2024年3月6日，新加坡卫生部部长王乙康在国会答复议员关于公立医院扩容、医疗成本的问题，并通报了正在医疗系统中推行的重大改革。

以下内容为新加坡眼根据国会英文资料翻译整理：

卫生部长（王乙康先生）：谢谢主席。我将在大部分演讲时间用来谈谈医疗方面的两个紧迫问题：一个是医院床位紧缺问题，另一个是医疗成本。然后，我将谈谈我们正在医疗系统中推行的重大改革，这将进一步解决这两个问题。

毕丹星先生、洪维能先生和林志蔚副教授提出了综合诊所和医院的容量和候诊时间的问题。确实，在新冠疫情后，许多国家的情况都是如此。世界各地医院的候诊时间都在延长。

在新加坡，推高医院床位占用率的原因是，新冠疫情后，病情复杂的老年人数量在增加，我们看到这一数字在激增。我此前向议会报告过，新冠疫情前后的住院平均天数从大约六天增加到七天，仅此一项，患者就增加了15%。这发生在人口快速老龄化的背景下，所以问题愈加复杂，并将成为长期挑战。

毕丹星先生建议我们实时公开各医院急诊科的动态候诊时间。这是可行的，但我们一直不愿意这样做，也是有原因的。目前，救护车紧急救治已经有一个流程，即将需要紧急救治的患者送往最近的医院进行治疗。然而，在急诊室，40%的情况并非危及生命或并不紧急，但他们最终还是去到了医院急诊室。因此，我们担心提供动态候诊信息可能会适得其返地促使更多非急诊病人前到医院，使整体情况更加恶化。

我知道，对于一个病情严重的患者来说，要轮候多个小时才能获得床位是非常不舒服和令人不安的。但请放心，即使病人正在轮候病床，医院也会在患者到达后迅速进行分诊，并对紧急情况开始治疗。

洪维能先生提出了关于樟宜综合医院的问题，该问题也在《海峡时报》的一篇文章中有所报道。樟宜综合医院是一座老建筑，只有四个救护车停靠位。因此，排队等候的速度会相当快。【请参阅《卫生部长澄清》，官方报告，2024年3月6日，第95卷，第131期，书面声明更正部分。】

但实际上，这并不是限制因素。我们可以在救护车上进行分诊。这只是什么大问题。我们需要关注的是重症监护室（ICU）的使用率、复苏室的使用率。如果这些科室满了，我们会转移救护车。救护车停靠位满了，我们可以处理。表面上看起来很糟糕，但实际上，从运营角度来看，这并不是一个难以克服的大问题。

林志蔚副教授建议增设更多的紧急护理中心（UCCs）。急诊护理中心已经被证明是有用且有效的。我们还一直在使用“家庭医生首选”计划（GPFirst），尤其是在樟宜地区，这也是有用的，我们将继续采取一切方法来缓解急诊室患者的负担。

为了更根本地应对这个挑战，我们需要扩大医疗能力，弥补因新冠疫情而失去的时间。

自去年6月以来，我们新增了大约640张急诊和社区医院床位。这些病床构成了我们今天拥有的超过11,000张公立医院床位。这就是我们的存量医疗资源 - 11,000张床位。我们计划到2030年再增加4,000张床位。从现在到2030年，每年都会有新增的床位投入使用。

从今年到2025年，兀兰医疗园将投入使用多达700张床位。2026年，盛港综合医院和欧南社区医院预计将把非临床区域改建成病房，预计将增加约350张床位。2027年，新加坡中央医院的集合门诊服务大楼将投入使用，预计拥有300张床位。2028年和2029年，重建后的亚历山大医院将逐步开放。2029年和2030年，新的东部综合医院园区预计将逐步开放。到2030年代初，届时将会看到一家新的区域公立医院竣工，我们已经着手开始这项工作。

我们刚刚在北部完成了一个项目，兀兰医疗园。我们正在在东部建设另一个项目。我们也在中央地区扩建新加坡中央医院。因此下一个新的公立医院应该是在西部。我们计划将其选址在新兴的人口中心——登加镇。它将与西部地区现有的医院形成最佳互补。登加的新医院将由国立大学医学院卫生系统集群运营。

