Providing only what is needed will keep healthcare costs sustainable: Senior Minister Lee
Don't over-treat, over-prescribe and be careful in adopting new treatments, he says
By Salma Khalik, Senior Health Correspondent, The Straits Times, 14 Jul 2024
Healthcare needs in Singapore will have to be managed not just by building new hospitals, but also through discipline in providing only what is necessary.
Speaking on July 13 at the official opening of the Woodlands Health (WH) campus, the third new general hospital opened in a decade, Senior Minister Lee Hsien Loong said the Republic cannot keep building new hospitals to meet the growing needs of a rapidly ageing population.
“We must also maintain discipline in not over-treating or over-prescribing, and be discriminating in adopting new medical treatments, procedures, drugs and technology, in order to keep our overall healthcare costs sustainable for the long term,” said SM Lee in outlining the path ahead for the healthcare system.
“At the same time, we must maintain the right mix of government subsidies, medical insurance and individual co-payment, to minimise wrong incentives, perverse incentives, which would lead to unsatisfactory outcomes.”
SM Lee said Singapore will continue to train more competent doctors, nurses and other healthcare professionals, and improve its healthcare facilities and infrastructure.
But he added that tough decisions and trade-offs are needed for the country to continue delivering high-quality, affordable healthcare to Singaporeans.
“There are too many examples elsewhere of healthcare services practically at breaking point. Populations suffer from poor healthcare delivery and long wait times, or exorbitant medical bills and high insurance premiums.
“And it shows in the outcomes – population health deteriorates, and so does the quality of life, even life expectancy,” said SM Lee.
Health Minister Ong Ye Kung, who was at the opening of WH, had also urged caution recently over the risks of escalating healthcare costs.
In comments made on July 12, he said the Ministry of Health (MOH) needs to rein in the unhealthy “buffet syndrome”, which sees patients picking expensive treatments and diagnostic tests because they have insurance to pay for them.
Over the last 10 years, Singapore has built three new hospitals – the 700-bed Ng Teng Fong General Hospital in 2015, the 1,000-bed Sengkang General Hospital in 2018, and now the 1,400-bed WH.
On the cards are another two public general hospitals – in Bedok and Tengah – and possibly also a non-profit private hospital.
In less than five years, the ageing population here has pushed up the average length of hospital stay from six to seven days, which raises demand for hospital beds by 15 per cent.
SM Lee said the healthcare system remains in good shape, with people having access to high-quality and affordable treatments, with reasonable wait times.
But he added: “Do not underestimate the difficulty of keeping the healthcare system working well.”
Former health minister Khaw Boon Wan, who made the decision to build WH, was at the event on July 13.
He had instructed the team in charge of building the hospital to take their time and to study what other countries with older populations are doing.
Dr Jason Cheah, the hospital’s chief executive officer, said it took 10 years to build WH. Public hospitals here generally take seven years to complete.
A major reason for the delay was disruption to work and a shortage of labour as a result of the Covid-19 pandemic.
By integrating an acute hospital, community hospital and nursing home at a single campus, it makes it easier for WH to provide patients with the correct level of care.
SM Lee said that aside from the full range of hospital services, the hospital will also provide long-term care services including daycare, home care, and nursing home and palliative care.
“This makes it much easier to right-site patients, and also a lot more convenient for patients to transition seamlessly from treatment to convalescence, and receive the appropriate care in one place,” he added.
The hospital also uses technology to raise operational efficiency. It has an automated pharmacy and an automated laboratory for blood specimens, both of which reduce manpower needs and human error.
Patients are also provided with bedside terminals (PBTs) that allow them to engage more fully with their care plan.
Quipped SM Lee: “The PBT also functions like an inflight entertainment system where patients can order their preferred meals or even watch YouTube videos! Presumably, not too exciting ones.”
Thanking Ms Jennie Chua, chairman of the WH campus, Mr Lee noted that some of the touches that make it “a very woke hospital” must have come from her. Meals at the hospital include mutton vindaloo, plant-based mapo tofu and even Irish stew.
Ms Chua previously oversaw the establishment of the Khoo Teck Puat Hospital in Yishun.
Opening of Woodlands Health eases load of other hospitals, including their emergency departments
By Salma Khalik, Senior Health Correspondent, The Straits Times, 14 Jul 2024
The opening of the Woodlands Health (WH) campus has been a boon to Madam Sundrampillai Indrani, 69, who suffers from severe back pain. She was given a polyclinic referral to Tan Tock Seng Hospital (TTSH) in February, but the earliest available appointment date was five months later.
