienced as well as friendly. Each visit they remembered who I was and I received their undivided attention. Had it not been for the high prenatal costs I would have continued my pregnancy journey with Raffles Hospital.

KK Women’s & Children’s Hospital

After leaving Raffles Hospitals I sought a cheaper option without compromising on medical care. I selected KKH because they deliver more babies per day (around 30-35) than any other hospital in Singapore. They are also close to my home.

prenatal costs

KKH is what’s known as a restructured hospital in Singapore. They operate as a private company but are wholly owned by the government. Foreigners pay a 20% premium for appointments and procedures.

My experience at KKH was underwhelming. While I did not expect the same level of service as at Raffles Hospital, I really felt like I was just a number here. Average waiting times for a scheduled visit were 90-minutes yet my actual consultation with the doctor rarely lasted more than 5-minutes. Before each appointment, there was also a 10-minute queue to submit a urine sample as well as record my weight and blood pressure.

There was almost no flexibility around scheduling of appointments. I was simply told when my next visit would be. It was near impossible to speak to someone by phone on occasions when I needed to reschedule.

KKH COSTS

At KKH, I paid each visit:

  • Doctor Professional Fees: $110.00 ($148.00 for first-time visit) (+7% GST)
  • Obstetric routine check: $14.00 (+7% GST)

My 20 week anatomy scan at KKH cost $138.00 (+7% GST). I was never offered the option of a prenatal package despite asking many times. Packages are a more economical way to manage costs as you pay for a bundle of doctors visits at a discounted price rather than paying per visit. They sent me my financial counselling via email after I asked many, many times. They quoted $7,076.00 (incl. GST) for regular delivery with 2 nights hospital stay and $11,455.00 (incl. GST) for a c-section with 3 nights hospital stay.

As a foreigner, I am considered a private patient at KKH which is why I am charged a 20% premium. Usually, they refer to me as a “non-resident” which was upsetting since I have lived in Singapore for several years. Well, the customer service I received at KKH was non-existent. I didn’t feel confident I was receiving tailored advice or care. After considering this, along with the older facilities at KKH, I decided to change hospitals again.

National University Hospital (NUH)

They say third time’s a charm and it certainly was for me in my search to find a good hospital. NUH is a public hospital. They are distinguished for their focus on natural childbirth (where possible) and encouraging women to breastfeed. NUH offer videos and educational classes to support these aims. As an aside: a c-section is significantly more expensive than natural childbirth in Singapore and for this reason, some other hospitals may encourage women who want to have a c-section when there are no medical grounds for it to earn more fees.

NUH is where all the doctors in Singapore are trained and so the standard of medical expertise here is high. But, what I like most about NUH, is that the Women’s Clinic is separate from the main hospital. The clinic is smallish, which gives it a more personal feel, and the facilities are clean and modern. They also offer complementary Milo and biscuits while you wait for the doctor.

prenatal costs

Waiting times can vary. Once I waited 120-minutes when I went for my 30 week growth scan. Queues really depend on the day and time. I generally try to secure an early morning appointment to see the doctor for which the average waiting time is 20-minutes. If you happen to be there on a day when the queues are terrible, it is fine to leave the clinic and go to the cafe downstairs as you will receive a text message when it is almost your turn.

prenatal costs

You can record blood pressure, weight and submit a urine sample through self-service during each visit. After your appointment, you either pay at the reception (which will mean a 10-minute wait). Otherwise, you can arrange to have the charges automatically deducted from your credit card and the invoice posted to you. This is a huge convenience and time-saver!

On my first visit to NUH I was given the choice of seeing a senior or regular doctor. The choice will impact ongoing prenatal costs. I chose a senior specialist. I won’t lie, my doctor is a very busy man. The service does not feel as personal as when I was at Raffles Hospital. However, it is still a lot more friendly compared to KKH.

Unfortunately, there was no financial advantage for me to take a prenatal package by the time I changed to NUH at around 28 weeks gestation. However, the reception staff still gave me the option.

