20150427 Understanding why we are paying the price for PAP’s screwed up public healthcare system

Statistics have confirmed PAP’s planning has been overrated. Singaporeans have been misled for decades, no thanks to state propaganda and a system of no accountability, even for epic screw ups.

1 Where’s PAP’s long term planning?

According to MOH annual report 2001, the number of hospital beds grew from 4,150 in 1980 to 6,079 in 2000. (pg 91)
Image edited to exclude IMH figures.

By 2014, the total number of hospital beds at the 7 public hospital had increased by only 2,500 to 6598.

Hospital beds in 2014

Hospital Beds
SGH 1597
NUH 991
TTSH 1400
CGH 790
ALEXANDRA 400
KK 830
KTPH 590
Total 6598

Although the total population had increased by 3.055 million (see table below) in 34 years, the PAP increased the number of hospital beds by a mere 2500! Where is the common sense from our million-dollar perm secs and ministers? Are we supposed to be thankful for their initiative to be warded in tents and along hospital corridors?

Year No. of beds Citizens Foreigners Total Pop.
1980 4150 2194300 219600 2413900
1990 4678 2623700 423400 3047100
2000 6079 2985900 1042000 4027900
2014 6598 3343000 2126700 5469700

2 There was actually no long-term planning

As has been mentioned in an earlier post, URA’s 1991 Plan projected a population of 4 million after 2031. Swiss standard Goh Chok Tong, ex PM, managed to achieve this by 2000, 31 years ahead. There was really no long-term planning.

From 2000 to 2010, the number of hospital beds had remained unchanged while the population had increased by about 1 million. There was clearly no long-term planning.

No wonder there was a severe hospital bed crunch where certain operations had to be delayed for months in 2010.

3 Planning for medical tourism while ignoring of citizens’ well being

With total control of public resources for more than 3 decades, the never-mind-what-the-people-think PAP became focused on only generating profits for Singapore Inc, ie medical tourism.

Higher profits = Higher GDP = Higher remuneration and bonuses. In 2008, ministers, perm secs and even our ceremonial president received 19 months bonuses.

The Economic Review Committee, set up in 2001, had accepted the Healthcare Services Working Group’s (HSWG) recommendation to position Singapore as the Healthcare Hub of Asia. PAP became focused on the number of foreign patients, their added value to our GDP and the “lost opportunity”; it has never been concerned about citizens’ healthcare needs.

PAP’s “lost opportunity” (pg 7)

4 Today’s hospital bed crunch due to poor planning last century

If Goh Chok Tong did plan for a 100,000 annual rate of population increase, he should have communicated this to former health ministers and perm secs. In between 1997 and 2010, more hospitals should have been constructed. Their planning stage would have been in the 1990’s under health ministers Yeo Cheow Tong (1988 to 1990, acting only, 1990 to 1994, real minister), George Yeo (1994 to 1997) and Lim Hng Kiang (1999 to 2003).

These 3 ministers must have been sleeping on the job while Khaw Boon Wan, who took over from 2003 to 2011, deluded himself into believing we had an affordable and sound system. We still don’t.

khaw living in MOH dreamland

After being Health Minister for 7 years, Khaw was still totally disconnected from the reality of ordinary citizens ie many Singaporeans had to forgo unaffordable medical treatment. Hmm… how could my polyclinic visit cost more than a heart bypass operation? Shouldn’t medical treatment be free for all common ailments if a heart bypass really cost only $8?

5 How many A and B1 class beds are used for medical tourism?

According to Dr Tan Lip Hong, a GP working in the heartlands for 19 years, PAP has been “under-investing in healthcare infrastructure for decades”. On a visit to the CGH last year, he had observed “A and B1 class beds were only about half filled”.

This is not unexpected as $390 per day room rate in an A class ward is unaffordable to most Singaporeans. In order to fill A class beds, “our restructured hospitals actually send missions to Myanmar, the Middle East and Africa to advertise our services”.

6 How many beds are used for medical tourism?

The PAP has not been very upfront on the abuse of restructured hospitals for medical tourism. In his parliamentary reply to NCMP Gerald Giam, Health Minister Gan remembered “..foreign visitors take up less than 2% of our hospital beds..” This gives the impression that negligible public resources were used when in fact there was already a shortage for locals. How could the PAP still think of medical tourism when citizens are already suffering because of a chronic shortage of hospital beds?

In 2010, CGH had occasionally experienced 100% bed occupancy rate. In 2014, CGH’s CEO confirmed “its bed occupancy rate has crossed 100% for certain periods… some patients have waited more than 24 hours ..” One patient waited 48 hours for a B2 bed and couldn’t bathe for 2 days.

To ordinary citizens, whenever the hospital bed occupancy rate goes above 80%, it’s as good as 100%. This is because 22% of beds in public hospitals are non-subsidised and therefore unaffordable. If they are not meant for medical tourism, most should have been converted into lower class beds..

