Debated in Parliament on 19 Jan 2015.
Ms Tin Pei Ling asked the Minister for Health in respect of increased expenditure in the public healthcare sector over the last five years (a) what percentage has been spent on (i) direct clinical services and (ii) administrative overheads respectively; and (b) how does the Ministry ensure equity of resource allocation among the various institutions.
The Parliamentary Secretary to the Minister for Health (Assoc Prof Dr Muhammad Faishal Ibrahim) (for the Minister for Health) : Mdm Speaker, the bulk of the expenditure in the public healthcare sector goes directly to medical and patient services. About 15%-20% of the public hospitals and institutions' expenditures are attributable to administrative functions, such as corporate services, human resource, finance, and IT. This is similar to other countries such as England, Canada and the Netherlands, and is lower than the United States which is reported to spend at least 25% of hospital costs on administration.
We are mindful of the need for our public healthcare institutions to keep administrative costs low and deliver healthcare services efficiently. This will help ensure that healthcare remains affordable and sustainable in the long term.
Ms Tin also asked about the allocation of resources among the institutions. The Ministry subvents the public healthcare institutions with block budgets. This is determined based on several factors, including workload, type of services provided, and the complexity of the medical conditions each institution has to manage. The block budget for each institution is reviewed regularly to take into account advancements in medical care, inflation, as well as the institution's workload and patient profile.
We will continue to refine the resource allocation to ensure that our public healthcare providers deliver services efficiently and achieve good health outcomes for Singaporeans.
Thank you, Mdm Speaker, and I thank the Parliamentary Secretary for the answer. I hear from the Parliamentary Secretary's reply that factors taken into account for the allocation include patient volume and workload. May I ask how will MOH ensure that the KPIs set in public hospitals will be in such a way that they
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would not drive unintended behaviours? For example, encouraging or perhaps pressuring patients to take on more procedures or more expensive procedures than necessary.
Madam, I would like to thank Ms Tin for her supplementary question. When we look at the performance of institutions as well as the hospitals and doctors, we have a holistic performance indicator. We recognise them for the things that they do, including the productivity of the institution and of the doctors as well, including the kind of clinical services that they do as well as teaching, research and administrative duties that they carry out. So, at the holistic level, we want to ensure that our stakeholders do the best for the patients and for the medical area that they are looking at.
At the MOH level, we do costing exercise where we work very closely with the institutions to ensure that our legislative framework is robust and, at the same time, we are able to meet the needs of the patients. On the other hand, at the institution level, each institution has its own governance framework. Maybe some of them would look at setting up an accreditation committee, peer review and even before the operation is carried out, there are pre-operation conferences to ensure that we take the appropriate treatment measures that set the best outcome for our patients.
Beyond the KPIs and budgetary framework, I would like to share with Ms Tin and Members that being doctors, they are professionals. Different doctors would have different opinions. So, I would like to urge patients to also refer to their doctors so that they can have second or third opinions, so that among doctors, they can talk to one another, discuss what would be the best treatment procedure for the patients so that they can provide the best outcome for them.
Mdm Speaker, supplementary questions, please. With respect to the 15%-20% of the budget directed towards administrative cost: firstly, is there a rising trend or a falling trend, and would MOH have some form of target and, if so, what is being done to meet that target?
Essentially, if you look at the international benchmark, there is no set or widely accepted benchmark around the world. What we have looked at are some basic and common benchmarks and the figures for each year vary for the different types of work. We feel that our current approach of 15%-20% is appropriate at this point in time. Nevertheless, as I had mentioned earlier, we will do our best to see how we can facilitate the process of working efficiently – and I think at the heart of the matter is always to meet the needs of our patients – because we want to take care of the patients and give them the best services and outcomes.
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Thank you, Mdm Speaker. I echo the hon Member's concern in his question. I would like to ask the Parliamentary Secretary as regards to not about just the trend of spending this amount of money on the administration but the headcount for administration. From what we can observe, the headcount for the administrative non-medical personnel seems to be growing much faster compared to the medical personnel in the hospitals.
Madam, I would like to thank the Member for the question. From his observation, he finds that the headcount has increased. With the services that we render to our people and with the ageing population, you would expect that there may be increases in the headcount. What is important is that while we try to reach out to our people in a manner that gives them the best option, we are also using technologies to see how we can facilitate treatment as well as the outcome for our patients.
So, we are mindful of the increases, if there are any, but like what I said earlier, there is no common track if you look at the different institutions that are available. What is key is how we can operate efficiently but not at the expense of our patients' needs.
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