RESTRUCTURED HOSPITALS' PURSUIT OF FOREIGN PATIENTS

RESTRUCTURED HOSPITALS' PURSUIT OF FOREIGN PATIENTS: 12.

Mr Seah Kian Peng asked the Minister for Health (a) what is the amount incurred annually by restructured hospitals on overseas marketing from 2007 to 2009; (b) what is the rationale for this expenditure and does it prevent the crowding out of private healthcare providers; and (c) whether this augments a hospital's core mission of providing quality health care for Singaporeans.

Mr Khaw Boon Wan: The public hospitals do not engage in overseas

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marketing. Their mission and priority are towards local residents, and especially those in the lower income group.

Public hospitals do treat foreign patients, as there is no reason to reject them. Given our high standard of care and competitive prices, we attract a significant number of foreign patients who come here deliberately for treatment. But they form less than 3% of our total patient load.

Singapore does strive to preserve its role as a regional medical hub, an initiative which we code-named "SingaporeMedicine", and it is spearheaded by the Singapore Tourism Board (STB). As a major provider of tertiary healthcare services, Ministry of Health lends its support to the promotion of SingaporeMedicine. This is because increasingly foreign patients come here for sophisticated treatment in such tertiary care disciplines. This is an area which Singapore, despite our higher cost, has an edge over our regional competitors. While we have many competent specialists in the private sector, many are in the public sector.

Mr Seah Kian Peng (Marine Parade): Just some clarifications and supplementary questions for the Minister. He mentioned that restructured hospitals do not take part in any overseas marketing. A friend of mine sent me a photograph of a billboard in a Russian city about coming to Singapore by a restructured hospital. I can send the Minister the picture which I must assume that is done by Singapore Tourism Board, if what Minister is saying is correct.

Nonetheless, I have these two supplementary questions. I wonder whether the retention of good doctors forms part of the reason for getting in these foreign private patients. I understand that possibly the doctors may be paid more

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when they treat such patients. And if so, how does these incentives scheme affects their motivation to treat local patients? Second supplementary question is that there was recently a relaxation of Medisave to be allowed for in-patient use and treatment at overseas hospitals. I wonder whether is this a symptom or consequence of our resources being used to treat foreign patients at the expense of local patients. So I would like the Minister to comment on this.

Mr Khaw Boon Wan: I look forward to receiving the poster or picture of a huge billboard, presumably by STB, under SingaporeMedicine. In recent years, we begin to get very interesting patients coming from very far away. Singapore has always been a regional medical hub. For 40 to 50 years, we have had many patients from Indonesia and Malaysia. But in the last five years especially, we are getting patients from very far away, and Russia is one growing market, Middle East is another. I think that is good for Singapore, good for our economic development and it is part and parcel of the sophisticated development of our tourism business. This way, people come here for treatment and not merely to gamble. But as I said, I will take a look at the poster. The doctors charge foreign patients slightly more, in fact the hospitals also charge foreign patients slightly more. Because as you know, for our Class A rates, we are just charging Singaporeans at cost. I see no reason why foreigners should merely be charged at cost. Because the alternative for them is to go to the Parkway group or some other private hospitals, where there will be a profit margin. So we leave it to the hospitals to decide how much premium they want to levy. But I think the key point is still that at the end of the day, fewer than 3% of our patients are foreigners. I do not think that is excessive. I mean if 30% of our patients or beds are occupied by foreigners, then obviously I got to sit down with the CEOs

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to see what is happening, or is it we have so many empty beds that we are able to cope with this extra load.

The Medisave for overseas hospitals' use was my response to very strong suggestions from unionists. From the consumers' point of view, it is to stretch their Medisave dollars.

Obviously, they will not go there if the prices are the same or more expensive. In fact, they quoted me examples where if you go to a hospital in Malacca, the cost is less than half. The reason is because nurses' salaries and rentals there are substantially cheaper than in Singapore.

I see this as offering choices for consumers. If you want competition, this is another factor in helping to promote the competition advantages in this sector. By keeping our borders open, it keeps our operators within Singapore more competitive because if, say, they are losing a lot of patients to Johor Baru, then they will have to figure out a way to bring their costs down so that they can cling on to the patient load. I think these are very good for consumers.

Mr Speaker: Mr Seah, last question.

Mr Seah Kian Peng: I thank the Minister for the clarifications. Just some follow-up questions. Sometimes when we look at numbers, 3% looks like a small figure, but if you are part of the 3% who cannot find a place in the hospital, it is a different problem. I would like to use the words which Minister Lim Swee Say likes to quote – if I am out of job, even if unemployment is 1.3%, it is 100% unemployment for the people affected. I think for that 3%, we need to look at it carefully.

The second point is about allowing Medisave to be used for treatment in hospitals outside of Singapore. Although that provides a choice, but we need to be assured that the quality aspects are not

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compromised. I would like the Minister to address how that particular aspect is taken care of.

Mr Khaw Boon Wan: On the point of 3%, we have to look at the overall bed occupancy. Last month – because I was preparing the answer for another parliamentary question – our hospitals' actual bed occupancy rate averaged 82% or 84%. There is enough slack. If our occupancy is 97% or 98%, then at 3%, you are really crowding out the locals. I think we have to look at it from that point of view.

Secondly, about ensuring quality – yes, certainly. This is one of the reasons why, since the unionists' suggestions, it took me more than a year to look at this problem, because if you just suddenly open the floodgate, there could be problems. But even then, I can never guarantee the quality of a particular service overseas. I cannot guarantee a particular quality of service even for hospitals in Singapore, say, a particular transaction. We cannot guarantee it because there could be individual misconduct or negligence, or whatever.

Consumers as always, whether seeking treatment locally or across-border, have to think carefully before they decide to cross the border, particularly if they get into complications. And if they want to pursue legal suits, they will know that cross-border claims will be that much more difficult. That is why, although I have opened up this scheme, I personally do not expect many to go over. But even for the few who are able to take advantage of it, it is great savings for them. They can then preserve their Medisave dollars longer. Is it not a good thing?