An ageing population and increasing clinical complexity are both propelling the rise in expenditure and utilization of healthcare in Singapore, a study has found.
Furthermore, advances in medical care have resulted in prolonged life expectancy and wider treatment options, but such developments have also led to higher long-term maintenance costs, especially among older adults.
“Addressing these challenges will require a sustained shift towards preventive, community-based, and value-driven models of care to ensure long-term system sustainability,” the researchers said.
Patient-level data from 2019 to 2024 across inpatient, outpatient specialist, and primary care settings were used in this retrospective observational study. The Modified British Columbia (ModBC) Population Segmentation Framework was applied to classify patients, while a locally adapted version of the Clinical Classifications Software Refined (CCSR) was employed to sort inpatient diagnoses.
Finally, the researchers reported healthcare costs in inflation-adjusted 2024 Singapore dollars (SGD) and performed both descriptive statistics and temporal trend analyses.
Healthcare spending
The patient population in Singapore was 1.21 million in 2019, and this rose to 1.37 million in 2024. Total healthcare expenditure also increased from SGD 4.37 billion to SGD 6.05 billion. Inpatient care remained the primary driver of cost, accounting for 63.8 percent of total expenditure in 2024, with a stable relative share over time. [Ann Acad Med Singap 2026;55:305-317]
Notably, the elderly population saw a disproportionate increase in healthcare expenditure, with the steepest per-user growth seen among those aged 80 years and above, “consistent with age-related acceleration in healthcare spending,” according to the researchers.
Absolute utilization also increased among older adults aged ≥60 years, but utilization rates remained stable within age groups, indicating the association of growth with changes in population composition instead of utilization intensity.
Nearly half of the total expenditure (46.7 percent) was driven by patients in the ModBC high-complex chronic conditions and cancer segments. Furthermore, diagnosis-level analyses using CCSR noted age-related differences in utilization patterns within these segments.
Ageing society
Singapore is one of the world’s fastest ageing societies, with a projection to become a super-aged society by 2030. [https://link.springer.com/10.1007/978-981-99-0872-1_1]
The proportion of Singapore residents aged ≥60 rose nationally from 21.4 percent in 2019 to 25.1 percent in 2024. The healthcare cohort in this study rose more rapidly from 29.4 percent to 34.2 percent. [https://www.singstat.gov.sg/publication-resources/population-trends-2025]
In SingHealth, the country’s largest public healthcare cluster, healthcare expenditure for the elderly population increased from SGD 2.24 billion (51.2 percent of total expenditure) to SGD 3.45 billion (57.0 percent) over the same period, according to the researchers.
“Our findings show that population ageing is amplified within healthcare cohorts, with a disproportionate concentration of utilization and expenditure among older adults,” they said. “Patients aged ≥60 years had higher total and per-user expenditures and experienced faster expenditure growth over time.”
This finding supports the steepening hypothesis, which suggests that age-specific healthcare spending grows much faster among older patients over time, as seen in other developed settings. [Geneva Papers on Risk and Insurance: Issues and Practice 2006;31:581-599; J Econ Ageing 2024;29]
“Taken together, our findings are consistent with a pathway in which population ageing and secular advances in medical care increase the number of clinically complex patients, alongside higher healthcare utilization and expenditure,” the researchers said.
“[P]opulation ageing is a distal, non-modifiable driver of demand, whereas clinical complexity is a more proximal, potentially actionable factor,” they added.