Singapore’s health system – efficient and effective?

A Facebook user, Catrina Wong, recounted her experience at the Singapore General Hospital (SGH) and KK Women’s and Children’s Hospital (KKH).

It all started when she felt acute pain on the left side of her lower abdominal area. She was rushed to the A&E department of SGH at about 9am. She took a barrage of tests – urine, blood, and X-Ray. But the hospital still couldn’t identify the cause of the pain. She was eventually examined by a doctor at about 6:30pm. That was about 9 hours after she first reached SGH.

The doctor at SGH who examined Catrina ordered an ultrasound scan. But the scan could only be done in two months’ time. Catrina was sent home with a bag of painkillers.

The pain persisted the next day. Unwilling to go through the long wait again, she went to Raffles Hospital (RH), which is a private hospital. She was immediately given painkillers. She also went for an ultra-sound scan, which revealed that she had a cyst growing next to her left ovary. According to Catrina, they medical staff at SGH did not detect this cyst.

An MRI was needed to determine the exact nature of the cyst. Catrina asked RH to refer her back to SGH for the MRI. After she emphasised the severe pain, she acute pain on the left side of my lower abdominal, SGH managed to schedule an emergency MRI for her. The cyst turned out to be endometriosis. Because of its size, Catrina would need an open surgery rather than a keyhole surgery to remove the growth.

Catrina was told that the earliest that the surgery can be performed was in two weeks’ time. According to Catrina:

“Even with extreme pain (which persisted even with pain killers), bleeding (light spottings) and numbness, I was told that’s the earliest date for surgery since the surgeon in KKH only works on Monday and operation theatre are fully booked.”

Catrina ended her post with a list of complaints about government hospitals:

“Just because government hospitals are subsidized doesn’t mean they can take people’s life lightly? Long waiting hours… And haphazard treatments or checks? And go home with 2 big bags of painkillers till we meet again… I try to survive on that 2 bags of painkillers and not rupture my cyst before my operation 2 weeks later…”

Are Catrina’s complaints valid? Are her experiences isolated? Or do most other Singaporeans have similar experiences with government hospitals? From my personal experience, I do hear of complaints from friends and relatives of having to wait for a long time before being able to get the necessary scan or medical procedure at government hospitals. In contrast, the wait to have those scans and medical procedures at private hospitals is drastically shorter. But the fees are also drastically higher.

The only study that examined in great depth different health care systems in the world was conducted by the World Health Organisation (WHO) 16 years ago, in the 2000. It was the only report so far that not only measured the health outcomes, but also attempted to measure whether the health systems met people’s expectations.

In that study, the WHO measured responsiveness. Responsiveness is defined as how well the healthcare system meets the expectations of people. It takes into account whether people felt that they were promptly attended to, and whether they were treated with dignity by health care professionals.

According to that study, WHO suggested that the responsiveness of Singapore’s public health care system was ranked 20th in the world. For comparison, the countries that WHO ranked to be more responsive than Singapore included USA (ranked first), Switzerland (2nd), Japan (6th), Australia (12th). Of the “developed” countries, WHO ranked Italy (22nd), Ireland (25th), and United Kingdom (26th) worse than Singapore.

So it seems that in 2000, Singapore’s public health care system was not very responsive to the needs and expectations of Singaporeans. But that was 16 years ago. Singapore has since increased our health care budget tremendously. The health care budget today is six times more than what it was a decade ago. Has the massive increase in health care budget resulted in an improvement in the quality of care?

According to Catrina’s experience, it would seem that we still have a long way to go before the performance of our public healthcare system meets the expectations of Singaporeans. Hopefully, with increasing health care budgets, we will see significant increases in the performance of our health care system, shorter waiting times, more affordable bills, and better health outcomes.

That said, nothing in the world is free. All good things come with a price. For better health care, what would we be willing to give up? Higher taxes? Lower spending in some other areas (e.g. defence, ministerial salaries)? Draw more from our net investments returns? Or run deficits and have future generations pay for our medical bills?

[Featured image: from Catrina Wong’s Facebook page]

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