SINGAPORE- The bed crunch in hospitals is not a new phenomenon ("Tackle bed crunch now"; last Tuesday).
That situation existed decades ago when I graduated, and will remain so regardless of the number of new beds and hospitals that the authorities add.
There are several causes, and solutions must be tailored to them.
First, Singapore is a small country with many well run, heavily subsidised public institutions. This allows easy access by the public. The heavy subsidies also encourage visits to the hospital at the slightest discomfort.
Second, our health system is developed with emphasis on acute and tertiary care. This has produced a population which will seek specialist and hospital care as their first and only option.
Third, the emergency departments and polyclinics are staffed by relatively younger doctors. Although these doctors are well trained and qualified, referring and admitting patients to the hospitals is a skill honed by experience.
Fourth, there are unseen pressures faced by the physicians in discharging patients. There are reasons other than clinical ones to consider. For instance, physicians may be wary of complaints.
Fifth, our society has evolved from a village to a modern one and family size has shrunk. There is less help available within the community and the family now to look after the discharged member.
Here are some suggestions.
First, our population needs to see hospitals as acute-care facilities where urgent and immediate treatment is offered. Post-treatment rest and recuperation must be done outside hospitals. Senior doctors can be put in charge of the effective discharge of patients daily.
Second, discharged patients can be referred to primary care physicians and private general practitioners (GPs) for follow-up. This will prevent the hospital outpatient services from being swamped.
Third, give the public more subsidies and incentives to first seek treatment at private GPs. This can be offered in addition to the current Community Health Assist Scheme.
If it is obviously cheaper to see a private GP, patients are less likely to visit the polyclinics and hospitals. Those who turn to private GPs and help alleviate the bed crunch should be rewarded with some form of incentive.
All these can be implemented easily and immediately while we wait for new facilities to be ready.
Leong Choon Kit (Dr)
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