SUBSIDISED BEDS IN PUBLIC HOSPITALS

SUBSIDISED BEDS IN PUBLIC HOSPITALS:

(Adequacy): 9.

Mdm Halimah Yacob asked the Minister for Health, in view of the rapidly ageing population (a) whether there are enough subsidised beds for patients in public hospitals to meet the increasing demand; and (b) whether the Ministry has plans to increase the number of subsidised beds in public hospitals.

The Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir, the supply of acute hospital beds must keep pace with increasing demand, as our resident population expands and ages. We try to match supply and demand, but it is quite a challenge to do so perfectly given the long lead time in putting up new hospitals.

Our current bed situation is tight, particularly in the Tan Tock Seng Hospital as it is the only hospital serving the large population in the north besides its own large catchment area. The over-crowding in Tan Tock Seng Hospital in turn causes spill-over to the other hospitals, especially National University Hospital and Changi General Hospital. There will be relief when the new general hospital in Yishun opens in three years' time.

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Meanwhile, we are adding new beds to existing hospitals. Since the beginning of this year, we have added 81 beds in Tan Tock Seng Hospital and NUH. All are subsidised beds. Another 67 beds in NUH and Changi General Hospital will be opened in the second half of this year, ie, over the next few months, also in the subsidised wards. We will continue the incremental expansion wherever practical until the new general hospital in Yishun opens.

As our resident population will continue to expand and age, demand for new hospital beds will continue to rise even after the new general hospital is fully opened with 550 beds around 2012. Our rough projections suggest that we will need 60-100 new beds per year until the population stabilises. A significant proportion of these beds will be in the subsidised wards. We are planning ahead. A new general hospital in the west will be built during the next few years. Otherwise, National University Hospital may become as over-crowded as Tan Tock Seng Hospital is today. Our plan is to keep Alexandra Hospital temporarily for a few years while the new general hospital in the west is being built. The exact timing and location are being studied.

Mdm Halimah Yacob (Jurong): Sir, I would like to ask the Minister, pending the completion of the two hospitals which the Minister mentioned, how does the Ministry intend to deal with this shortage of total beds, whether the measure the Minister mentioned just now is sufficient to meet the shortage of beds in the subsidised wards?

Mr Khaw Boon Wan: Sir, as I said, the plan is to add in incrementally because patient demand does not increase suddenly to 500 beds in a few years' time. It increased gradually, just as

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population ages gradually every day. So the rough projection of between 60 and 100 new beds per year should be adequate. And I think the plan that we have added this year and next year should be able to meet the demand. But let me make a word of caution here that for public hospitals, as I have explained in this House before, we try to run it on high occupancy because that is the only way to keep costs as low as it is feasible. The easiest thing is to keep on adding beds but demand will simply swell to meet up. By keeping beds a bit tight, it forces the administration to look out for areas of possible wastages, and eliminate them. If I may give a simple example of day surgery - I remember introducing day surgery in public hospitals over 20 years ago when I was running NUH. At that time, it was a new concept and habits had to change. So the take-up was slow. I am quite glad that more than 20 years later, today more surgeries are done as day surgeries than as inpatients. That is a dramatic achievement. But we have probably hit the maximum of what is possible for day surgeries. In recent months, we begin to study what other medical treatments which may not require surgeries but which can be done on an outpatient basis. And each time we push the frontier, if we can save X% of hospitalisation, then we save a lot of costs both for the patient as well as for the society. This is an important effort that we must continue to push on.

Dr Lim Wee Kiak (Sembawang): Mr Speaker, Sir, with the mentioning of means testing for hospitalisation by the Minister, I was just wondering whether the need for subsidised beds will be reduced with the introduction of means testing. Can the Minister give us an update on the proposed means testing?

Mr Khaw Boon Wan: Sir, means testing is always a topic at the top of my head, and it will continue to be at the top of my head. But I have also many other urgent

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matters to attend to. So, in due course, we would address this issue. The concept is simple: those who can afford less ought to be subsidised more than those who can afford more. But translating it is not so simple. Over the weekend, I have read Mdm Halimah's comments on this issue and we will take those into consideration when I am ready to explore this subject in greater detail. But, meanwhile, I have still got many things to do - ElderShield reform, MediShield reform, etc. We will come to it in due course.

Mdm Halimah Yacob: I want to thank the Minister for his explanation. Because of this shortage of beds, there is a concern that patients could be turned around very quickly. I would like to ask the Minister to give an assurance that

those who need treatment will be kept long enough in the hospital. That is the concern on the ground.

Mr Khaw Boon Wan: Sir, for us in this business of healthcare, our instinct is always to save life and not to do harm. So I do not think doctors would be discharging patients before they are ready to be discharged. A lot of times, the pressure is on where we know we have done all we can for the patients in an acute hospital setting, and the patients can be competently handled in a community hospital or nursing home. That is where the discharge is all about, where we are worried about "abuse" - if I may use that word - of expensive acute hospital. When the acute episode is over and we have done what we can, say after surgery and the patient may need a few more days of recovery but can be adequately managed in a community hospital, our preference is to move that patient from a very expensive acute hospital - expensive both to the patient as well as to society at large - to a nursing home or community hospital. But, currently, the pricing sometimes skews the outcome, because they may

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find that SGH is so cheap and the consultants are there, even though they know they could be adequately handled, say, in Ang Mo Kio Community Hospital. But they say, "Please, can we stay one, two or three more days?" But each time we allow that, there are patients waiting in the emergency department, new patients with acute medical conditions, who can benefit from the use of that bed. That is the sort of trade-off which we have to do, and we hope patients will continue to be cooperative. But, I think if we price it rightly, they can be more readily cooperative.