PUBLIC HOSPITALS (Review of costs and charges)

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PUBLIC HOSPITALS:

(Review of costs and charges): 19.

Mr Gan Kim Yong asked the Acting Minister for Health in view of the varying bill sizes charged by the different public hospitals, (a) whether efforts have been made to review the operating costs and charges imposed by hospitals with higher bill sizes; (b) what has been the

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outcome of such review if any; and (c) what actions have been taken to reduce the bill sizes of these hospitals.

The Acting Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir, the mission of our public hospitals is to provide good and affordable healthcare to Singaporeans, especially those from the lower and middle income groups. The key is to do more with less, so as to save money for the patients. Frills should be eliminated and unnecessary services avoided. This is of course not a once-off exercise but a continuous process of regular review of daily operations and clinical practices to identify areas of savings without compromising clinical care.

Some initiatives undertaken so far include group procurement, encouraging day surgery where appropriate and better discharge planning. They have resulted in more efficient use of resources, reduced length of stay and moderated the increase in healthcare cost.

The publication of hospital bill sizes is another initiative in this process of review. Hospitals can now compare their cost with those of other hospitals when treating similar types of patients. No two hospitalisations are identical. But on a statistical basis, if a hospital remains a significant outlier compared to the other hospitals, this must alert the management to review their way of handling such types of patients. This allows the hospital and the clinicians to ask intelligent questions about why their charges are significantly different from the others. Finding answers to such questions may then lead to actions which benefit both the hospitals and the patients.

An added benefit of publishing such statistics is that patients and their family physicians can now have a better idea of what to expect before their hospitalisation. They would be in a better position to make more informed choices with regard to their hospitals.

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We have launched this initiative for three months now and I am glad that the public has welcomed the efforts. We will continue to improve on the contents of the publication.

The hospitals too have found the exercise useful and are actively following up. For example, Changi General Hospital (CGH) reviewed the medical conditions in which they had the highest bill sizes and found that their unit prices were not out of sync with the others. Their higher bills were due to differences in clinical practice.

Let me give you an example. Prostate operations, where CGH used to admit patients immediately for investigations when they turned up in the A&E for acute retention of urine. CGH has now adopted the other hospitals’ practice of doing the investigations for urine retention on an outpatient basis. Patients are now admitted only when they require surgery. This reduces the average length of stay by two days, with a corresponding reduction in the bill size.

Another example of a change in clinical practice is the substitution of oral medication for intravenous medication. The National University Hospital has introduced the use of oral re-hydration for paediatric diarrhoea cases instead of total intravenous hydration. This costs less and shortens the length of stay. Patient care is not affected.

Likewise, Alexandra Hospital has also reviewed their prescribing practices to encourage the use of cheaper alternatives, such as using standard instead of non-standard drugs for gastroscopy.

Let me quickly add that in some instances, higher bills may not mean bad practices. For example, CGH offers a more costly treatment for asthma. This is because CGH thinks that it is more effective in the long term, avoiding future

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hospitalisation and therefore save costs for the patients overall.

We should encourage such diversity in treatment protocols among our hospitals. It allows us eventually to better assess which is the more cost-effective protocol which can then be adopted by others as the best practice.

Mr Gan Kim Yong (Holland-Bukit Panjang): Mr Speaker, Sir, I have a couple of supplementary questions. Firstly, I would like to ask the Minister whether he would assure Singaporeans that in the process of reviewing these charges, the quality of medical care will not be compromised. For example, I think Changi General Hospital has decided to shorten the length of stay for some of the hospitalisations. Would this lead to the doctors prematurely discharging patients?

My second supplementary question is that this comparison of fees is good and welcome. However, there is also a flipside of the story, ie, whether it would lead to some hospitals, realising that their charges are way below the others, looking towards increasing their fees as a result, and whether the Ministry has investigated whether there were any such increases.

My third supplementary question is whether the Ministry takes an active role in reviewing the charges imposed by hospitals or they leave the review to the respective hospitals.

Mr Speaker: Mr Khaw, you have less than a minute to reply.

Mr Khaw Boon Wan: Yes, I can give the assurance that quality will not be compromised. This is the starting point, that in this whole exercise, quality is paramount. But there are different practices. Medical practice is sometimes a bit of art and science, so it is not always clear which is the best regime. That is why I prefer a certain amount of

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diversity. Some hospitals have a longer length of stay because they think on a long-term basis, it serves the patients' interests better. Others think they can do with a shorter stay. We cannot be sure which is better until some time has passed. Like all things, let us have experiments and, along the way, hopefully, there will be some enlightenment.

3.00 pm

Mr Speaker: Order. End of Question time.

_[Pursuant to Standing Order No. 21(3), Written Answers to Question Nos. 21 and 22 on the Order Paper are reproduced in the Appendix * . Question Nos. 20 and 23-32 have been postponed to the sitting of Parliament on 6th January 2004.] _

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BILLS INTRODUCED: