DELIVERY OF HEALTH CARE (Improvements)

[Mr Speaker in the Chair]

Dr S. Vasoo asked the Minister for Health to specify some of the improvements in delivery of health care since the restructuring of hospitals.

The Senior Minister of State for Health (Dr Aline K. Wong) (for the Minister for Health): Mr Speaker, Sir, restructuring has brought about many improvements in the delivery of health care service in public hospitals. Some of these improvements include more patient oriented services, better communication with patients, improvements in patient waiting times, new clinical services and improvements to infrastructure. I would describe a little the improvements in each of these areas.

(i) More Patient Oriented Services

One significant area of improvement is in the reorganisation and simplification of operational systems, procedures and work flow which have made hospital services more convenient to patients and more responsive to their medical needs. For patients who require admission, a one-stop admission service at ward level has been introduced at Toa Payoh Hospital (TPH) and Singapore General Hospital (SGH). At the outpatient level, specialist outpatient clinics have been reorganised into multi-disciplinary one-stop clinics, eg, Urology Centre, Brain Centre, Heart Centre and Diabetes Centre at SGH; Arthritis Clinic at Tan Tock Seng Hospital (TTSH) and Oncology Centre at Kandang Kerbau Hospital (KKH).

(ii) Better Communication with Patients

Through an extensive service improvement programme, all hospital frontline staff and supervisors have been trained to be more caring and courteous in their dealings with the public. There has been significant improvement in the way doctors, nurses and counter clerks relate to the patients, their relatives and the public. Financial counselling is routinely provided to all patients and their relatives before admission. Information booklets on hospital services and certain treatment procedures have been made available to patients. This has helped to allay the anxiety of patients before admission or surgery. iii) Improvements in Patient Waiting Times

There has been a general improvement in waiting times for appointments for surgery and specialist outpatient clinic consultation and waiting times to see the doctor at the specialist outpatient clinics and at the pharmacies to collect medicines. (iv) New Clinical Services

New clinical services have been introduced in the hospitals' departments since restructuring. These include Medical Oncology, Neurosurgery and Neurology in SGH, Ear, Nose and Throat and Eye services in TPH, genetic counselling and menopause clinics in KKH, and Podiatry service in TTSH. SGH and TTSH also have walk- in clinics to treat non-emergency patients who would normally have been attended to at the Accident and Emergency (A&E) Department. This has allowed the doctors at the A&E Departments to spend more time on the emergency patients.

(v) Improvements to Infrastructure

With the opening of ambulatory surgery centres in the hospitals, more patients can now undergo surgery as day patients, thus reducing their hospital cost. New technology such as Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scans have been introduced. The operating theatre and intensive care facilities have been upgraded. Physical improvements have been made to the wards and specialist outpatient clinics in all hospitals so that patients can now enjoy a better ambience and greater comfort as an inpatient or as an outpatient.

All these improvements have led to a high level of patient satisfaction. In general, more than 90% of feedback from patients have rated the hospital care as good or excellent.

Dr S. Vasoo (Tanjong Pagar GRC): Sir, I want to ask the Senior Minister of State for Health two questions. First, in response to these changes, has the waiting time for medical care improved significantly? Second, has a review been undertaken regarding the access to medical care for the lower income group?

Dr Aline Wong: As I informed the Member in my general reply, there has been improvement in waiting time. But for specific information on the waiting time by the kind of service, I would appreciate it if he could file a Question and we will give him the detailed breakdown. But generally, between 1990 and 1995, all the hospitals have seen an improvement in waiting times.

On the question of access to health care services for the poor, they have always had access to our public sector hospitals. As the Member is well aware, we subsidize B2 and C wards heavily. We have also introduced a new class of ward, B2+, in some hospitals and they are subsidized at 50%. Medifund has been introduced and the number of applicants has actually gone up and the proportion of cases which have been given financial assistance is still very high. I think some 99.6% have been given assistance. So restructuring does not and has not meant a decline in access to good health care at the public sector hospitals.

Dr Vasoo: Sir, have there been any cases which have been denied health care because they are unable to find the funds to get the medical care required?

Dr Aline Wong: I am not aware of any cases, but if the Member has any case to report, I would be pleased to look into it.

Dr Kanwaljit Soin (Nominated Member): Sir, would the Minister please tell us why there have been so many changes in the manner of paying fees to doctors and how have these differing schemes impacted on the quality of medical care?

Dr Aline Wong: In the late 1980s and early 1990s, there was a consultancy fee scheme for doctors in the restructured hospitals. The idea was to encourage doctors to improve the quality of service to patients. After a couple of years, we found there were some weaknesses in the system and therefore some changes had been implemented to correct the weaknesses. One of the changes was to introduce the point system in remunerating doctors, so that the doctors earned points irrespective of whether they serviced private patients or subsidized patients.

The recent feedback is that some doctors find this system not satisfactory either, because they feel that they are being timed and weighted for every single bit of work they do and they feel that their professionalism has been hindered. Now the hospitals are looking into reforming this system again.

In reply to the Member, I must say that these changes have been found necessary. If she thinks that there have been too many revisions within a period of a few years, the people on the ground feel that some more changes are necessary because there are weaknesses in the existing system. But whatever system it is, there is always a certain degree of imperfection that we may have to live with.

Dr Kanwaljit Soin: Would the Minister please confirm that self-referrals, where the patients refer themselves to various specialists instead of being referred by another doctor, are available and how widely are they used?

Dr Aline Wong: Yes, at the outpatient specialist clinics at the restructured hospitals, it is possible for patients to "walk in" to see a doctor, ie, they can make appointments by themselves to see a doctor. But generally, the bulk of the patients in the restructured hospitals come from referrals.

Dr Kanwaljit Soin: Sir, would the Minister agree that these self-referrals by patients could lead to unnecessary consumption of medical services and sometimes wrong referrals? So would the Minister consider doing away with self-referrals to consultants and only allowing referrals by other doctors so that there is no unnecessary wastage of medical services?

Dr Aline Wong: As I said, the proportion of self-referrals is very small. If we were to do away with it, ie, by requiring all patients to have a referral before they can see a specialist in a restructured hospital, then we require altogether a very different system from what we have. We have to think about this proposal carefully and whether this constitutes another form of wastage of resources for the nation. To cut down costs, the patients themselves also have to be educated. They should not just go and see a specialist for a small thing. But may I suggest to the Member that this question is not really related to the main Question asked by Dr Vasoo.