7 PAP still planning to fail

In Jan 2014, Minister Gan said he would try to resolve the bed shortage issue with an additional “1,900 acute hospital beds..” by 2020, bringing the total number of acute hospital beds to around 8,500. Did Gan remember the population will have increase by 600,000 in 2020, based on an annual increase of 100,000? It is likely we need 8,500 beds today and not in 2020. (see table below)

Year Population Hos. Beds
1980 2.4 mil 4,150
2020 6 mil 8,500 (est)

Has the PAP taken into account our ageing population and increased healthcare needs? Are acute general hospitals prepared to handle an emergency which affect hundreds/thousands of people?

Conclusion

With total control over the demand (population growth, tourists) and supply (public resources, tax dollars) in a 716 sq/km little red dot, planning for our healthcare needs should have been a breeze. Instead, our talented scholar ministers and perm secs somehow blundered.

Our healthcare system is screwed up by the PAP because:
– PAP has no long-term planning
– PAP’s priority is on profiting from public healthcare infrastructure, ie medical tourism
– PAP’s priority is not our healthcare needs.

PAP has engaged in propaganda to create the illusion of an affordable, world class healthcare enjoyed by citizens and showcases this to the world. PAP has become a victim of its own propaganda.

So long as there is no accountability, there will be more blunders from the PAP and, rest assured, citizens will be paying the price.

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9 Responses to 20150427 Understanding why we are paying the price for PAP’s screwed up public healthcare system

  1. nrek says:

    Lack of beds because people want to claim insurance. You can only claim your pte insurance plan if you are hospitalised.

    • Xmen says:

      No, it is pure bad planning. Between 1980 and 2014, the number of beds in public hospitals increased by 59% while the total population increased by 127%. Using the same bed-to-population ratio in 1980, there should be 9404 public hospital beds in 2014, not 6598 beds. That is a whopping 2800 missing beds. In fact, the number of beds should be even higher given the older age profile in 2014.

  2. phillip ang says:

    Our public hospitals are run on a just-in-time model for inventory – as if the government knows when each individual will be hospitalised.
    PAP conveniently forgot our older age profile when it had to increase govt expenditure but not when there’s revenue ie retaining more money in our CPF for govt use. 😦
    The hospital bed shortage is so serious and will only worsen with PAP’s population growth target.

    • Xmen says:

      Everything (transport, housing, healthcare etc) is breaking at the seams at the moment. I expect PAP to drastically slow down population growth, not because of popular opposition, but because the system is breaking down. However, they will certainly spin it as heeding people’s feedback. The sad thing is many people will fall for it.

  3. xyz says:

    My aunt is a retired nurse (back in the days when nurses were civil servants and had lifetime pensions). She saw this article and said that actually there are missing hospitals under the 1980 column. There used to be the old Changi Hospital, Toa Payoh Hospital, Jurong Hospital. I think there were also another 1 or 2 other govt hospitals.

    Hence back in 1980, there were in fact MUCH more than 4,150 public hospital beds.

    In other words, PAP actually REDUCED the number of public hospital beds from 1980 to the early 1990s, when PAP closed down the older hospitals. The reason was because PAP restructured & corporatized the govt hospitals & polyclinics to be more “efficient”, “competitive”, and more profit-oriented. The early 1990s was a time that made many Singaporean nurses angry & fedup at the govt policy, and many Singaporean nurses quit the restructured hospitals or took early retirement.

    • phillip ang says:

      Thanks.
      A lot of statistics have been concealed. Ordinary citizens are forced to bear the brunt of PAP’s flawed policies.
      Perm secs and senior civil servants are only focused on profiting from public resources on behalf of PAP in return for ‘protection’ for their failure.
      (Nursing is a very noble profession but corporatisation has resulted in wage depression for nurses. PAP equates foreign nurses to local nurses which is actually an insult. No fake degrees/diplomas?)

  4. wongcheokwan says:

    Medical safety PRECAUTION is most important.Do all nurses know how to extract a syringe of blood without introducing air into the blood vessel? It is air that causes blood clot inside the blood vessels.

    • xyz says:

      Air in blood vessels don’t cause blood to clot per se. However large air bubbles in vessels can result in interrupted blood flow or embolism. Large air bubbles in veins can cause pulmonary embolism where major lung vessel is blocked — resulting in pain on breathing, impaired gas exchange, oxygen desaturation, backflow of blood in right ventricle of heart, and can cause death. Most blood drawing is from veins. Nowadays very rare to introduce air into blood vessels, cause it’s done by vacutainer devices (using vacuum to automatically suck out the blood).

      Air in arteries is more serious and can result in heart attack or stroke. But drawing blood from artery is rare and can be done only by doctors (but most doctors in C-class, B2-class and even B1-class are foreigners today).

      My aunt became a clinical instructor after her retirement and she worked in a couple of restructured hospitals. Her experience is that foreign nurses are very “gung-ho” with invasive procedures on patients, because back in their home countries, even as students, they are strongly encouraged to “practice” on life patients — these are usually the poor people in their govt hospitals. Compared to local trained nurses where the overriding emphasis is on patient safety, and even after 3 years of basic training, S’pore staff nurses cannot do invasive procedures like cannulation, blood drawing, administering whole blood products, etc without going for additional training and approval by hospital.

  5. wongcheokwan says:

    @xyz

    Thanks for your comments. You understand very well the lurking bloody dangers.

    Inside my body blood doesn’t clot. If I get a cut, drops of blood flows out and clot in contact with

    the air. Best wishes.

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