Public hospitals facing severe bed crunch?

“Prominent blogger, Leong Sze Hian wrote on his blog [Link], “In my opinion, the obvious reason for the beds’ crunch, to the best of my knowledge, has never been highlighted in the media – that the total number of hospital beds in Singapore has seen zero increase over at least the last 12 years or so, despite an increase in the population by more than 1 million.”

Actually, the government did increase the number of hospital beds but the problem is they also expanded the population in Singapore considerably over the same period.” Link

The latest serious hot topic in cyberspace now – other than the multi-million kidnapping case or some unhappy cinema patrons at Rex Cinema, is the dearth of beds in government run public hospitals. Many citizens have expressed outrage on this latest worrisome situation. We are talking about NOT one but all the government run public hospitals in our Singapore. How could it be? What happened to our legion of planners and scholars taking huge salary and yet fail to deliver this basic service to our citizens which we have always taken for granted until recently? It seems that this is one of the latest trends happening in Singapore where “Things Are Falling Apart!” Realy langgar!

I do not agree with Uncle Leong’s statement. I only subscribe partially to the second statement. Let me substantiate what I say here.

Back then in 1990 when I was an investigation officer (IO) on duty, I had to visit and interview patients in all the public hospitals across the island. We rotated between IO(R) – Routine or IO(C) – Crime every 4 or 5 days. All routine cases reported to the police between 6am to 6am the next day would come under my preview if happened in my divisional boundary. For example if patient had a fall at home and got warded, I’d need to investigate to rule out foul play. As such, I usually commenced my hospital rounds after 2am after a quick supper. Before 8am, I would need to go through all the reports of the day and prepare a summary of main cases. After a short break, it’s time to review all cases with all the Heads in the conference room. In those days, they called it ‘morning prayers”. Usually, I would plan my route by shooting to the old Changi Hospital, Toa Payoh, TTSH, SGH, AH. Sometimes, I would go to NUH, East Shore or even Mt Alvernia hospitals. Common cases referred to the police then were patients had a fall, drugs overdose usually taking sleeping pills. It’s my job to find out exactly what happened to them. Usually there were 3 to 8 or even 10 cases during my tour of duty. If something was amiss, follow- up investigation would ensure.

Back then when I went on my hospital rounds, there were hardly any foreigners in our public hospitals. Even the nurses were mainly locals. I could see that there were always few empty beds next to the patients in the common ward. In those days, the hospitals were more simple and less advanced. Toa Payoh and Changi Hospitals then were certainly not as big as the current ones. There was no Yishun hospital also. Raffles hospital was also not in existence. So called community hospitals were unheard off also.

Fast forward to today, more than 20 years later we are witnessing a severe shortage of hospital beds in all the government run hospitals. With bigger, better and more properly equipped hospitals and yet we are facing this unthinkable nightmare. Why? It just does not make sense at all. I’m bewildered by this latest incompetency.

I was discussing this sad state of affairs with my good friend. He alerted me to the news report.

“Today’s papers say hospitals are putting tents to put patients in and even getting to sleep in corridors. This is worst than 3rd world countries. You must blog about it. There are too many PRCs taking advantage of our healthcare? Or is it poor planning? Disgusting!!!”

There are few facts we need to consider. The fact that there are much more bigger and better equipped hospitals than before effectively demolished Uncle Leong’s opinion that there is “no increase in hospital beds.” The second argument that with influx of foreigners – not local population increase in my opinion – the government run hospitals not able to cope is only partially true.

The problem lies with the deployment of public hospitals to non citizens resulting in the current severe shortage. Public hospitals are strictly meant for natives and should not be strained by non-natives. It is as simple that. All non natives should seek private medical services in the private hospitals. But then, the government is running public hospitals with strong profit motive up to the optimum level. They are taking in non natives cuz they pay more than locals. Foreigners will definitely seek medical attention in public hospitals since they are much cheaper than private ones even though they pay higher than locals. Those public servants turned-entrepreneurs running public hospitals simply cannot resist the urge to take in foreigners cuz of more profits and huge revenue. That is the kind of mindset adopted in all the public hospitals leading to such an embarrassing fisaco.

Again our Singapore brand name has taken another downward dive when the MSM splashed pictures of tents in hospital compound with hospital common corridors sprawling with beds overflowing from the sardine packed wards. When I visited those hospitals back in the 1990s, it was unheard of. Even in the old run down Changi hospital with limited space constraints, there was no such thing as lacking of beds for locals.

The root cause is that our public hospitals are heavily used by non natives. With the influx of foreigners especially there is a new trend of “medical tourists” and our serious aging population, public hospitals just cannot cope. Of course, government spending was also not generous. It did not keep pace with galloping demands! They would prefer to buy more F35s – the world’s most expensive toys where only the filthy rich with tons of money to throw liberally!

If only public hospitals cater exclusively to locals, I am sure that there will be no shortage of beds for citizens. Let the private hospitals handle non-citizens’ healthcare. But then, no CEO in a public hospital will take this approach simply because foreigners are paying more than locals whom are “heavily subsidized” by govt for their medical treatment. But then, medical treatment for locals are also not cheap either. With such high medical costs and yet there is still so much demand for medical services certainly seems ironical. I will bet to the last dollar no one would want to get warded in a public hospital due to the extremely high costs. An extended stay with few operations in a public hospital will definitely wipe out your CPF MediSave savings. Who wants to go there for the fun of it?

Now that the problem has exploded into the open with tents pitching up in public hospital compound, the truth is out. Why did they not foresee such a problem? Current measures as reported in the press are only fire fighting ad hoc remedies but do not solve the root cause of it. They need to really get into the root cause of it instead of putting up so much talk in damage control saying that so many or how many hospitals are being built. Our population aging, due to the holiday season etc. How many hospitals can you build to put a brake on straining our limited resources on public hospitals?

In short, the answer is not to build more but how do you manage? What is the government’s priority when it comes to healthcare for natives and non natives? Natives first than followed by non natives or what? Public hospitals run by the government for citizens only or to be shared by the tons of foreigners? That is the crux of the matter. Bottom line of public hospital costs vs basic citizens’ entitlements to a reasonable subsidized medical treatment is another angle that the government of the day will need to reconcile. Let’s hope that they get their acts together fast and don’t be blinded by rich paying foreigners leading to such a pathetic state of affiars. I’m sure our late Dr Goh KS and pioneer founding leaders would never let such thing happen if they were still around.

Look at the picture below. Do we need to come to this stage where citizens are required to queue to get a place in a public library (hospital beds)? They are more than 1,000,000,000 people and we are only 5.3 million. They got better excuses and pretexts if they fail their own people but can we afford to make more blunders? Have we breach the margin of tolerance? Time is running out cuz it’s getting nearer to the finishing line.

PS: I just got this list of 10 solutions or suggestions from our brilliant Lohcifer.

1.) Increase number and quality of local specialists.

2.) Study demographics of surrounding/foreign countries to determine which countries likely to come here for healthcare and what the anticipated numbers are (looking into aging population there, etc.

3.) Build bigger hospitals with perhaps separate wings for medical tourists. Build extensions to existing hospitals.

4) Implement patient flow management process.

5.) Refer non critical cases to GPs.

6.) Incalcate culture of home care, providing training to household members teaching them how to provide care at home for the sick.

7.) Incentize those who self-medicate.

8.) Introduce programs enabling patients to help themselves thru online self-assist and such.

9.) Educate public to develop mindset that a hospital visit is only necessary if life & death.

10.) Income tax discounts & other incentives for those who stay away from hoslitals for fixed number of years.

Just some thoughts.

– Lohcifer of Loh & Behold.