Synching healthcare for an ageing population
Singapore’s population is ageing rapidly and the repercussions are being felt across the country. Nowhere is this more evident than in the healthcare system, where policymakers have to make decisions about hospitals, social services and manpower for which the benefits may not be seen for several years.
Keeping the system in sync as we build up healthcare capacity to respond to growing needs is a challenge of heroic proportions.
As an illustration of the challenge: When a new acute care hospital opened recently, it was noted that instead of alleviating the hospital bed crunch, the hospital immediately filled up and waiting times in the A&E seemed just as onerous. Intuition seemed to suggest that new capacity should visibly alleviate some of the pressure. Why wasn’t there prolonged relief?
One explanation is that the capacity of one more hospital was still not sufficient to accommodate demand for hospital admissions, and the relief — such as it was — lasted only as long as it took for the new hospital to fill it up. Like a bathtub filling faster than it is emptying, increasing the size of the bathtub provides only a temporary measure.
The crucial question for Singapore policymakers is not simply how many hospitals to build, but how to decrease inflow and increase outflow so that we do not need as many hospitals.
CARE IN THE COMMUNITY
Hospitals are wonderful for what they are especially good at: Urgent, high-intensity and specialty services.
But they are also expensive and hospital stays can be burdensome to patient and families, and are associated with risk, such as hospital-acquired infection.