Capacity and Patient Loads at Restructured Hospitals

Mr Seah Kian Peng asked the Minister for Health (a) what is the amount of profit that the restructured hospitals made last year from private patients; (b) whether there is excess capacity in these hospitals and, if so, how much; and (c) how many subsidised patients does a senior consultant see in a month and what proportion is this out of his total patient load.

The Minister for Health (Mr Gan Kim Yong): Mr Speaker, in 2010, there were 4 million outpatient attendances at our public hospitals, of which 2.7 million, or about 67% or two-thirds, were subsidised. During the same period, there were 345,000 inpatient discharges, of which 250,000 were from subsidised Class B2/C wards; and if we include B1 wards, which also received some subsidy, this accounted for close to 85% of the total inpatient workload. Government subvention to the public hospitals for their subsidised patient services alone amounted to $2.2 billion. Generally, services that are not subsidised, such as Class A ward admissions or private day surgery, are charged on a cost-recovery basis. The public hospitals generated an aggregated surplus of about $11 million, or around 1% of the revenue, from such services in 2010.

At our public hospitals, every admitted patient is assigned a specialist who will lead the delivery of care, usually through a team-based system comprising other doctors, nurses and allied healthcare professionals. We do not monitor the workload of individual senior consultants by their subsidised and total workload.

Mr Seah also asked about the capacity in the public hospitals. Most of our public hospitals are running at about 85% capacity on average. At this level the capacity is tight and we are taking steps to address this. For example, in terms of manpower, we increased the number of specialists last year by about 8%, from 1,850 to about 2,000. We are also expanding our healthcare infrastructure. Public sector acute hospital beds increased by over 600 beds, or about 10%, over the period 2000 to 2010, with the completion of Khoo Teck Puat Hospital last year.

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But bed numbers are just one measure of healthcare capacity. As our hospitals develop evidence-based care pathways to better manage patients, they are also able to reduce the average length of stay whilst at the same time improving the quality of care. These measures effectively expand the capacity of hospital beds, allowing us to admit more patients with the same number of beds.

Our public hospitals also streamlined their processes and as a result, they were able to maintain the median waiting time for admission from the Emergency Department of about 1.4 hours in 2009 and 2010, despite a 4.5% increase in admissions. They have also maintained the median waiting time for new Specialist Outpatient Clinic appointments for subsidised patients at around 28 days in 2009 and 2010, even though attendances rose by 3.5% from 2009 to 2010. For subsidised patients requiring urgent appointments, such as suspected cancer, the current median waiting time is within two weeks. But I think we can improve further.

We will continue to expand our infrastructure and manpower to meet our healthcare needs. The Ng Teng Fong General Hospital will add 700 beds in 2014. Planning for the Sengkang General Hospital has begun. Other than acute hospitals, we are also ramping up other facilities such as community hospitals and nursing homes; and we will strengthen our primary care capabilities, including the setting up of medical centres in the community to address the demand for specialist services. This is an area that Mr Seah raised in the next question. I hope I will have time to speak on this in greater detail then. I would like to reassure Mr Seah that we will continue to review our capacity to meet our present and future healthcare needs.

Mr Speaker: Mr Seah, keep it short.

Mr Seah Kian Peng: I thank the Minister for his answers. Two supplementary questions, specifically, what is the capacity and what is the occupancy in Class C wards if he has that information. I am also concerned whether there are any patients, Singapore patients, who have been asked to choose a higher class ward because there are insufficient beds in Class C and, if so, how many were affected? On remuneration, I would like to ask the Minister whether there are any incentives for doctors to see Class C patients over private ones. If there are none, can I suggest that the Ministry think of how it can lower the differential between public and private patients from the doctor's salary point of view?

Mr Gan Kim Yong: Mr Speaker, Sir, I do not have the specific occupancy rates for Class C wards but I would assume that in most of our hospitals' Class C wards, the occupancy rate is very high. For some patients, when they are admitted, the Class C wards may not be available and we would ask the patients whether they would want to opt for higher class wards like B2 or B1 wards. But if the patients are unable to afford the higher wards and if medical conditions required it, we will ward them in a higher ward and on a case-to-case basis, we will allow what we called an upgrade, an "up-warding" to allow them to be admitted so that patients will not be denied admission just because the lower class wards are full while higher class wards are available. We do what we can to accommodate them on medical grounds.

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With regard to the incentive for doctors: I think doctors have to be governed and guided by medical conditions rather than monetary incentives, whether we skew them towards Class C patients or private patients. I think it is better for doctors to assess the needs of the patients and they generally look at all patients in a team-based approach so that patients are given the appropriate treatment. At the same time, we are also looking at reviewing the remuneration system for our doctors to ensure that we encourage them to deliver appropriate care for our patients.