Challenges of Healthcare in Singapore

“We are delighted with the collaboration with UPMC, as are our patients, community, and shareholders. The relationship has exceeded our expectations.”

– Dr. Tan Kai Chah, executive chairman of AAMG

Meeting the Challenges of Healthcare Reform in Singapore: Asian American Medical Group Partners with UPMC to Deliver Advanced Clinical Services to Patients throughout the Region.

A 1984 plan that allowed Singapore’s hospitals more autonomy and offered patients greater choice resulted in a shift toward hospital privatisation. As a result, hospitals faced new challenges in responding to the increased demands from patients for an improved quality of care. To help meet this challenge, Asian American Medical Group (AAMG), engaged UPMC in a strategic collaboration to add further value to the Group’s strong clinical offerings in the region.

This collaboration has enhanced AAMG’s clinical capabilities through shared protocols, rigorous quality standards, and technology, while also creating a platform for AAMG to expand into other countries in Asia such as Malaysia, Myanmar, Russia and China.


The healthcare system in Singapore is often heralded as one the world’s best. Bloomberg ranked it as number one in Most Efficient Healthcare 2014: Countries. Towers Watson, a global consulting firm, called it “one of the most successful healthcare systems in the world in terms of efficiency in financing and the results achieved in community health outcomes.” For decades, Singapore has served as a high-quality medical hub for all of Southeast Asia.

Singapore’s success has been attributed in large part to a national health plan introduced by the country’s Ministry of Health in 1984. Before implementation of the plan, medical care in the country was provided mainly by the public sector but suffering from rapid increases in public healthcare costs. Government officials also recognised growing problems in hospital efficiency. As a result, the Singapore government decided to restructure its healthcare delivery system, allowing hospitals more autonomy and privatising insurance. By giving individuals greater control and increasing personalised services for patients, both the quality of care the efficiency of Singapore’s healthcare system were significantly improve.

However, with increased demands form patients, hospitals were challenged by competition for talent and labour; ever increasing complexity and costs associated with advancing technology, equipment, treatment, and training; and new requirements to establish independent standards of care and reliable processes to measure outcomes. In addition, neighbouring countries – once dependent on Singapore to serve large percentages of their patient populations – began building comprehensive hospital systems of their own.

To meet these challenges head-on, AAMG reached out to best-in-class institutions around the world, including UPMC, to collaborate.

“UPMC was honoured to be asked to partner with AAMG,whose innovative transplantation work and stellar reputation in Asia made it an attractive match,” said Charles Bogosta, president of UPMC International.


Formerly the Asian Centre for Liver Diseases and Transplantation (ACLDT), AAMG’s operation include the Asian American Liver Centre (AALC), one of Asia’s foremost liver transplant centres and the Asian American Radiation Oncology (AARO), the first independent radiation oncology clinic in Singapore.

Established in 1994 and located in Gleneagles Hospital, Singapore, the Group attracts about 8,000 patients annually, ninety percent of which are international patients originating from Asia, the Middle East and Russia. AAMG is led by renowned hepatobiliary expert and liver transplant surgeon Tan Kai Chah (K.C. Tan), MD, who has performed some of the world’s most noteworthy and pioneering work in the field.

With a focus on delivering exceptional patient outcomes, Dr. Tan and his team of highly-trained specialists provide comprehensive care to patients with liver, pancreas and bile duct diseases. The team has performed more than 200 living donor liver transplants – the first team in Southeast Asia to do so.

“An incredible mutual respect and trust developed between the teams. We were able to have meaningful conversations about clinical outcomes, potential changes to practice approach, and shared best practices.”

– Cheryl Brill, vice president of International clinical operations and quality of UPMC



Almost immediately, the collaboration between AAMG and UPMC began achieving important milestones toward delivering world-class medical care throughout Southeast Asia.

The partnership produced a second-opinion pathology program that allowed the medical team in Singapore to share images, including information for complex cases, with UPMC physicians in Pittsburgh, Pennsylvania, United States, and Palermo, Italy.

“This improved outcomes and reduced complications, including helping patients avoid long stays in our ICUs, said Kang Hoe Lee, MD, respiratory physician and intensivist of AAMG.

