My father came down with a urinary tract infection last week. At his age, the Emergency Department did not want to risk giving him only outpatient treatment, and decided he should be hospitalised for closer observation. That led to four hours’ waiting for a bed at the National University Hospital.
It so happened that a few days earlier, the Straits Times had a story about the shortage of beds. Again.
The newspaper reported:
It is crunch time again at some public hospitals, even with the opening of the 500-bed Khoo Teck Puat Hospital (KTPH) in Yishun less than a year ago. Of the seven public hospitals, three are particularly affected: Changi General Hospital (CGH), KTPH and Tan Tock Seng Hospital (TTSH). The last time public hospitals faced a major bed crunch was in the months leading up to the opening of KTPH in August last year. The worst-hit then was TTSH, which curtained off parts of its corridors to add more beds. It also diverted ambulances to other hospitals almost on a regular basis. The current situation is not yet that bad, but appears to be heading that way rapidly. The hard-pressed hospitals have initiated contingency plans.
Taking all public hospitals together, the occupancy rate has ranged from 75 per cent to 85 per cent since August last year, said the Ministry of Health (MOH). A spokesman said: “We expect demand for beds to rise in tandem with a growing total population and a higher proportion of elderly residents.” In September last year, hospital bed occupancy ranged from 46 per cent at AH to 85 per cent at TTSH.
The latest figures for March this year showed occupancy ranging from 55 per cent at AH to 89 per cent at CGH. TTSH, KTPH and National University Hospital all had occupancy rates above 85 per cent in March. More recent weekly figures for April and last month showed that at midnight – the time at which bed occupancy rates are pegged – there were days when these hospitals were more than 90 per cent full. As empty beds include those in intensive care – which must always have some empty beds for emergencies – and isolation wards, there could be very few ward beds available for patients arriving early the next day.
While MOH said the median waiting times for a bed “remained at the range of one to 1.5 hours with the occasional spike”, these spikes are happening more often. In the week of May 15, TTSH had three days when the median waiting time was three hours or more – so only half the patients got a bed within three hours.
— Straits Times, 4 June 2011, Bed crunch time again at some public hospitals, by Salma Khalik
My father must have been caught up in one of those spikes, waiting four hours.
A follow-up article a week later showed the situation to be persisting, but also added that the increase in the number of patients seemed quite sudden:
Industry watchers attribute the high bed demand to the rapidly ageing population. What is surprising is that this appears to have happened overnight.
Inpatient increases in both 2008 and 2009 were less than 1 per cent a year.
Statistics for last week showed four of the six hospitals had more than 85 per cent of their beds occupied at midnight – when counts are taken – on most days.
The exceptions were Singapore General Hospital (SGH), with occupancy rates hovering at 84 per cent, and Alexandra Hospital (AH), where more than one in four beds remained empty.
At Changi General Hospital (CGH), the worst-hit of the six, bed occupancy topped 90 per cent on three days and 95 per cent on three other days last week.
KTPH had occupancy at or above 90 per cent on five of the seven days last week.
Former health minister Khaw Boon Wan had said he wanted public hospitals to have average occupancy rates of 85 per cent for maximum mileage.
Private hospitals generally prefer lower rates of 70 per cent, as anything above that could mean having to turn away patients on peak days.
— Straits Times, 10 June 2011, Jump in number of inpatients at hospitals, by Salma Khalik
This second report was accompanied by a table showing the number of in-patient admissions from 2005 to 2010, which you can see at right. The total for 2010 was 9.7 percent higher than 2005, representing an increase of about 2 percent per annum.
9.7 percent had a familiar ring. This was because last July, in the post Bed crunch continues even as new hospital opens, I presented a table in which I showed that the new hospital would increase bed capacity by 9.6 percent, the first increase of any kind since Changi General Hospital in Simei opened in 1998. In other words, the growth in in-patient admissions have fully taken up the extra capacity afforded by the new Khoo Teck Puat Hospital. That we are facing a bed shortage again is thus easily explained.
That the government added 9.6 percent more beds a long 12 years after Changi General Hospital, with a further 6.9 percent more (to make 16.5 percent increase) by 2015 when the new hospital in Jurong is slated to open indicates that they are planning a gradual increase in capacity of 1 percent per annum. The year 2015 would be 17 years after Changi Hospital’s opening in 1998.
On the face of it, this ties in with the statement in the second Straits Times report that “Inpatient increases in both 2008 and 2009 were less than 1 per cent a year.” But was this rate of increase because the numbers of ill people increased 1 percent a year, or because we could only admit 1 percent more per year, with the additional sick ones refused admission?
I decided to test this, especially in view of the clue given in the first Straits Times report, that “We expect demand for beds to rise in tandem with a growing total population and a higher proportion of elderly residents,” attributed to an unnamed spokesman from the Ministry of Health. This suggests that bureaucrats are (in theory) planning increases with demographic data in mind.
Now, it so happened that we had a census in 2010, and the Statistics Department even published a neat little table titled “Elderly population” (see Link). There was a similar table from Census 2000, enabling me to calculate the percentage increase of elderly Residents (i.e. citizens + Permanent Residents):
As you can see, the total number of elderly persons grew 48.7 percent over the decade, or about 4 percent per year on a compounded rate. The number of the very elderly (i.e. over 75 years old) grew even faster, at about 5.5 percent per year, to total about 70 percent over ten years.
How is it that the ministry can plan for 1 percent per annum growth when data so easily available produces a figure several times faster?