Meanwhile, her back pain got worse. In April, WH, which comprises a hospital, community hospital and medical centre, got in touch to ask if she would like to see one of its doctors instead. She could do so in early June, shaving more than a month off her TTSH wait.
“It felt like a blessing, not just because it was nearer to where I live, but more importantly, because the pain was getting worse and I couldn’t even stand,” she said. She has since seen a doctor and gone for two physiotherapy sessions, and can now walk with less pain.
Madam Indrani is among more than 1,300 patients who had appointments to see specialists at Khoo Teck Puat Hospital (KTPH) or TTSH but have moved to WH.
Mr Joe Sim, group chief executive officer of National Healthcare Group (NHG), which runs all three hospitals, said: “We noted in May that some patients who initially had to wait for a specialist outpatient clinic (SOC) appointment in two months were able to get their SOC appointment in WH within two weeks.”
Woodlands Health, which was officially opened by Senior Minister Lee Hsien Loong on July 13, has helped to ease the load of not only outpatient clinics – but also KTPH’s emergency department (ED). Between May 2 and June 15, about 350 patients were transferred from the latter to WH.
These were mostly patients who needed urgent care, but whose conditions were not life-threatening. They were conveyed between hospitals with WH’s hospital transport. A WH spokesman said about seven were transferred daily, but the number could go up to as high as 18 a day. This has eased the bed occupancy rate at KTPH to around mid-90 per cent daily, down from 100 per cent.
Earlier in 2024, some patients who needed to be hospitalised at KTPH had to wait two days or more before they were moved to a ward.
Added Mr Sim: “WH clinicians were stationed at the ED of KTPH to triage and transfer suitable patients to WH since its opening in May 2024. This has enabled more timely and accessible care for our patients, improving the overall management of specialist appointments and bed capacity.”
He described the cooperation as a “one NHG effort” as they all belong to the same healthcare group.
One of three public healthcare clusters in the country, NHG takes care of the medical needs of people living in central and northern Singapore. The other two clusters are SingHealth in the east and the National University Health System in the west.
With the opening of the new hospital, Singapore now has nine public general hospitals. Two more, in Bedok and Tengah, are in the pipeline.
Located at 17 Woodlands Drive 17, WH, which has about 2,400 clinical staff, has 460 beds in use now. It will have a total of 1,400 acute, community and long-term care beds when it is fully opened. There are also provisions to add 400 beds in the future if the need arises.
With acute and community hospitals sharing the same building, patients can be moved seamlessly from acute to step-down care, such as medical, nursing and rehabilitation, with the same doctors in charge.
Aside from the integrated acute and community hospital, the 7.7ha facility has a medical centre with specialist clinics and a long-term care facility.
WH is built with possible future pandemics in mind. It has one negative pressure ward and 60 rooms that are negative pressure-ready. Negative pressure prevents any contaminated air in the ward or room from flowing into the corridor.
Its ED has eight resuscitation rooms, of which two have been designated for patients with infectious diseases. There is also a large sheltered area adjacent to the ED ambulance bay that can be converted to hold patients temporarily.
The hospital wards have built-in additional points to provide oxygen and suction capabilities so extra beds can be included if needed. The same applies to all the cubicles in the ED so they can accommodate two beds.
The hospital has even put power points in its trauma lifts, in case of emergencies and if electricity is needed to power equipment to sustain a patient.
But it is not all about resources and infrastructure. In planning the hospital, the patient’s mental well-being is also a priority.
Originally, the hospital was positioned next to a park. WH did a land swop with NParks so the building extends into the original parkland, with 1.5ha of the parkland now sited between two of WH’s buildings to form a Healing Garden.
The Healing Garden is looked after by NParks, and is the largest purpose-built therapeutic garden, said SM Lee, who added that it “creates a calming and inviting environment, where patients can undergo ‘green therapy’”.
One of the buildings facing the garden is a 322-bed nursing home run by Ren Ci. The charitable Buddhist organisation, with 30 years of experience in the healthcare sector, also runs a community hospital, a chronic sick unit, nursing homes, as well as senior care centres and an active ageing centre.
Dr Jamie Mervyn Lim, CEO of Ren Ci Hospital, said the proximity to WH allows for a shared care model. “We can reduce polypharmacy, streamline specialist outpatient clinic appointments, as well as facilitate advance care planning and symptom control for patients with complex care needs,” he said.
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