衛生部：新加坡醫療模式無需學習歐洲

2024年3月6日，新加坡衛生部長王乙康回答議員有關急診室、醫生人口比的議題。

以下内容為新加坡眼根據國會英文資料翻譯整理：

盛港集選區議員 林志蔚先生：我想談談部長提到的急診室（ED）中40%的病例是非緊急情況的觀點。當然公平地說，我認識到這種行為不僅僅是新加坡獨有的。在美國，急診室經常也因過度使用而擠滿人，盡管原因不同，與無保險有關。是以，我認為擴大24小時急診中心 （UCC）的建議既是補充的，又是與整體容量問題不同的。

那麼我的第一個問題是，如果衛生部同意UCC确實可以成為二級護理格局的一部分，我們如何增加它們的使用率？衛生部可以提供什麼樣的激勵措施或教育努力，讓非緊急病例選擇去UCC而不是我們的急診室呢？

我的第二個問題與他提到的醫生與人口比例有關。他提到日本在面對龐大的老年人口時有着類似的比例。但我敢說，他提到的歐洲國家在醫療人員方面實際上更為充足，以應對超級老齡化社會。對此，我想知道衛生部是否會考慮增加承認來自外國的醫學院的數量。畢竟，正如他所說，人才競争是全球性的，是以似乎沒必要進一步限制我們從國外招聘人才。

王乙康先生：我不認為我們應該将UCC描述為衛生部是否同意它們是有用的。我們提出了UCC。事實上，第一個啟動的是在三巴旺集選區，多年來它極大地幫助了邱德拔醫院的急診室，被證明是有用的。正如我之前提到的，如果有必要，如果我們需要建立更多的UCC – 這是一個經過驗證的模式 – 我們将考慮這樣做。

不過，還有其他模式也挺有競争力的。東部的GPFirst也做得不錯。是以，我們可以綜合考慮兩種模式，看看哪個更适合。

至于醫生和人口比例的問題，我在之前的發言裡已經談到了一些。歐洲的醫生和人口比例比其他地方高一點。雖然在亞洲發達國家間比較，我們差不多。不過我也不太清楚為啥。有人說可能是福利國家的傳統，也有人說他們對人力規劃沒搞好。但你看，歐洲的各國情況也不都那麼美好。

比如說，荷蘭就停止了療養院的使用，因為沒有足夠的醫生或者護理人員。是以現在，如果你是荷蘭老年人，通常的護理模式就是在家裡，有護工或者護士每天來幾次。德國的醫生也告訴我，他們現在的處境挺困難的。各個州的醫院都配置不夠合理，這是他們告訴我的。是以，盡管醫生多了，但他們也沒能提供人們需要的醫療服務。

是以，我覺得這個問題不能隻看一個數字。醫生在哪接受教育訓練，他們接受的專業教育訓練，整個醫療系統的運作方式，國家的保險制度或者福利政策是否造成了供應過剩，這些都得考慮進去。是以，我們在面對醫療挑戰的時候，需要全面考慮這些因素。

至于我們本地的醫生和人口比例，它一直在增加。十年前大約是2.0，現在是2.6。是以未來，也許本地的三所醫學院能多招點學生。也有更多在海外接受教育訓練的新加坡醫生回來的可能，這些都是我們要考慮的。我們的醫生和人口比例一直在增加，而且我們的人口也在老齡化，是以很可能會再增加。但我得提醒大家，歐洲的模式也許不适合完全照搬。

以下是英文質詢内容：

Assoc Prof Jamus Jerome Lim (Sengkang): I would just like to pick up on the point the Minister shared about the 40% of ED cases being non-critical. Of course, to be fair, I recognise that such behaviour is not unique to Singapore. In the US, ERs are often also flooded by overuse, albeit with different reasons that have to do with the uninsured. My suggestion for expanding UCCs is, therefore, I think, both complementary but distinct to the question of capacity in general.

My first question then is, if MOH agrees that UCCs can indeed be a complementary part of the secondary-care landscape, how do we increase their take-up? What sort of incentives or educational efforts can MOH provide to non-urgent cases to choose to access UCCs instead of our EDs?

My second question relates to his point about the doctor-to-population ratio. He shared that Japan has a comparable ratio in the face of a large elderly population. But I would venture that European countries, which he mentioned, are in fact better-prepared in terms of medical staffing for their super-aged societies. On that, I wonder if MOH will consider increasing the number of medical schools that it recognises from foreign countries. After all, as he said, the competition for talent is global and, so it seems unnecessary for us to further hamstring our efforts to recruit from abroad.

Mr Ong Ye Kung: I do not think we should describe as, whether MOH agrees that UCCs are useful. We came up with UCCs. In fact, the first one that started was in Sembawang group representation constituency (GRC) and it greatly – over the years – greatly helped Khoo Teck Puat Hospital’s ED, helped them manage their ED load and it has proven to be useful. And as I mentioned, if need be, if we need to set up more UCCs – this is a proven model – we will consider doing so.

1.15 pm

But there are competing models. GPFirst in the east has also worked quite well. So, between the two, either or, I think we should consider them.

As for doctor-to-population ratio, I explained to some extent in my speech, the European doctor-to-population ratio is somehow just higher than the rest of the world. Even in Asia, comparing developed economies, we are more or less about the same level. I do not know what is the reason, some say it is the legacy of the welfare state, others say they did not plan for manpower. But when you look at individual European countries, it is not that pretty a picture.

The Dutch, for example, they have stopped using nursing homes because there are not enough medical personnel nor doctors to man them. So today, if you are an old person in Holland, in Netherlands, the default care model is actually home care with a lay person, maybe a nurse, maybe an allied professional visiting you twice or three times a day. That is what they have resorted to.

Germany, the doctors there told me they are in dire straits. Across the states, the hospitals are not efficiently configured and that is what they told me and therefore they are also, despite having more doctors, not delivering the healthcare that the people need.

So, as I mentioned, it is just one number. It is not a numbers game. Where they are trained and what kind of specialty, how the entire system is run, whether the insurance system of that country or the welfare system is creating oversupply, all these play a part. So we take all these into consideration as we manage our healthcare challenge.

As to our own doctor-to-population ratio, it has been increasing. Ten years ago, it was about 2.0, today it is 2.6. So moving forward, there is some room for three local medical schools to take in slightly more perhaps. There is possibility of having more overseas-trained Singaporean doctors returning, all these we have to consider. Our ratio has been increasing, we are ageing, most likely we will increase further. But I would just caution the European model may not be the model that we want to emulate fully.

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