COMMUNITY HOSPITALS

COMMUNITY HOSPITALS:

(Affordability of fees): 8.

Mdm Halimah Yacob asked the Minister for Health (a) what measures are in place to ensure that fees of community hospitals remain affordable; (b) whether more assistance will be provided to these community hospitals if their donations are affected by the economic downturn; (c) whether the Ministry will consider reviewing the means testing criteria to align them to those of the public hospitals; and (d) what is the impact on the Ministry's efforts to encourage patients to move from acute hospitals to community hospitals.

The Minister for Health (Mr Khaw Boon Wan): By design, community hospitals (CHs) cost less to run than acute hospitals. They are less capital, manpower and skills intensive. This does not compromise care because the patients admitted there do not require the intensive treatment offered by acute hospitals. The cost of running the community hospital is about one third the cost of running an acute hospital.

The Ministry of Health subsidises many patients for their community hospital care. Our subsidy extends up to middle income Singaporeans, say, with a monthly income of $5,200 per month for a family of four. Patients can use Medisave to help pay their bills and MediShield also covers the hospitalisation in community hospital for those who subscribe to it. For patients who still have financial difficulty paying the bills, Medifund provides the safety net. In addition, the community hospitals run by charities raise funds, as part of their social mission, to help provide financial assistance to patients in need.

Last year, my Ministry increased the subvention to community hospitals to help them and their patients cope with the

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economic slowdown and we will do more as we discussed in last month's Budget debate.

I have explained before why means-testing in community hospitals and acute hospitals is not identical although both share the same objective of wanting to help the low income group. I have feedback that some patients get missed out at the margin. I am studying this problem and I am confident that I can fix this anomaly.

Patients who no longer need acute hospital care and can benefit from community hospital care will save money if they transfer to a community hospital. We set up the Agency for Integrated Care to strengthen discharge planning and facilitate transfers. The number of admissions to community hospitals has been increasing steadily. We are also getting acute hospitals to collaborate closely with community hospitals to make the transfers hassle free. Tan Tock Seng Hospital and Ren Ci community hospital formalised such a collaboration recently and we encourage other hospitals to do the same.

Mdm Halimah Yacob: Sir, I thank the Minister and while I welcome the Minister's proposal to look at those affected and who are at the margins, I would like to ask whether the Minister would be kind enough to extend the margins so that they are not so narrow because the community hospitals' means-testing is different from the public hospitals – it is a lot more stringent and because of the substantial increase in the hospital fees of community hospitals, a lot of middle income Singaporeans are affected. In the case of one hospital, the C class ward has gone up to $3,900 per month in terms of the ward charges.

My second question to the Minister is: how many patients who are in the community hospitals are receiving subsidies and this constitutes how many

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percent of the total number of patients residing in the community hospitals.

Mr Khaw Boon Wan: As I have said, Sir, I am studying this anomaly at the margin to make sure that patients do not lose out when they move from acute hospitals to community hospitals. Otherwise it would not work because if it does not save you money, then why should you go to community hospitals. I am studying this problem and I will fix the anomaly. I am quite confident I can do that.

As to how many of the community hospitals patients are subsidised, if I recall correctly, I think about half.

Mr Speaker: Ms Denise Phua, last question.

Ms Denise Phua Lay Peng (Jalan Besar): Sir, if healthcare is considered an essential service that should normally be provided by the State, I would like to ask the Minister to clarify why is Government not running the community hospitals. Afterall, Ren Ci Hospital itself is run now by, I think, an MOH-appointed CEO and is located right next to the Tan Tock Seng Hospital. Are there not any benefits to, for example, reaping economies of scale? So, where is the line drawn or decision criteria by which Government makes decisions on whether or not to run a facility, especially in a service like healthcare?

Mr Khaw Boon Wan: Ms Phua raised an interesting question, which I have been reflecting as well as to whether is it better that community hospitals come directly under the Ministry of Health.

In fact, when it started, it was under the Ministry of Health. As a young officer, I was involved in planning the first community hospital, the Ang Mo Kio

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Community Hospital. But, subsequently, the Ministry felt that it was worth trying out to see if charities could run community hospitals. That was how the change came about.

I do not think it is critical, one way or the other, that we must be the provider or we must not be the provider. But we know we will always be the financier for the lower income group because that is our job to make sure that the low income can afford essential services, whether in acute hospitals or in community hospitals. Whether the provider must necessarily be the Government, I think one can debate on such an issue. The key point is that they must be competent, are able to do the job and do bring additional value to the table. I believe they do.