SINGAPORE] As Singapore moves to adopt universal healthcare through MediShield Life, observers say the government needs to review its long-term care financing structure and explore community-based alternatives in view of the hospital bed crunch here.
The bed crunch is a problem that has grown with the population over the years.
Data from the Singapore Department of Statistics showed that the rate of increase in hospital beds from 2006 to 2013 did not match the rate of population growth.
Over the seven-year period, the total number of hospital beds went up by 508, from 11,527 in 2006 to 12,035 in 2013.
Between 2008 and 2011, there was a dip in the number of hospital beds.
This corresponds with the number of public and private hospitals here - 30 in 2006 which dipped to 29 in 2008 before going up to 31 in 2012. The number remained unchanged in 2013.
A breakdown of the data showed that the number of public hospital beds rose marginally, from 8,320 in 2006 to 9,387 in 2013, while private sector beds fell from 3,207 to 2,648 over the same period.
However, the country's total population during the same period grew from over 4.4 million to almost 5.4 million.
The rate of increase in hospital beds was just not enough to cater to the burgeoning population, health economist Phua Kai Hong pointed out.
"If hospital beds per 1,000 people are calculated including Singapore's non-resident population, as they too have to be served, then the ratios show a steady decrease from 2.62 in 2006 to about 2.23 in 2013.
"The situation for public sector hospital beds has declined from 1.89 per 1,000 population in 2006 to 1.74 in 2013."
Chia Shi-Lu, chairman of the Government Parliamentary Committee for Health, said that increasingly, demand for hospital beds comes from elective patients, and a simple way to alleviate the bed crunch is to cut these admissions.
The move would free up beds for emergency patients, while elective patients would have to wait longer for their procedures.
The global trend, said Dr Chia, is to reduce hospital admissions, so hospitals are getting smaller as the elective procedures are done in day surgery or short-stay settings, with the use of step-down community facilities.
"Similarly, many emergency admissions can actually be dealt with in the community with appropriate primary care, but that framework is still a little lacking in Singapore," noted Dr Chia.
In January, Health Minister Gan Kim Yong spoke of plans to ramp up the supply of hospital beds. He said 1,200 beds will be added this year, of which 500 are to come from Ng Teng Fong General Hospital by end-2014.
By 2020, another 10,000 beds will be created.
In all, six new hospitals will be added by 2020.
With the ramp-up in supply, the rate of hospital beds per 1,000 population is estimated to jump to more than 4.20 by 2020, if the total population remains unchanged from 2013.
But is this sustainable?
The rise in demand for hospital beds comes on the back of a rapidly ageing population, when baby- boomers are entering retirement.
Dr Phua cautioned that health policies must be calibrated carefully to avoid over-compensating the supply side.
He urged the ministry to adopt a "total systems approach" - to not only look at financing long-term care but also exploring community-based alternatives.
Dr Chia expressed similar concerns, pointing out that the oversupply of beds may encourage admissions and shift the focus away from non-hospital-based care.
Both men agreed that the long-term solution is to focus on primary and preventive health as the key building block of Singapore's healthcare system, a move the ministry has embarked on.
In the week of June 30, data from the Health Ministry's website stated that the bed occupancy rate for the six hospitals ranged between 77.2 per cent and 97.9 per cent.
The bed crunch is a problem that has grown with the population over the years.
Data from the Singapore Department of Statistics showed that the rate of increase in hospital beds from 2006 to 2013 did not match the rate of population growth.
Over the seven-year period, the total number of hospital beds went up by 508, from 11,527 in 2006 to 12,035 in 2013.
Between 2008 and 2011, there was a dip in the number of hospital beds.
This corresponds with the number of public and private hospitals here - 30 in 2006 which dipped to 29 in 2008 before going up to 31 in 2012. The number remained unchanged in 2013.
A breakdown of the data showed that the number of public hospital beds rose marginally, from 8,320 in 2006 to 9,387 in 2013, while private sector beds fell from 3,207 to 2,648 over the same period.
However, the country's total population during the same period grew from over 4.4 million to almost 5.4 million.
The rate of increase in hospital beds was just not enough to cater to the burgeoning population, health economist Phua Kai Hong pointed out.
"If hospital beds per 1,000 people are calculated including Singapore's non-resident population, as they too have to be served, then the ratios show a steady decrease from 2.62 in 2006 to about 2.23 in 2013.
"The situation for public sector hospital beds has declined from 1.89 per 1,000 population in 2006 to 1.74 in 2013."
Chia Shi-Lu, chairman of the Government Parliamentary Committee for Health, said that increasingly, demand for hospital beds comes from elective patients, and a simple way to alleviate the bed crunch is to cut these admissions.
The move would free up beds for emergency patients, while elective patients would have to wait longer for their procedures.
The global trend, said Dr Chia, is to reduce hospital admissions, so hospitals are getting smaller as the elective procedures are done in day surgery or short-stay settings, with the use of step-down community facilities.
"Similarly, many emergency admissions can actually be dealt with in the community with appropriate primary care, but that framework is still a little lacking in Singapore," noted Dr Chia.
In January, Health Minister Gan Kim Yong spoke of plans to ramp up the supply of hospital beds. He said 1,200 beds will be added this year, of which 500 are to come from Ng Teng Fong General Hospital by end-2014.
By 2020, another 10,000 beds will be created.
In all, six new hospitals will be added by 2020.
With the ramp-up in supply, the rate of hospital beds per 1,000 population is estimated to jump to more than 4.20 by 2020, if the total population remains unchanged from 2013.
But is this sustainable?
The rise in demand for hospital beds comes on the back of a rapidly ageing population, when baby- boomers are entering retirement.
Dr Phua cautioned that health policies must be calibrated carefully to avoid over-compensating the supply side.
He urged the ministry to adopt a "total systems approach" - to not only look at financing long-term care but also exploring community-based alternatives.
Dr Chia expressed similar concerns, pointing out that the oversupply of beds may encourage admissions and shift the focus away from non-hospital-based care.
Both men agreed that the long-term solution is to focus on primary and preventive health as the key building block of Singapore's healthcare system, a move the ministry has embarked on.
In the week of June 30, data from the Health Ministry's website stated that the bed occupancy rate for the six hospitals ranged between 77.2 per cent and 97.9 per cent.