Most recently, AAMG established the first independent radiation oncology clinic in Singapore, AARO. The clinic delivers specialised radiation therapy treatments as well as management and advisory services to partner radiotherapy and oncology units in the region.

UPMC and AARO collaborate to advise and train regional partners in advanced treatment techniques such as Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS/SBRT), enabling them to offer a suite of multi-disciplinary and comprehensive cancer services.

“An incredible mutual respect and trust developed between the teams,” explained Cheryl Brill, vice president of international clinical operations and quality of UPMC. “We were able to have meaningful conversations about clinical outcomes, potential changes to practice approach, and shared best practices, which enabled us to easily adapt to changing market conditions and demands for the best quality care possible.”



Continuous learning and sharing of best practices is core to UPMC’s mission, and its work in Singapore was no exception. From the start of the collaboration, learning was taking place on both sides of the world.

“In terms of training, we were lacking doctors experienced in certain sophisticated treatments like oncology and robotic surgery; and nursing training, administration, and management,” Dr. Tan said. “These were areas in which UPMC was very helpful. UPMC brought an excellent standard to all aspects of our work.”

Additionally, the collaboration resulted in numerous business relationships and opportunities in Asia and Russia.

“I think we complemented each other very well,” said Dr. Tan. “As a result of the relationship between AARO and UPMC, we were able to enhance the treatment offered by a cancer centre in Pinlon Hospital, Yangon, Myanmar. Together, we also helped to establish a network of diagnostic centres in Russia. UPMC also enabled us to contract with best-in-class medical equipment suppliers, as well as third-party payers.”

“On the other side of our relationship, UPMC wanted to further expand research and clinical development into Asia.” Dr.Tan added. “We offered our experience and relationships to UPMC as it continued to establish itself here.”

2015 Symposium
The AAMG/UPMC collaboration includes the joint organisation of an annual symposium that aims to bring together clinicians from healthcare institutions in Asia, the U.S., Europe and Canada to identify trends, patterns, and best practices to optimise patient care. In 2015, over 100 healthcare practitioners came together in Singapore to discuss minimally invasive hepatopancreatobiliary (HPB) surgery and precision radiotherapy.



Since entering into the collaboration, AAMG’s partnership with UPMC remains strong. While the end-goal of enhancing the Group’s services and expanding its transplantation capabilities has remained constant, the teams have been able to adjust priorities to respond to the continually-evolving healthcare market in Asia.

“We are delighted with the collaboration with UPMC, as are our patients, community, and shareholders. The relationship has exceeded our expectations,” Dr. Tan emphasised. “UPMC brought the reputation, technology, equipment, clinical prowess, and management leadership needed to help us elevate AAMG and distinguish ourselves in the markets we operate.”

“We were pleased to have the opportunity to help AAMG expand its transplantation capabilities and deliver world-class healthcare truly focused on patients,” Mr. Bogosta said. “We look forward to continuing to work together to provide comprehensive care for patients where they live.”

“Going forward, there is much more we plan to do,” Dr. Tan said. “We have no doubt that, as our partnership continues to grow deeper, we will realise the vision of a comprehensive transplant centre and have more and more measurable outcomes in Asia to talk about.”

“UPMC brought the reputation, technology, equipment, clinical prowess, and management leadership needed to help us elevate AAMG and distinguish ourselves in the markets we operate.”

– Dr. Tan Kai Chah, executive chairman of AAMG


UPMC, an academic medical centre affiliated with the University of Pittsburgh, is a recognised leader in providing healthcare services in the United States and internationally.

UPMC International offers a full range of healthcare consulting and management services focused on advancing care in communities and regions across the globe. Working in-country with its partners, UPMC’s multidisciplinary team helps in assessing what is needed to achieve clinical or operational success to ultimately build a high-quality health system. Utilising knowledge and best practices that are grounded in years of experience, UPMC provides expertise in areas such as facility and construction planning, education and training for all levels of clinical staff, clinical program design and customisation, and health information technology infrastructure development.

By working with UPMC to identify and implement customised solutions, countries can reshape their local economies and give patients access to the best-possible healthcare, close to home.

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