GOVERNMENT RESTRUCTURED HOSPITALS (Admission of patients to B2 or higher class wards)

Mr Low Thia Khiang asked the Minister for Health, in 1994 and 1995, how many patients were admitted to B2 or higher class wards in Government restructured hospitals such as Singapore General Hospital, Toa Payoh Hospital, Tan Tock Seng Hospital and Kandang Kerbau Hospital due to C class beds being not available at the time of admission.

The Senior Minister of State for Health (Dr Aline K. Wong) (for the Minister for Health): Mr Speaker, Sir, the number of C class patients who were lodged in B2 or higher class wards in 1994 and 1995 was small. It ranged from none to very few in a year in most of the acute public sector hospitals, such as Toa Payoh Hospital, the National University Hospital, Alexandra Hospital and Changi Hospital, to about two a day in SGH and three to four a day in Tan Tock Seng Hospital.

The demand for beds of the various classes is closely monitored. It covers demand by patients for beds of lower class as well as for beds of the higher classes. Bed provision is adjusted, if necessary, to meet the changes in demand. When bed occupancy is high with the efficient use of beds, there can be situations when there is a shortage of beds in certain wards, because of the need to designate wards by gender, by class and, at times, by medical specialty. More C class beds will be added if there is a demand for them.

Mr Low Thia Khiang: Sir, my question was: what was the number in 1994 and 1995? I think the answer the Senior Minister of State gave was on the number of patients per day. But I would like to know what is the total number in 1994 and 1995.

Dr Aline Wong: I am afraid I have only got the average number per day. But if he can just multiply it by the number of days in a year, he can get the total number.

Mr Low Thia Khiang: Sir, my question was: what was the total number in 1994 and 1995? The question was very clear and I do not understand why the Senior Minister of State gave me an average, and I do not think I could see the full picture in terms of the number and whether there are sufficient C class wards. Anyway, I would also like to ask whether the Ministry of Health segregates the figures of C class ward patients who were admitted to B2 or higher due to (1) either there was no bed available at the time of admission; or (2) because certain treatments were not available in C class ward. Will the Senior Minister of State be able to highlight this?

Dr Aline Wong: I am sorry for the not-so-specific answer to his question about the number in 1994 and 1995. If there are no C class beds available for patients at the time of admission, they will be lodged in B2 class. And if there is a C class bed available later, the patient can downgrade to C class ward. If there is no C class bed available for the length of his stay, then the patient is requested to pay at B2 rate. But if he cannot pay, he can always request for downgrading and the Medical Social Worker would look into it. If he is in financial difficulty, he can be helped by Medifund or waiver.

What is the exact nature of the Member's second question, please?

Mr Low Thia Khiang: Sir, my second question was whether the Ministry segregates the figures of patients who were upgraded at the time of admission due to unavailability of C class beds and the other situation where certain treatments were not available in C class.

Dr Aline Wong: The other class of patients would be told at the point of admission, especially if it is an elective case or elective surgery, that for certain sub-specialities, C class bed is not available. But this situation applies only in very few tertiary sub-specialities in SGH. The figures I have do not segregate between these two. But further to my point, my answer to his question about the number of patients not being able to be admitted to C class because of shortage of beds, I think the picture per day is actually a more accurate picture because the hospital has to watch bed turnover and bed occupancy per day. So at the time of admission, it depends on that particular day. I think this is a clearer picture in answer to his question. But in any case, I apologise for not giving him the exact figure.

Mr Low Thia Khiang: Sir, I do not quite agree. Because if you know the exact figure for a year, then you can track the trend, rather than per day or based on admission.

Sir, the Senior Minister of State has mentioned just now about patients who are upgraded to B2 or higher class if C class beds are not available and, of course, they can apply for Medifund or waiver. My question is: if a patient at the time of admission requested to be admitted to a C class ward, and because there was no C class bed available and was put into a B2 class ward, will he be charged at C class rate?

Dr Aline Wong: I have already answered that question. If he requests to be admitted to C class bed and there is no C class bed available at the time of admission, then he will be put into B2 class. He will be asked to pay at B2 rate because he, in fact, consumes B2 class services. If he cannot pay, he can apply to downgrade to C class

Mr Low Thia Khiang: Sir, for instance, at the time of admission, a patient was upgraded to B2 class and stayed for three days. On the fourth day, he requested to be downgraded to C class. Altogether, he stayed in hospital for five days. For the total hospital bill, will he be charged based on C class rate or B2 rate?

Dr Aline Wong: For the first three days when he stayed in B2 class, he is charged at B2 rate. For the last two days, when he was in C class, he is charged at C class rate.

Mr Low Thia Khiang: What happens when a patient says that he does not want to apply for Medifund? Because, to qualify, he has to meet the criteria. If a patient does not qualify for Medifund and his intention is that he wants to stay in a C class ward, but he is being upgraded and asked to pay B2 rate, is this fair? Because it is not the patient's choice. Because of circumstances, he is upgraded and thereby asked to pay a higher rate. Is this fair?

Dr Aline Wong: He is staying in a B2 ward and he consumes the services provided to him at B2 rate. So it is not a question of fairness. Also, from the point of view of the hospital, it is impossible to predict, on a daily basis, how many patients would request to go to which class of ward.

Dr Kanwaljit Soin (Nominated Member): Sir, would the Senior Minister of State please tell the House whether there are C class beds available for the speciality of burns?

Dr Aline Wong: No. There are no C class beds for burns patients at SGH. This is a highly specialised sub-specialty and it is not possible to have that kind of ward and medical sub-specialisation where we can provide for C class beds.

Dr Kanwaljit Soin: Sir, would the Senior Minister of State agree that many of the patients who sustain burns, especially children, come from the poorer families? Medically, it is accepted that many of the children who sustain burns do come from the lower-income families. Would the Senior Minister of State agree that there is a need, where burns are concerned, for C class beds?

Dr Aline Wong: I do not see any logical reason why the C class wards would be occupied specially by children from the low-income families. I think it caters to all families from all kinds of backgrounds. But, as I said, if the patient or his family cannot afford to pay, he can always apply for a waiver or Medifund help.

Dr Kanwaljit Soin: Sir, is the Senior Minister of State aware that burns usually occur to children from the low-income families because of the lack of supervision? I would like to tell the Senior Minister of State that this is from my own personal knowledge and having worked in a Burns Unit for quite a few years.

Dr Aline Wong: Sir, I can only take note of the Member's concern. I think this supplementary question is a bit out of the original question.

Mr Speaker: You are right.