The government has highlighted in the Population White Paper the healthcare infrastructure preparations for a possible 6.9 million population in the year 2030. Healthcare is a complex eco-system and hopefully planning has been holistic and beyond simply matching one or two parameters such as number of beds or number of healthcare professionals to population growth…
Will our Healthcare System be Ready?
From ‘Today’ 4 Feb 2013
The recently-released Population White Paper projects Singapore’s population to potentially increase to 6 million in seven years’ time and 6.9 million by 2030. The Government has sounded the reassurance that healthcare infrastructure is being ramped up and “the number of acute hospital beds will increase by 2,200, a 30 per cent increase from today”.
Health Minister Gan Kim Yong, over the weekend, reaffirmed that his ministry ensures its efforts align with the Government’s planning norm so that by 2030, “we will make sure that we have sufficient capacity to meet the population at that time”.
Is this enough?
The chart shows the number of acute hospital beds per 1,000 population in Singapore in 2011 and 2020 (projected based on the White Paper), compared with select Organisation for Economic Cooperation and Development (OECD) countries. Two observations jump out: Firstly, Singapore today has far fewer beds compared to many other developed countries.
Secondly, even with 2,200 additional beds in 2020, because of ongoing population growth, Singapore will increase by just 0.07 to 2.27 beds per 1,000 population, still far below the OECD average today of 3.4 acute hospital beds per 1,000 population.
However, unlike housing or transport, Singapore’s immigration-fuelled population growth may impact healthcare less severely. Age profile matters in health, and the conventional wisdom is that new citizens, Permanent Residents and migrant workers should be relatively young and hardly move the needle in terms of demand for specialist services and hospital beds. It is the elderly who form the largest users of in-patient care.
That said, there are still effects that warrant consideration as Singapore debates the White Paper.
USE OF HEALTH SERVICES
While newcomers may not tax in-patient services significantly, they will need primary care (general practitioners) and emergency services just like everyone else. Singapore already has over-burdened polyclinics and Accident and Emergency Departments across the country, and this will likely push waiting times up even more.
Let us re-examine the conventional wisdom. While newcomers may barely need inpatient care, their relatives will. My experience in the private sector has been that some expatriates of Asian origin do bring their parents to Singapore for healthcare. Of course, they seek private healthcare but remember we are an inter-related ecosystem and explosive demand in the private sector will undoubtedly lure more doctors out of the public sector and also increase healthcare costs nationally.
Our healthcare system is carefully balanced on a knife’s edge. For efficiency, we hover around the sharp inflexion point on the demand-waiting time graph, and even very small increases in demand can cause waiting times to spike dramatically. See how waiting times in the Emergency Departments can be “magically” cleared by discharging a handful of patients from the wards. Conversely, a few patients refusing to be discharged in the wards above can wreak havoc in the emergency room below.
OVERCROWDING AND MENTAL HEALTH
There is substantial literature on the effects of crowding in urban settings, and while the data is not conclusive, many academics generally agree that overcrowding is associated with increased levels of psychological stress.
It will be vital for policy makers to consider mental health issues in determining what levels of population densities are appropriate, and specifically make provisions for the lower socio-economic segments of society. As a Cornell University report highlights, “exposure to poor environmental conditions is not randomly distributed and tends to concentrate among the poor and ethnic minorities”.
INFECTIOUS DISEASES RISK
Related to high population densities is the risk of faster spread of infectious diseases. One paediatrician raised concerns that we would see more outbreaks of Hand, Foot and Mouth Disease, influenza and the like. More epidemics, and more severe ones. Also, would 6.9 million people make it harder to react and respond to a SARS-type outbreak? Are our public health crisis responses readied?
The health and healthcare effects of rapidly growing the Singapore population are not insubstantial. It is simplistic to consider only slivers of healthcare resources such as in-patient beds or the size of the healthcare workforce, but even the state of these do not reassure compared to other developed countries.
To allay Singaporeans’ concerns, the Ministry of Health should reveal the detailed projections and plans it has developed to cope with the multi-hued effects of population growth, including not just physical but also psychological health and pandemic preparedness.
Dr Jeremy Lim has held senior executive positions in both public and private healthcare sectors. He is currently writing a book on the Singapore health system. This is part of a series on health policies in Singapore.