Assoc Prof Jamus Jerome Lim (Sengkang): In my speech on the Motion on supporting healthcare in May last year, I spoke about how hospital bed and medical personnel capacity in our fair nation falls short of what may be expected, not just compared to almost every other advanced economy, but also to our own internal benchmarks. This has led to us failing to meet health service quality targets set by MOH. Things have improved somewhat since then, but capacity still remains constrained. Medium wait times at the end of January can still exceed half a day in Changi General and Khoo Teck Puat, while the bed occupancy rate for all but one of the public hospitals hovers above the Ministry’s own preferred 80% ceiling.
There is a dire need to relieve not only our capacity shortfalls in the short run, but also any projected long-run need. Indeed, the planned expansion of Alexandra Hospital and the Woodlands Health Campus is likely to only fix current shortfalls, but remain insufficient as our population grows and ages.
What this comes down to is a willingness to sacrifice short-run efficiency by accepting a certain amount of redundancy in the interim, at least until the needs inevitably arise. My sense is that this will only occur when our current occupancy rate for hospitals remains substantially below 80%, at least for a certain duration. To achieve this, I believe that the current system can stand to expand its transition care offerings. I will suggest three ideas.
First, we can ramp up our urgent care offerings as an intermediate option, complementing existing GP polyclinics versus A&E solutions. While still uncommon, there are already several urgent care centres (UCCs) in Singapore, including the reclassification of Alexandra Hospital’s A&E department into a UCC, along with several private providers. Singaporeans should be educated about using this channel for non-life-threatening medical emergencies, especially with regard to the substantially shorter wait times compared to A&E. It can also relieve the pressure on polyclinics to triage such cases for which they are not designed for.
Second, we can improve the incentives for transition care at home, perhaps with cash incentives paid directly to patients using savings that would otherwise go toward hospitalisation expenses. The Government can directly encourage this by providing rebates to insurance companies for encouraging select cases to pursue this route.
Third, while I support the decision to expand the non-profit model, whether the experiment will ultimately prove viable, will also hinge crucially on whether the associated tax exemptions are accompanied by increased or decreased flexibility of operations. Otherwise, if the approach is simply one of delivering more subsidies that exchange for greater health price regulation, economy plus healthcare, the true advantage of the non-profit model may be lost. At the same time, I encourage MOH to also look at public health bills.
The Minister for Health (Mr Ong Ye Kung): Assoc Prof Jamus Lim suggested using more Urgent Care Centres (UCCs). UCCs have been useful and effective. We have also been using the General Practitioner First (GPFirst) scheme, especially around Changi area, and that is also useful, and we will continue to deploy all possible methods to alleviate patient loads at the EDs.
To tackle the challenge more fundamentally, we need to expand capacity and catch up with the time lost, due to the COVID-19 pandemic.
We opened about 640 new acute and community hospital beds since June last year. They make up the over 11,000 public hospital beds that we have today. That is the stock we have – 11,000. We intend to add another 4,000 beds by 2030. And we should see new capacity coming on stream every year, from now to 2030.
In response to Assoc Prof Jamus Lim’s suggestion, I do not think we therefore need to give an incentive for transition to home care now. It will be better to develop MIC@Home into a well-accepted mainstream mode for acute inpatient care. We will also further expand the capacity of MIC@Home, as a first step, from 100 in 2023, to 300 in 2024, with the potential to scale up further.
The Chairman: Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim (Sengkang): I would just like to pick up on the point the Minister shared about the 40% of ED cases being non-critical. Of course, to be fair, I recognise that such behaviour is not unique to Singapore. In the US, ERs are often also flooded by overuse, albeit with different reasons that have to do with the uninsured. My suggestion for expanding UCCs is, therefore, I think, both complementary but distinct to the question of capacity in general.
My first question then is, if MOH agrees that UCCs can indeed be a complementary part of the secondary-care landscape, how do we increase their take-up? What sort of incentives or educational efforts can MOH provide to non-urgent cases to choose to access UCCs instead of our EDs?
My second question relates to his point about the doctor-to-population ratio. He shared that Japan has a comparable ratio in the face of a large elderly population. But I would venture that European countries, which he mentioned, are in fact better-prepared in terms of medical staffing for their super-aged societies. On that, I wonder if MOH will consider increasing the number of medical schools that it recognises from foreign countries. After all, as he said, the competition for talent is global and, so it seems unnecessary for us to further hamstring our efforts to recruit from abroad.
Mr Ong Ye Kung: I do not think we should describe as, whether MOH agrees that UCCs are useful. We came up with UCCs. In fact, the first one that started was in Sembawang group representation constituency (GRC) and it greatly – over the years – greatly helped Khoo Teck Puat Hospital’s ED, helped them manage their ED load and it has proven to be useful. And as I mentioned, if need be, if we need to set up more UCCs – this is a proven model – we will consider doing so.
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But there are competing models. GPFirst in the east has also worked quite well. So, between the two, either or, I think we should consider them.
As for doctor-to-population ratio, I explained to some extent in my speech, the European doctor-to-population ratio is somehow just higher than the rest of the world. Even in Asia, comparing developed economies, we are more or less about the same level. I do not know what is the reason, some say it is the legacy of the welfare state, others say they did not plan for manpower. But when you look at individual European countries, it is not that pretty a picture.
The Dutch, for example, they have stopped using nursing homes because there are not enough medical personnel nor doctors to man them. So today, if you are an old person in Holland, in Netherlands, the default care model is actually home care with a lay person, maybe a nurse, maybe an allied professional visiting you twice or three times a day. That is what they have resorted to.
Germany, the doctors there told me they are in dire straits. Across the states, the hospitals are not efficiently configured and that is what they told me and therefore they are also, despite having more doctors, not delivering the healthcare that the people need.
So, as I mentioned, it is just one number. It is not a numbers game. Where they are trained and what kind of specialty, how the entire system is run, whether the insurance system of that country or the welfare system is creating oversupply, all these play a part. So we take all these into consideration as we manage our healthcare challenge.
As to our own doctor-to-population ratio, it has been increasing. Ten years ago, it was about 2.0, today it is 2.6. So moving forward, there is some room for three local medical schools to take in slightly more perhaps. There is possibility of having more overseas-trained Singaporean doctors returning, all these we have to consider. Our ratio has been increasing, we are ageing, most likely we will increase further. But I would just caution the European model may not be the model that we want to emulate fully.
Ministry of Health
5 March 2024 & 6 March 2024
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=budget-2378
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=budget-2389
Office of the Leader of the Opposition 