Ministry of Health: Singapore's healthcare model does not need to learn from Europe

On March 6, 2024, Singapore's Minister of Health Ong Ye Kung answered a question from MPs on the ratio of emergency rooms and doctors to population.

The following is a translation of the Singapore Eye based on Parliamentary sources:

Sengkang GRC MP Mr Lim Chi Wee: I would like to make the point mentioned by the Minister that 40% of cases in emergency rooms (ED) are non-emergency. Of course, to be fair, I recognise that this kind of behaviour is not unique to Singapore. In the United States, emergency rooms are also often overcrowded due to overuse, albeit for different reasons, related to uninsured. Therefore, I believe that the proposal to expand the 24-hour Emergency Center (UCC) is both complementary and distinct from the overall capacity issue.

So my first question is, if the Ministry of Health agrees that UCCs can indeed be part of the secondary care landscape, how can we increase their use? What kind of incentives or educational efforts can the Ministry of Health provide to get non-emergency cases to choose to go to the UCC instead of our emergency room?

My second question has to do with the ratio of doctors to population that he mentioned. He mentioned that Japan has a similar proportion in the face of a large elderly population. But dare I say that the European countries he mentioned are actually more adequate in terms of medical personnel to cope with super-aging societies. In this regard, I wonder if the Ministry of Health will consider increasing the number of medical schools that admit foreign origins. After all, as he said, the competition for talent is global, so it doesn't seem necessary to further restrict us from hiring from abroad.

Mr. Ong Ye Kung: I don't think we should be useful to describe the UCC as whether the Ministry of Health agrees with them. We came up with the UCC. In fact, the first one to be launched was in the Sembawang GRC, which over the years has greatly helped the emergency room of Khoo Teck Puat Hospital and proved to be useful. As I mentioned earlier, if necessary, if we need to build more UCCs – which is a proven model – we will consider doing so.

However, there are other models that are also quite competitive. GPFirst in the east is also doing well. So, we can consider both models together and see which one is more suitable.

As for the issue of the ratio of doctors to the population, I have already touched on some of them in my previous statements. The ratio of doctors to population in Europe is a little higher than elsewhere. Although compared with the developed countries in Asia, we are about the same. But I don't know why. Some say it may be a tradition of the welfare state, while others say they don't do a good job of manpower planning. But you see, things aren't all so rosy in Europe.

The Netherlands, for example, stopped using nursing homes because there were not enough doctors or nursing staff. So now, if you're an elderly Dutchman, the usual mode of care is at home, with a nurse or nurse coming several times a day. Doctors in Germany also told me that they were in a difficult situation. The hospitals in the various states are not properly allocated, that's what they told me. So, despite the abundance of doctors, they are not providing the medical care that people need.

So, I don't think this question can be just a number. Where doctors are trained, the specialized training they receive, how the health care system as a whole works, and whether the country's insurance system or welfare policies are causing an oversupply all need to be taken into account. Therefore, we need to consider these factors holistically when facing medical challenges.

As for the proportion of doctors and population in our local area, it has been increasing. Ten years ago it was about 2.0, now it's 2.6. So in the future, maybe the three local medical schools can recruit more students. There is also the possibility that more Singaporean doctors who have been trained overseas will come back, and these are all things that we have to consider. Our ratio of doctors to population has been increasing, and our population is also aging, so it is likely to increase again. But I have to warn you that the European model may not be suitable for full copying.

The following is the content of the question in English:

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.

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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.

CF丨Editor

Edited by CF丨

Singapore Parliament丨Source

Singapore Parliament丨Source

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