Subsidy and Other Preoccupations 15

Great. angry doc devoted so many posts on means testing, and now they tell him it's bed availability he should be worried about.


Khaw: Treat hospital bed shortage with care
A bed for acute illness costs Govt $1,000 a day; heavy usage ups costs
Tan Hui Leng

The current high occupancy rate at some public hospitals is stressing doctors to discharge their patients, admitted Health Minister Khaw Boon Wan yesterday.

Occupancy has hit highs of more than 90 per cent for some hospitals recently, above Mr Khaw's ideal of 85 per cent. "When you run at over 90 per cent, it's very stressful," said the Health Minister, who was the chief executive of several hospitals from 1985 to 1992.

"Stressful in the sense that, every day, our doctors have to go down to beg the patients (to be discharged)."

Occupying a hospital bed for acute illness costs the Government an average of $1,000 a day, compared to "a few hundred dollars" for a community hospital bed.

This is "the cost to society", said Mr Khaw at the sidelines of an event yesterday. "If I don't actively shift patients down, our total cost will just be heavy."

Urging patients to cooperate with doctors to be relocated to suitable care institutes when they are fit enough to be discharged, he said: "Hopefully, people will be more circumspect."

"When we say we need to discharge you to a nursing home, it's not for frivolous reasons, we really need to free up those beds."

High occupancy rates do not allow for a sudden surge in patient numbers, he explained.

Last week, Today reported that some hospitals were facing a surge in occupancy, hovering at a 88-to-97-per-cent occupancy rate recently, a problem compounded by seasonal diseases such as the flu and dengue.

To tackle the problem, the Health Ministry will add a total of 67 new beds to the National University and Changi General hospitals over the next few months.

Earlier this week, Mr Khaw told Parliament that there will be a new hospital in the west in the "next few years".

This is in addition to the new Khoo Teck Puat Hospital in Yishun, which is being built.

Even with the current squeeze, the Health Minister said he is in no rush to implement means-testing in subsidised hospital wards.

Although earlier reports had quoted him as saying means-testing could start in 12 months, Mr Khaw said this may not be the case. His current priorities are the ElderShield review and another round of MediShield review to revise patient co-payment from the current 40 per cent down to 20 per cent.

Details about the revamped ElderShield scheme would be available by the end of June or early July.

Possible changes to Medisave may be introduced in the revamp as the ministry mulls a staggered withdrawal rate for those with bigger balances, he added.


Now there is already a ruling in place at the hospitals which allows for patients to be charged at the full (unsubsidised) rate if they choose to remain in the hospital even after they are deemed "fit for discharge" (usually after a grace period of a week or so). That being the case, angry doc wonders why doctors need to beg patients to leave. Are the patients staying on despite the withdrawal of subsidy (in which case the expectation that means testing will ease bed shortage will be proven wrong), or is it a case of the the ruling not being enforced?

The decision for fitness for discharge is a medical decision; the decision on what happens after that decision is made is an administrative one, and angry doc feels that doctors should not be made to beg patients to comply with an administrative decision.

But this situation raises another question: is the bed shortage due to an absolute shortage of beds with respect to real medical needs, over-subsidy, or just an ineffectual execution of a system which we already have in place to reduce over-staying? And is means testing a solution to our 'bed shortage', or do we just need a healthy dose of moral courage in deciding who gets a bed?