Today's report of a nation-wide bed crunch at public hospitals is a damning indictment of the Singapore healthcare system. A PAP MP has noted that spikes in admissions correlate with the holiday season (as opposed to a spike in illness), but this seasonal effect, given that a track record for it has existed for a long time, should have been corrected for ages ago. Why does overcrowding continue to occur with such severity?
This nonsense about "holiday season admits" misses the point entirely. The "spike in illness" contrast is a distraction from the question of whether provision of healthcare is generally inadequate. Let us consider a larger reason for the inadequacy of the healthcare system: The diversion of public resources to serve medical tourists.
Indeed, the writer of a Feb 2013 letter to the Straits Times titled "Public Hospitals Should Stay Out of Medical Tourism" is correct.
There are pundits and apologists who make claims that "few foreign patients are treated at public hospitals" (actually 30% of them are) and that "medical tourists are few in number" (actually, medical tourists spent SGD 1 billion here in 2011 in contrast to government healthcare expenditure of SGD 4.08 billion that same year). Based on those faulty premises, they conclude that medical tourism does not contribute to hospital overcrowding. Aside from actually having a look at the data, they should learn a bit about basic operations management before running their mouths and misleading people.
In the Singapore setting, the presence of medical tourism causes more space to be allocated to pricier wards, meaning a reduction in the number of beds available to non-affluent patients and a net reduction in the number of beds (pricier wards are more spacious and "private"). This means a reduction in capacity that makes hitting full occupancy in class C wards (and sometimes class B wards) a more regular occurrence.
Furthermore, medical tourists typically utilize only the most experienced physicians. Thus, one can see how letting foreign patients use public hospitals helps senior doctors seeking to eventually start private practices build a customer base. Hospitals should not aid and abet this because it is simply against their interests from a staffing perspective and the interests of Singaporeans at large.
We must get our priorities right. Public hospitals should prioritize serving Singaporeans (and PRs). Furthermore, it is Singaporeans who have laboured to create the hospital infrastructure (among other things) to give themselves and their descendants better lives. Thus it is clear what should be done from the "moral perspective".
Medical tourism should be left to the private medical tourism industry. If it is a big business, then one might expand the medical school and increase enrolment, while being careful to only graduate students who show themselves to be qualified. As is well-known, there are more qualified applicants than places. So this is doable. Those who find that medicine is not their cup of tea may reasonably transfer to related courses of study (such as pharmacy, which is actually about medicine, or even more distant relations like psychology).
On the matter of "career progression" from public hospitals to private practice, if doctors would like to make the transition, they should do so at their own risk and not seek to build a foreign client base while working for the government and using government equipment. (In other industries, there are often legal implications for "client poaching".) Public hospitals are not "business incubators".
It is my contention that by realigning the priorities of the medical system and public hospitals back to serving the public, the problems of overcrowding can be substantially ameliorated, and the numbers clearly suggest that this is true.