尽管有扩大医疗容量的计划，但在考虑容量时，我们不应陷入“建设医院”的思维定势。我们有潜力在医院之外，在社区中提供更好的医疗服务。

并非所有患者在治疗过程中都需要在医院接受重症监护和持续监测。许多病人需要的疗养和康复，并能保证就近获得医疗帮助。因此，我们为亚急性和康复病人建设了更多的社区医院，为等待长期护理安排的病人提供过渡护理设施。

通过我们的努力，长期住院患者的数量有所下降。这些患者被界定为病情稳定可以出院，但是他们在等待长期护理期间一直住在医院，并且住院时间超过21天。这就是我们所说的长期住院患者。两年前，在我们医院系统中，每次大约有300名这样的患者。现在，每次不足200名，但仍有改进的空间。

为了方便患者从急诊医院适当转到社区医院，我们还将进行以下政策调整，具体如下：

一、为社区医院提供更多资金。急诊医院把合适的患者转移到社区医院遇到了一些阻力。为什么呢？例如，某些诊断服务，如计算机断层扫描（CT）和磁共振成像（MRI）以及某些更昂贵的药物，如今在社区医院得不到补贴。这是基于这样的考虑，即这些患者正在康复，可能不需要这些干预措施。不幸的是，这意味着将患者转移到社区医院时出现了操作上的延误。有些患者在医学上已准备好转移，但却在等待复诊扫描检查。他们应该立即转移到社区医院，并在那里进行扫描。

患者或许会担心，在转移后，如果出现意外情况需要扫描，该怎么办？因此，他们坚持留在急诊医院，以防万一。为了消除这种阻力，从今年第四季度开始，我们将允许更多诊断服务（如CT和MRI扫描）以及相关药物在社区医院得到资助。

更广泛地说，我们还将社区医院补贴框架与急诊医院的补贴框架统一起来。过去两者是不同的。这样，患者在住院期间，无论在哪种医疗环境下，都将锋利相同的补贴，即50%至80%。通过这个改进，大多数社区医院的患者住院账单将会减少。

二、将居家病房（MIC@Home）作为主流服务。什么是MIC@Home？这是一个试点项目，我们在患者家中设置虚拟病床，并邀请医生和护士定期探访他们，就像他们在医院一样。陈有明医生、毕丹星先生、黄玲玲女士和佳馥梅女士已经提出或谈论过这样的计划。

截止去年年底，已有2,000多名患者从这项计划中受益。这相当于节省了约9,000个医院床位的使用天数。经过几个月的实施，我们确信这项计划对患者很有帮助，并在缓解医院压力方面潜力极大。

因此，从今年4月起，MIC@Home将成为我们公立医疗机构的主流护理模式。因此，患者大可放心，他们在MIC@Home所支付的费用不会超过在公立医院接受急诊住院护理的费用。我们所有的医院都打算将居家病房的价格定在与普通医院病房相当或更低的水平。患者将得到补贴、医保和医药储蓄金的支持，这与实际住院治疗并没有区别。

对于林志蔚副教授的建议，我认为我们现在不需要为过渡到家庭护理提供激励措施。更好的办法，是将居家病房发展成一个被广泛接受的急性住院护理的主流模式。作为第一步，我们还将进一步扩大居家病房的服务能力，从2023年的100人扩大到2024年的300人，并有可能进一步扩大规模。

三、鼓励远程医疗。一个典型的综合诊所就诊者中，有40%是因为慢性疾病管理。去年，我们扩大了补贴范围，并允许使用医药储蓄金进行远程医疗，用于慢性病管理。到今年下半年，我们还将把医药储蓄金的覆盖范围扩大到预防性保健服务的远程医疗咨询，如定期健康检查后的随访复查。这项措施涵盖了综合诊所就诊者的另外10%。

