Friday 14 March 2014

Back to Third World from First in health care? Hardly

Unfair not to acknowledge earnest efforts to ramp up infrastructure but...
By Chua Mui Hoong, The Straits Times, 13 Mar 2014

TRUE to form, Mr Low Thia Khiang went for the jugular.

The Workers' Party secretary-general and Aljunied GRC MP, a veteran of Budget debates since 1992, aimed straight for the weak spot in the Ministry of Health: the shortage of public hospital beds and long waiting times at emergency wards.

He referred to a front-page report in this newspaper in January which recounted how one hospital put up an air-conditioned tent for patients waiting for a hospital bed, and said: "The hospital bed crunch, together with the public transport crunch and the riot in Little India is a star example of Third World problems in First World Singapore."

He could not resist another dig: "One certainly hopes that Singapore does not make history by going from Third World to First, and back to Third within one generation."

Mr Low's acerbic comment will resonate with Singaporeans who feel Singapore is overcrowded. But he is also being a tad unfair in not acknowledging the earnest effort by the Government to ramp up infrastructure in all areas including hospitals.

In Parliament yesterday, Health Minister Gan Kim Yong said there will be another 11,000 more hospital and nursing home beds by 2020. After that, another four new acute hospitals are being planned.

Mr Gan also explained MOH's approach for the long term: to shift the emphasis away from acute hospital care to preventive care to keep patients healthy; and to community and home care so patients can be discharged faster from acute hospitals and have follow-up care done at their home or in community clinics and hospitals. Home-based care will be ramped up with more subsidies.

This failed to satisfy Mr Low who came back twice to the shortage of hospital beds. Noting that this was an issue even in 2005, he asked pointedly what had been done since then.

He added: "What would be the waiting time that the patient can expect when he needs a hospital bed for admission? We have feedback that there are patients who waited for eight hours or some as long as 23 hours. I think that's too long, it's not something which we would expect in a First World country, right?"

Mr Gan refused to be baited, choosing instead to respond calmly that in normal times, patients should not wait for "more than a few hours". He stressed that patients are cared for during the wait and medically assessed, so those who need urgent care are warded immediately.

No other People's Action Party MP rebutted Mr Low when they rose to speak.

And so Mr Low's fiery riposte that might have sparked a lively debate on the hospital bed crunch fizzled into a damp squib.

I thought it was a pity.

Yes, Mr Low was clearly playing to the gallery with his First World to Third juxtaposition, and asking if queueing for a hospital bed will "become an activity of active ageing for the seniors".

But he did raise an important issue that merits fuller discussion.

If MOH is playing catch-up in hospital bed supply now, he asked, "what can Singaporeans expect in health care 2020 in respect of hospital bed availability?"

Nominated MP R. Dhinakaran also described the bed shortage and long waiting times at emergency departments as "worrying".

Singaporeans can see the efforts being made to build more hospitals/homes/MRT lines/ hawker centres/ childcare centres and a whole list of other services.

Fair-minded citizens understand that it takes time for these to be ready and that service providers are managing as best they can meanwhile.

But the fact remains that past projections failed to anticipate demand. So how can Singaporeans have confidence that what's being done now will be enough to meet the needs of the future?

It is interesting that several MPs during this year's debate asked the Government about its planning norms; or went straight out to suggest that it speed up the building of services like community hospitals (Dr Teo Ho Pin); polyclinics (Mr Liang Eng Hwa); and hawker centres (Ms Lee Li Lian). This suggests that MPs too are wondering if ministries' planning is in sync with residents' needs, or if it is behind the curve again, risking an under-supply in future.

To be sure, the Government did pledge during the debate on the White Paper on population last year that it would build ahead of demand. The test will come in a few years' time, when residents can see if long queues for a flat/hospital bed/MRT train are over.

Yesterday's debate also reminded me of how far the country has come in health-care policy - and how far more it needs to go.

Progress has been made on many fronts. Universal health coverage will finally be attained with MediShield Life. A tsunami of increased subsidies have made long-term care and outpatient care more affordable. Preventive and community care are now desirable alternatives to hospital-focused care, years after MPs like Lily Neo championed them. With the new Agency for Integrated Care, there's a more holistic approach to nursing homes, elder care and caregiving. These are hardly Third World plans.

But some things - like long waiting times for hospital beds - have not improved.

Workers' Party MP Png Eng Huat raised another issue: insurance for those with pre-existing illnesses. He noted that cancer survivors, for example, are considered "cured" after five years but suffer a "life sentence" of being uninsurable after the illness.

I can vouch for this, as a cancer survivor myself. Sure, we will be covered under MediShield Life. But private insurers that offer upgraded MediShield plans can still cherry-pick and reject those with pre-existing illnesses.

This means that even those who can afford Class A unsubsidised hospital beds, if they were insured, will end up filling subsidised hospital beds because of their insurance plan limitations. This will lead to increased pressure for subsidised beds.

Some health regulators elsewhere forbid exclusions for pre-existing illnesses after a certain number of years, not for life.

MOH can do better in this area.

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