COS 2012: Managing hospital resource constraints

For some time now, our government restructured hospitals have been facing a bed crunch, as several Members before me have mentioned. With the current high bed occupancy rates, can we be sure our hospital system will be able to cope in the event of a major outbreak or a national disaster, without resulting in preventable deaths?

Parliament

Speech on 6 March 2012 in Parliament during the Committee of Supply Debate on the Ministry of Health’s budget.

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Mr Chairman,

For some time now, our government restructured hospitals have been facing a bed crunch, as several Members before me have mentioned. With the current high bed occupancy rates, can we be sure our hospital system will be able to cope in the event of a major outbreak or a national disaster, without resulting in preventable deaths?

I appreciate that hospital staff and administrators are doing their best to manage these space constraints, but perhaps we need to explore other ways to free up bed space.

Currently about 22% of all beds in acute care government hospitals are non-subsidised beds. In our largest hospital, SGH, non-subsidised beds make up 28% of its beds . This is according to a reply from the Minister to my Parliamentary Question last month.

If these hospitals convert some of their private wards to subsidised wards, can more bed space be created?

Sir, another concern I have is the doctor shortage in our public hospitals. I recognise that this is a long-standing and multi-faceted issue, which has no simple solutions. Apart from recruiting more doctors, I believe more can be done to make the most of existing resources.

According to a Straits Times report on March 1st, the pay structure in public hospitals includes three components:

First, a basic salary, which is the same across doctors of the same grade.

Second, an allowance pegged to the medical speciality, with doctors doing surgery getting more.

And third, a fee scheme determined by the type of patients a doctor treats. A doctor who sees non-subsidised patients will earn more under this scheme than one who treats more subsidised patients. A doctor who sees non-subsidised patients who are foreigners earns even more.

Sir, does the third component—the fee scheme—have an effect of incentivising doctors to see private and foreign patients, over subsidised local patients?

Is it possible that some senior doctors are seeing a higher proportion of private patients and leaving the subsidised patients to the more junior doctors?

If so, would the subsidised patients be losing out because the more senior doctors spend less time seeing them, or will the junior doctors get burnt out by the high patient load, contributing to their departure for private practice?

May I suggest adjustments to the fee scheme component, to reward doctors based on the number of patients they see and the complexity of the cases, regardless of whether these are subsidised or non-subsidised patients.

I believe this will more fairly compensate doctors who shoulder a higher patient load, and at the same time better ensure that the experienced doctors are available where they are most needed.

This could help reduce patient waiting time as well as improve the quality of care, especially for subsidised patients.

Author: Gerald Giam

Gerald Giam is the Member of Parliament for Aljunied GRC. He is a member of the Workers' Party of Singapore. The opinions expressed on this page are his alone.

4 thoughts on “COS 2012: Managing hospital resource constraints”

  1. Valid points, but i think you should post the Minister’s responses. Without it, it doesn’t do anyone any good and comes across like a rant.

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