NUH COSTS

Per visit at NUH, I normally pay:

  • Doctor Professional Fees: $108.07 ($144.45 for first-time visit) (incl. GST)
  • Obstetric routine check: $8.78 (incl. GST)

As a foreigner I probably pay more in prenatal costs than a local. But I have never been made to feel like a foreigner during any of my visits here. They do not insist on terming me as a “non-resident” such as at KKH, which is alienating. I paid an additional $256.80 (incl. GST) for prenatal classes at NUH, which I will talk about in a subsequent post.

I was given financial counselling after my first NUH visit. I was quoted $4,993.00 for regular delivery with 1 night hospital stay, and up to $6,423.00 in case of complications. That is an average of $5708.00. I was not given a quotation for a c-section as my doctor does not anticipate I will need it.

Pregnancy price comparison

Here is a price comparison based on my experience in 2020. The figures are inclusive of GST.

The delivery charges quoted are for natural delivery and a private hospital room. They only include hospital stay and doctor’s fee. You will be charged additionally for epidural as well as any costs incurred by your baby’s stay including items they consume (i.e. diapers, formula).

At the end of the day, the health and well-being of yourself and your baby are what matters most. So go with the hospital and doctor that you feel most comfortable with rather than basing your decision on prenatal costs and delivery charges. Another thing to consider when choosing a hospital is what happens if something goes wrong. Do they have sufficient facilities and medical expertise to cope with the situation? Insurance does not always cover premature birth or congenital illnesses. NICU costs are roughly $2,000-2,500 per day at both public and private hospitals. However, the cost of specialist care and surgery can skyrocket if you are at a private hospital.

Maternity Insurances

Insurance is not cheap, or easy, in Singapore and is not necessarily the solution to all your pregnancy financial woes. In actual fact, if you have a standard pregnancy where nothing goes wrong, it is cheaper not to pay for insurance and go to a public hospital. However, in the event something goes wrong, insurance could be a life-saver.

Standard medical insurance in Singapore will not cover pregnancy. Maternity cover is an optional add-on to an existing insurance scheme that both you and your partner will need to have. You must opt-in for the maternity cover around 1 year before falling pregnant in order to qualify.

Such insurance will cover prenatal costs (including appointments, scans and tests), delivery charges, emergency c-section and some delivery complications up to a cap. The cost depends on the insurer and your age. A middle-aged woman can expect to pay $11,000-$15,000 per year. These policies are mostly catered to ex-pats and will have international coverage excluding the USA. Given you would need to have the insurance for a year first and then throughout your gestation you’re looking at an insurance bill of around $22,0000. Of course, the insurance will cover much more than just maternity so it may be worth it.

Choosing the right insurance is a minefield. AXA, Allianz, Aetna and Cigna all have reasonable policies. I recommend seeking a free consultation from Pacific Prime if this is of interest.

There is also another type of maternity insurance you can opt for between 13 and 36 weeks of pregnancy. It covers for delivery complications including emergency c-section and congenital illnesses for the newborn baby. Premiums are around $300 to $500 a month. The payout for congenital illness tends to be capped at $3,000 to $5,000, which is very low in my opinion.

Many of these latter maternity insurances are also tied to other financial products such as life insurance or income protection, for which there would be a minimum commitment period of several years. Furthermore, the volume of paperwork both you and your doctor need to complete is extensive. If you are deemed to have a high-risk pregnancy (which includes expecting twins), or you have other pre-existing health conditions, you are unlikely to qualify.

For more information on these type of insurances, you can visit this 2020 guide by Best in Singapore or this personal blog by Dr Wealth.

Whether or not to invest in insurance is a personal decision. Like I said earlier, it is a safety net should something go wrong. It is not unheard of for huge medical bills to spiral a family into poverty in Singapore. Also remember, you can give yourself, and your baby, the best chance of a healthy birth by eating well and staying fit throughout your pregnancy.

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