有了这项变化，在资金支持方面，远程医疗与实体咨询的待遇几乎相同。唯一的区别是针对常见疾病的远程医疗，即患者出现症状，如咳嗽、感冒和发烧时。患者仍然不能使用保健储蓄支付此类常见疾病的远程咨询。我们暂时搁置了这一点，因为许多人滥用这种远程咨询以获取病假证明书，我们在这方面有所保留。因此，在我们考虑这一最终举措之前，需要加强签发病假证明书的纪律性。

以下是英文质询内容：

The Minister for Health (Mr Ong Ye Kung): Thank you, Chairman. I will devote a large part of my speech to address two pressing issues for healthcare: one is the hospital capacity crunch; the other is healthcare cost. Then, I will talk about the major transformation that we are bringing about in our healthcare system which will further address these two concerns.

Mr Pritam Singh, Mr Ang Wei Neng and Assoc Prof Jamus Lim raised the issue of capacity and waiting times at polyclinics and hospitals. Post-COVID-19, indeed, this is the experience of many countries around the world. Waiting times have gone up all around the world.

In Singapore, what is driving up hospital bed occupancy is the increased number of seniors with complex conditions post-COVID-19, and we saw a surge in the numbers. I have reported to the House earlier that average stay in hospital went up from about six days to seven days pre- and post-COVID-19, and that alone represents a 15% increase in patient load. This is happening against the backdrop of a rapidly ageing population, which compounds the problem and makes it a long-term challenge.

Mr Singh suggested that we provide dynamic waiting times of emergency departments (EDs) across hospitals publicly, in real time. It is possible, but we have been reluctant to do so, I think for a good reason. Ambulances today already have a process in place to ferry patients needing urgent care to the nearest appropriate hospital for priority treatment. However, at the EDs, 40% of cases are not life-threatening or urgent, but they ended up there anyway. So, our worry is that giving dynamic information may perversely drive more non-urgent cases to hospitals and worsen the overall situation.

I know it is very uncomfortable, very unsettling for a patient who is quite unwell to have to wait many hours for a bed. But please be assured that hospitals will triage patients quickly upon arrival and start treatment for urgent cases, even if the patient is waiting for a bed.

Mr Ang Wei Neng raised the issue of Changi General Hospital which was also reported in a Straits Times article. Changi is an old structure. It only has four ambulance bays. [Please refer to "Clarification by Minister for Health", Official Report, 6 March 2024, Vol 95, Issue 131, Correction By Written Statement section.] So, the queue will build up quite fast.

But actually, that is not the limiting factor. We can always triage in the ambulances. It is a small problem. What we need to watch out for are Intensive Care Unit (ICU) occupancy, resuscitation occupancy. If those are full, we divert the ambulances. Ambulance bays are full, we can handle. On the surface, it looks bad; but actually, operationally, it is not a huge problem to overcome.

Assoc Prof Jamus Lim suggested using more Urgent Care Centres (UCCs). UCCs have been useful and effective. We have also been using the General Practitioner First (GPFirst) scheme, especially around Changi area, and that is also useful, and we will continue to deploy all possible methods to alleviate patient loads at the EDs.

To tackle the challenge more fundamentally, we need to expand capacity and catch up with the time lost, due to the COVID-19 pandemic.

We opened about 640 new acute and community hospital beds since June last year. They make up the over 11,000 public hospital beds that we have today. That is the stock we have – 11,000. We intend to add another 4,000 beds by 2030. And we should see new capacity coming on stream every year, from now to 2030.

Starting this year, and next, in 2024 and 2025, Woodlands Health will commission up to 700 beds. In 2026, Sengkang General Hospital and Outram Community Hospital are expected to expand by about 350 beds by converting non-clinical areas into hospital wards. Then in 2027, the Elective Care Centre at Singapore General Hospital (SGH) is expected to open; that has 300 beds. In 2028 and 2029, the redeveloped Alexandra Hospital is expected to open progressively. Then in 2029 and 2030, the new Eastern General Hospital Campus is expected to open progressively. Then we move into the early 2030s, that is when we hope to see the completion of a new regional public hospital that we have started work on.

