卫生部：新加坡医疗模式无需学习欧洲

盛港集选区议员 林志蔚先生：我想谈谈部长提到的急诊室（ED）中40%的病例是非紧急情况的观点。当然公平地说，我认识到这种行为不仅仅是新加坡独有的。在美国，急诊室经常也因过度使用而挤满人，尽管原因不同，与无保险有关。因此，我认为扩大24小时急诊中心 （UCC）的建议既是补充的，又是与整体容量问题不同的。

那么我的第一个问题是，如果卫生部同意UCC确实可以成为二级护理格局的一部分，我们如何增加它们的使用率？卫生部可以提供什么样的激励措施或教育努力，让非紧急病例选择去UCC而不是我们的急诊室呢？

我的第二个问题与他提到的医生与人口比例有关。他提到日本在面对庞大的老年人口时有着类似的比例。但我敢说，他提到的欧洲国家在医疗人员方面实际上更为充足，以应对超级老龄化社会。对此，我想知道卫生部是否会考虑增加承认来自外国的医学院的数量。毕竟，正如他所说，人才竞争是全球性的，因此似乎没必要进一步限制我们从国外招聘人才。

王乙康先生：我不认为我们应该将UCC描述为卫生部是否同意它们是有用的。我们提出了UCC。事实上，第一个启动的是在三巴旺集选区，多年来它极大地帮助了邱德拔医院的急诊室，被证明是有用的。正如我之前提到的，如果有必要，如果我们需要建立更多的UCC - 这是一个经过验证的模式 - 我们将考虑这样做。

不过，还有其他模式也挺有竞争力的。东部的GPFirst也做得不错。所以，我们可以综合考虑两种模式，看看哪个更适合。

至于医生和人口比例的问题，我在之前的发言里已经谈到了一些。欧洲的医生和人口比例比其他地方高一点。虽然在亚洲发达国家间比较，我们差不多。不过我也不太清楚为啥。有人说可能是福利国家的传统，也有人说他们对人力规划没搞好。但你看，欧洲的各国情况也不都那么美好。

比如说，荷兰就停止了疗养院的使用，因为没有足够的医生或者护理人员。所以现在，如果你是荷兰老年人，通常的护理模式就是在家里，有护工或者护士每天来几次。德国的医生也告诉我，他们现在的处境挺困难的。各个州的医院都配置不够合理，这是他们告诉我的。所以，尽管医生多了，但他们也没能提供人们需要的医疗服务。

所以，我觉得这个问题不能只看一个数字。医生在哪接受培训，他们接受的专业培训，整个医疗系统的运作方式，国家的保险制度或者福利政策是否造成了供应过剩，这些都得考虑进去。所以，我们在面对医疗挑战的时候，需要全面考虑这些因素。

至于我们本地的医生和人口比例，它一直在增加。十年前大约是2.0，现在是2.6。所以未来，也许本地的三所医学院能多招点学生。也有更多在海外接受培训的新加坡医生回来的可能，这些都是我们要考虑的。我们的医生和人口比例一直在增加，而且我们的人口也在老龄化，所以很可能会再增加。但我得提醒大家，欧洲的模式也许不适合完全照搬。

Assoc Prof Jamus Jerome Lim (Sengkang): I would just like to pick up on the point the Minister shared about the 40% of ED cases being non-critical. Of course, to be fair, I recognise that such behaviour is not unique to Singapore. In the US, ERs are often also flooded by overuse, albeit with different reasons that have to do with the uninsured. My suggestion for expanding UCCs is, therefore, I think, both complementary but distinct to the question of capacity in general.

My first question then is, if MOH agrees that UCCs can indeed be a complementary part of the secondary-care landscape, how do we increase their take-up? What sort of incentives or educational efforts can MOH provide to non-urgent cases to choose to access UCCs instead of our EDs?

My second question relates to his point about the doctor-to-population ratio. He shared that Japan has a comparable ratio in the face of a large elderly population. But I would venture that European countries, which he mentioned, are in fact better-prepared in terms of medical staffing for their super-aged societies. On that, I wonder if MOH will consider increasing the number of medical schools that it recognises from foreign countries. After all, as he said, the competition for talent is global and, so it seems unnecessary for us to further hamstring our efforts to recruit from abroad.

Mr Ong Ye Kung: I do not think we should describe as, whether MOH agrees that UCCs are useful. We came up with UCCs. In fact, the first one that started was in Sembawang group representation constituency (GRC) and it greatly – over the years – greatly helped Khoo Teck Puat Hospital's ED, helped them manage their ED load and it has proven to be useful. And as I mentioned, if need be, if we need to set up more UCCs – this is a proven model – we will consider doing so.

1.15 pm

But there are competing models. GPFirst in the east has also worked quite well. So, between the two, either or, I think we should consider them.

As for doctor-to-population ratio, I explained to some extent in my speech, the European doctor-to-population ratio is somehow just higher than the rest of the world. Even in Asia, comparing developed economies, we are more or less about the same level. I do not know what is the reason, some say it is the legacy of the welfare state, others say they did not plan for manpower. But when you look at individual European countries, it is not that pretty a picture. 

The Dutch, for example, they have stopped using nursing homes because there are not enough medical personnel nor doctors to man them. So today, if you are an old person in Holland, in Netherlands, the default care model is actually home care with a lay person, maybe a nurse, maybe an allied professional visiting you twice or three times a day. That is what they have resorted to.

Germany, the doctors there told me they are in dire straits. Across the states, the hospitals are not efficiently configured and that is what they told me and therefore they are also, despite having more doctors, not delivering the healthcare that the people need.

So, as I mentioned, it is just one number. It is not a numbers game. Where they are trained and what kind of specialty, how the entire system is run, whether the insurance system of that country or the welfare system is creating oversupply, all these play a part. So we take all these into consideration as we manage our healthcare challenge.

As to our own doctor-to-population ratio, it has been increasing. Ten years ago, it was about 2.0, today it is 2.6. So moving forward, there is some room for three local medical schools to take in slightly more perhaps. There is possibility of having more overseas-trained Singaporean doctors returning, all these we have to consider. Our ratio has been increasing, we are ageing, most likely we will increase further. But I would just caution the European model may not be the model that we want to emulate fully.

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