PUBLIC HOSPITALS

PUBLIC HOSPITALS:

(Bed availability during downturn): 1.

Mdm Halimah Yacob asked the Minister for Health (a) whether there are sufficient subsidised beds available in the public hospitals to meet the increasing number of patients who opt to seek treatment at public hospitals during the economic downturn; (b) what measures will be taken to address the shortage; and (c) what is the average waiting time for admission into public hospitals for elective and non-elective surgeries.

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The Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir, we have been increasing the number of subsidised beds to cope with rising demand as a result of expanding population and ageing. For example, in 2007, we added 133 subsidised beds, and last year, another 125. This year, we will add another 34 subsidised hospital beds. In total, this will give us a stock of 3,656 subsidised hospital beds.

The pressure for subsidised beds will be further relieved when Khoo Teck Puat Hospital opens next year, as it will add another 330 subsidised beds, which is substantial because it is almost 10% of our current stock of subsidised beds.

For patients requiring emergency surgery, there is no waiting. They are promptly attended to upon triage at the Accident and Emergency departments.

As for subsidised patients requiring elective surgery, the waiting time varies with the specialty. Almost all elective surgeries are carried out within 40 days, which is not bad.

Dr Lily Neo (Jalan Besar): Sir, may I ask the Minister whether there have been any postulation studies in recent years on hospital beds requirement, especially in our ageing population, and whether there is now a priority in expanding the step-down care facilities in order to ease the demand on expensive acute hospital beds?

Mr Khaw Boon Wan: Sir, the short answer is "yes". I discussed a little bit of that at last month's Budget debate. And that is why there has been support from the Ministry of Finance for a very substantial increase in the Budget this year. Looking forward, we know that we will also need to increase it further.

In the case of Singapore, the population growth – particularly the non-

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Singaporean population growth – has been substantial. The organic growth itself is manageable, but the increase in the foreign residents here is substantial, eg, in the last decade, we added a million. For a small population, that is a very sharp increase.

M ore importantly, as Dr Neo has pointed out, it is the ageing of the population which will raise the demand. I have been watching age-specific admission rates, and we all know that for the elderly, the admission hospitalisation rates are much higher than the younger population. For the population of residents already here, it is quite arithmetical. We can just churn out projection figures. And that is why we built Khoo Teck Puat Hospital – although, in hindsight, I would be happier if I had started the process maybe two years before we did. We are now planning Jurong General Hospital, and I am carefully studying whether there may be a need for a future hospital in the north eastern sector, which is currently served by Changi Hospital.

As Dr Neo pointed out, it is not just acute hospitals. The step-down care sector will grow even faster. And if we do not ensure proper development of step-down care facilities, patients will flock to acute hospitals. It is very costly for them and I am not very sure whether it is good quality of care, because the hospitals are highly sub-specialised. The seniors will inevitably end up seeing many sub-specialists and being referred from one clinic to the other, whereas many of them could have been better treated in the step-down care sector.

W e have discussed the growth of step-down care previously too. The growth has been in two directions, both quantitatively as well as qualitatively – capabilities as well as numbers. Part and parcel of that is manpower – training the appropriate level of care. So we have a lot of things to do.

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Mdm Halimah Yacob (Jurong): Sir, I would like to ask the Minister whether the number of 134 additional beds for 2009 is sufficient, bearing in mind that we are in the midst of a very severe economic downturn and there will be more people moving to the subsidised wards.

Would the Minister be able to comment on the comment made recently by the CEO of a public hospital who said that one way of addressing the shortage of beds was purchasing beds from the private hospitals? Is that one of the things that the Ministry is considering?

Third, I want to ask the Minister whether the hospitals are seeing an increase in the number of patients who find difficulty in paying their bills, and how do the hospitals address that point.

Mr Khaw Boon Wan: Sir, with the downturn and its possible impact on hospitalisation, I have been looking at the admission figures and they remain quite stable. There has been an increase. It has been increasing every year. But the main driver is still the ageing of the population and the sharp increase in the total population here. Whether there is a direct result of the downturn – it is not noticeable to us yet. I think part of the reason is because in the hospital sector, we are the dominant player. We have 80% market share. What our doctors in polyclinics have told me is that they experience this surge much more than in hospitals, because their market share is only 20%. During a downturn, people tend to move to the cheaper sector. While both are affected – acute hospitals and clinics – the clinics, because of their sheer small size, face it more.

Overall, I will be happier if I had started the construction of Khoo Teck Puat Hospital two years earlier. I cannot change history, so we have been coping with interim solutions. The additions in the last three years were deliberate and in

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anticipation of this. It does not mean that this year's addition is less than last year. That is because we added in the easier beds a couple of years ago in anticipation of this. We will cope; we will have to cope. The relief will come early next year when the Khoo Teck Puat Hospital opens.

I just drove past the hospital site, they have reached level 10 now. I think they will be topping out quite soon. So we are not affected by delays in the construction.

On whether we need to use private hospital beds, we will see if it is necessary and also if it is practical. Subsidised beds are in open wards. In for-profit private hospitals, they are all single room/double room. They are quite different. I think what is more important is to make sure that we utilise our resources as best as we can. The average occupancy rate is about 85%, which is all right.

On whether the downturn will mean more default in payments, we anticipate some of this. I said so in last month's debate too. We are pumping in some money to the hospitals in anticipation of an increase in bad debt provisions.

Mr Speaker: Mr Zainudin, last question.

Mr Zainudin Nordin (Bishan-Toa Payoh): Sir, if, by chance, there is no plan for development at the Alexandra Hospital, will the Ministry consider to hold back and still have the extra beds at Alexandra and Khoo Teck Puat Hospitals?

Mr Khaw Boon Wan: Yes, Alexandra Hospital is a ready resource with about 350 beds. That is why a couple of years ago, I decided that even as we open Khoo Teck Puat Hospital, we will keep Alexandra Hospital until a larger and newer hospital in Jurong comes about. So we have resources at Alexandra Hospital to tide us over. But long term, that is a very expensive piece of real

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estate, and I am sure the Government has other plans for that place.