Interview with Dr Paul on the bed crunch issue in public hospitals

The Straits Times yesterday reported on hospitals facing a severe bed crunch. What are the reasons behind it? Is there a bigger problem than just a peak-season demand for beds? What can be done to resolve it?

TOC spoke to Dr Paul Ananth Tambyah to hear his views. (Dr Paul has more than twenty years of experience practising and lecturing in the medical profession.)

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1) You’ve seen the recent reports on the lack of beds in public hospitals. You also spoke about this issue briefly during TOC’s healthcare forum. From a doctor’s perspective, how severe is the problem really? 

This is a perennial problem and unfortunately is a result of funding policies which are very hospital-centric. It has become something that doctors in the public sector have become accustomed to and has undoubtedly contributed to the exodus to the private sector where doctors feel that they can better treat their patients safely. To be fair, the same is true in some other systems such as the United States which have underfunded and overcrowded public healthcare sectors.

2) Housing beds in tents and corridors – is this really suitable for treating patients or specific illnesses? Of course, some will say this happens in field hospitals, too. 

Tents and corridors are at least better than not being seen at all! They are obviously suboptimal as there are issues with getting healthcare workers to the patients as well as privacy and infection control implications. We are not in a war or disaster zone and hopefully should not need to use a field hospital!


3) Some observers have indicated that this shortage is due to the holiday season. Do you agree, and if not, what is the possible reason? 

It is true that there might be a rebound after the recent Christmas and New Year holidays. This results in elective operations being squeezed into the period after the New Year and just before the Chinese New Year. I do not have all the figures, however, it would be unlikely that hospitals are not cancelling elective operations if the bed crunch is really due to a rise in elective surgeries.

There are many other factors which may have contributed to this surge including the ongoing dengue epidemic (although a lot more of these patients are being treated as outpatients). We need more data to understand the specific reasons for the increase at this time if indeed it is an unusual surge.

4) We have new hospitals. Why is this not alleviating the situation? 

The nett total number of beds in service has not increased in step with population growth over the last two decades. The new hospitals have replaced some of the older hospitals which have closed (Toa Payoh hospital, the old Changi hospital etc). Even if there are new hospitals, they need staff to run the wards. The rapid development of the new private sector hospitals has also drained some qualified staff from public hospitals. This further aggravates the problem of insufficient bed capacity.


5) What do you think needs to be done to resolve the situation? 

The long term solution is a comprehensive, universal, single payer healthcare insurance scheme that covers primary care, hospital care as well as long term care. In the short term, there are intermediate steps that could be taken for example such as providing quality public sector long term care rather than depending on VWOs and the private sector. Many current in-patients could probably be looked after in high quality long term care facilities or with home nursing if these were funded by the national health insurance system (Medishield). Medishield is currently limited to hospital care as well as a few selected outpatient treatments. This has diverted patients to hospitals and aggravated the squeeze.

6) Can we not compel private hospitals to assist, assuming they have capacity? Noted that Gleneagles has assisted Changi in July last year.

Definitely! Breaking the private-public barrier is an important first step in dealing holistically with the problem. Baby steps have been taken towards this with the enhancements in CHAS. This needs to be taken all the way with a comprehensive health insurance system.

Doctors, nurses and allied health professionals in Singapore’s public hospitals are working very hard but the infrastructure constraints have severely stressed them all. They and all the people of Singapore deserve a healthcare financing system which places patients first and is sustainable in the long term. As you know, I think that the SDP healthcare plan which we forwarded to the Medishield Life Review Committee under Mr Bobby Chin is such a plan.

 

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TOC thanks Dr Paul for sharing his insights on the issue. Dr Paul is also one of the medical professionals who sits in the Singapore Democratic Party’s Healthcare Advisory Panel. All comments are sent in Dr Paul’s personal capacity and do not represent any of the institutions he work with.

Photo Credits : Straits Times

 

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