Private Hospitals Part 3 - Show Me The Money

I was waiting for someone to bring this up, and my wish came true. :)

Printed in the Forum Page today:

I am heartened to read that private hospitals are appropriately staffed and equipped to handle all manner of emergencies around the clock ('Raffles Hospital well-equipped to handle multiple trauma cases round the clock'; last Thursday).

I am, however, less certain that the majority of patients picked up by the Singapore Civil Defence Force (SCDF) can afford to pay for this level of care at private hospitals.

The existing policy of taking them to the nearest public restructured hospital probably serves the needs of most patients well, given Singapore's small size, well-placed public hospitals and good road transport infrastructure.

SCDF ambulances may be abused if patients can decide where they want to be taken. Having said that, there are medical emergencies where a delay of mere minutes can mean the difference between life and death. We thus have a situation where the resources are available and lives can be saved, but cost is an issue. Yet, there is no possibility of means testing or financial counselling.

Are private hospitals willing to take on a good Samaritan role and possibly even make small financial sacrifices by charging public rates when they receive critical patients from the SCDF?

If they agree, perhaps SCDF officers can be given the option of calling the nearest private emergency department when patients fulfil certain clinical criteria, so the hospital can decide whether to accept them or not.

Patients can then choose to be transferred back to public hospitals when their conditions have stabilised. Patients with the means can choose to stay on to complete treatment.

I hope the Ministry of Health, SCDF and private hospitals can work together to ensure that no lives are lost simply because of the adherence to rigid outdated protocols or the inability to pay.

Aaron Lee


First, a few misconceptions must be clarified.

Mr. Lee did not mention the feature article printed in the Straits Times last Saturday, so it appears that he's unaware of the local emergency medicine community's rebuttal regarding Raffles Hospital's emergency department capabilities.

Second, patients transported by SCDF ambulances cannot choose which hospital to go to. That's only allowed with private ambulances.

Third, even if one day, SCDF ambulances can go to private hospitals, expecting the paramedics to call the nearest ED to see if the patient "fulfils certain clinical criteria" would be so time-consuming it would make things a lot easier to just go straight to the public institution, which doesn't ask long-winded questions.

And honestly, in a real emergency, the ambulance usually arrives at the ED's doorstep within minutes. Who has time for a Q&A en route, especially during a collapse?


Cost is a massive obstacle, but don't expect any solutions in the near future unless the key players are somehow motivated enough to shove this through all the red tape.

On paper, it sounds simple. Private hospital EDs may be able to manage lower-income patients if the MOH extends subvention to the private sector, which is what's practised with public institutions.

However, the same subsidy is unlikely to cover private hospital ED fees because their investigations and specialist referrals cost more, and their management protocols may be extremely different ( i.e. CT vs MRI? what drugs do they prescribe? do they advocate admission rather than outpatient workup? ). All these factors can potentially result in hefty bills.

MOH should increase the subsidy amount for private hospitals, you say? Sure, but someone has to pay eventually. Higher taxes, anyone?

If you expect the private sector to - as Mr. Lee put it so idealistically - "take on a good Samaritan role and possibly even make small financial sacrifices by charging public rates when they receive critical patients from the SCDF", you should check into IMH immediately. It will not happen.

Besides, receiving SCDF cases is just the tip of the iceberg. As already highlighted in Saturday's article, private hospital EDs currently do not employ emergency physicians, i.e. emergency medicine specialists, who are senior, experienced in resuscitation and trained to manage a wide range of illnesses of varying severity.

Also, if there's a surge in the number of ambulance cases to the private sector, can their EDs handle the load? Do they have enough resuscitation facilities and equipment? Do they have sufficient staff? Are specialists from the key disciplines (cardiology, general surgery, anaesthesia ) available on-site if urgently needed?

If private hospitals can't step up to the plate, nothing will change.