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Dear SDP Healthcare Panel,
Thank you for a well-written and well-argued
report. There are points and arguments within the proposal well-worth looking at and arguing for.
My primary concern is the lack of details vis-a-vis the containment of healthcare costs of the conversion of all wards to two-bed wards and the idea of doing away with class distinctions.
The conversion of C-class and B-Class wards to A-Class wards with no thought to cost-effectiveness or, for that matter, deliverables is cause for concern.
There may be flaws in the Medifund system but your plan that the government pay’s 90% and the people pays 10% without an effective cost-containment structure will do nothing for effective cost control.
Yap E K
Dear Mr Yap,
Converting all wards to 2-bedders would not be possible in current hospitals. There will still be different bed standards. That is why we recommend a hospital admission policy that fills 1-bedders first, then 2-bedders, etc. The minimum bed standard is expected to be 4-bedders in existing hospitals.
For new hospitals, however, the wards will be built on a 2-bedded standard, we do not recommend 4-bedded wards. The 2/3-bedded norm is in line with recommendations in other developed nations for infection control reasons (see below).
The SARS crisis in 2003 has exposed the woefully inadequate bed norms in our public hospitals, as well as segments of our healthcare infrastructure which were ill-prepared to cope with a major infectious disease epidemic. This doesn’t mean that there will be no single-bedders. Such wards will still be available but dictated by treatment norms, e.g. isolation wards for immunocompromised patients.
Having a uniform bed norm and a single-ward class will also remove inequities in patient care and delivery, as top specialists will no longer be motivated to confine their expertise to only the richer patients. Moreover, infection control will be enhanced, and removal of the accommodation frills and luxuries seen in today’s paying wards will result in a substantial reduction in delivery cost.
Maximum consideration would be given to providing a conducive and private environment for the patient to recover by the use of good architectural design, panels, screens and other innovative methods.
As to the concern regarding the proportion of government to private expenditure, we recommend a ratio of around 84:16. This excludes private healthcare. Taken as a whole (including private healthcare spending), the government spending on healthcare (GHE) is estimated to be about 71% of Total Healthcare Expenditure (THE).
We do not think that it is possible to continue with the 3M model because it is fundamentally flawed. No amount of tweaking of the 3M model can change this fact.
Because of information asymmetry, healthcare cost is in large part not driven by patient demand. It is impossible for a patient – when a doctor, for instance, prescribes him one tablet of antihypertensive a day – to ask: “Doctor, I would like to take an extra tablet a day.”
Rather, cost is largely provider-driven. As a large proportion of healthcare is still provided by the public sector, if we return to the basics and base our clinical practice on evidence-based (and not commercially-driven) principles, we can ensure that the patient receives only the necessary and appropriate care he needs.
Under our plan, the government will administer a single-payer health fund as well as remain the single largest provider of not-for-profit healthcare services. This eliminates the incentive for potential abuse of the system by either user or provider. The single-payer system also allows for the efficient implementation of strict compliance and audit measures to contain healthcare costs.
SDP Healthcare Advisory Panel
The majority of Singaporeans, especially the older generation, are frugal by nature. They tend to consider a 2-bedded hospital ward, as proposed in the healthcare plan, a luxury (thus, costly).
Ordinary Singaporeans I spoke to are not ready for it, because they are already accustomed to the option of either 4-bedded or 6-bedded wards under the current system.
We are not proposing that all wards become luxury A-class wards. Much of the frills that we see in the public ‘Restructured’ hospitals resemble 5-star hotels which are unnecessary.
Our idea of 2-bed wards is to provide patients with quality treatment and recovery without the frills that unnecessarily add on to costs.
More importantly, from an infection control point of view, rooms with more than two patients are no longer acceptable in developed countries.
A hospital in Chicago which treats a huge number of homeless people and drug users has switched to a 1- and 2-bedded system as it is more cost-effective than larger wards and treating them for the infections that they acquire in hospital.
Locally, SGH data showed that the vancomycin resistant enterococcus epidemic (VRE) was concentrated in the crowded C-class wards. Even SARS affected patients only in the 4-bedded and six-bedded units but not the 2- or 1- bedded ones.
The trouble is that as the costs of these hospital acquired infections are borne by the patients, they are not obvious to those who have not been affected.
SDP Healthcare Advisory Panel
Are hospitals safe?