We have just completed one in the North, Woodlands Health. We are building another one in the East. We are expanding SGH in the central region. So, the next new public hospital should be in the West. We are planning to site it in Tengah Town, which is an emerging population centre. It will best complement current hospitals in the West. The new hospital in Tengah will be run by the National University Health System cluster. Mr Ang Wei Neng is nodding his head.

Notwithstanding this plan to expand capacity, we should not be trapped in the mindset of "building hospitals" when thinking about capacity. There is potential to better anchor care outside of hospitals, in the community.

Not all patients require high acuity care and constant monitoring in a hospital throughout their treatment course. Many need convalescent care and rehabilitation, with the assurance that medical help is readily available nearby. That is why we have built more community hospitals for sub-acute and rehabilitation patients, and Transitional Care Facilities for patients who are waiting for longer-term care arrangements.

With our efforts, the number of long-staying patients have come down, and these are patients defined as medically stable for discharge but they have been staying in the hospitals while waiting for longer-term care and they have been staying for longer than 21 days. This is what we refer to as long-staying patients. Two years ago, it was about 300 such patients at any one time in our hospital system. Now, it is under 200 patients at any one time and there is still room for improvement.

To facilitate appropriate transfers from acute hospitals to community settings, we will also be making a few policy changes, as follows.

One, more funding for community hospitals. Acute hospitals have experienced friction in transferring suitable patients to community hospitals. Why? For example, certain diagnostic services, such as computed tomography (CT) and magnetic resonance imaging (MRI) scans and certain more expensive drugs, are not subsidised in community hospitals today. This is based on the consideration that these are recovering patients and they may not need these interventions. Unfortunately, this means operational delays in transferring patients to community hospitals. There are patients who are medically ready to be transferred, but they are just waiting for a follow-up scan. They should be transferred without delay and do the scan at the community hospitals.

Others worry that after transfer, what if, unexpectedly, I need a scan for some reason. Hence, they insist on staying in the acute hospital, just in case. To remove this friction, from the last quarter of this year, we will allow more diagnostic services like CT and MRI scans and relevant drugs to be subsidised at community hospitals.

More broadly, we will also align the community hospital subsidy framework to the acute hospital subsidy framework. It used to be different. That way, patients receive the same subsidy rate, which is 50% to 80% throughout their inpatient stay, regardless of settings. With this enhancement, most community hospital patients will see smaller hospital bills.

The second change is to make Mobile Inpatient Care at Home (MIC@Home) a mainstream service. What is MIC@Home? This is a pilot project where we set up virtual hospital beds at the homes of patients, and have doctors and nurses visit them, as if they are in the hospital. Dr Tan Wu Meng, Mr Pritam Singh, Ms Ng Ling Ling and Ms Mariam Jaafar have asked or talked about such a scheme.

11.30 am

At the end of last year, more than 2,000 patients have benefited from the scheme. This translates to around 9,000 hospital bed days saved. Having done this for several months, we are convinced that the scheme works well for the patients and has great potential to relieve stress at hospitals.

Hence, from April this year, MIC@Home will become a mainstream model of care in our public healthcare institutions. As a result, patients can be assured that they will not pay any more for MIC@Home than they do for acute inpatient care in a public hospital. All our hospitals intend to price MIC@Home similar to, or lower than, a normal hospital ward. Patients will be supported by subsidies, MediShield Life and MediSave, no different from a physical inpatient stay.

In response to Assoc Prof Jamus Lim's suggestion, I do not think we therefore need to give an incentive for transition to home care now. It will be better to develop MIC@Home into a well-accepted mainstream mode for acute inpatient care. We will also further expand the capacity of MIC@Home, as a first step, from 100 in 2023, to 300 in 2024, with the potential to scale up further.

The third change is to encourage telehealth. Sir, 40% of attendances in a typical polyclinic are for chronic care management. Last year, we extended subsidies and allowed the use of MediSave for the use of telehealth, for chronic care. By the second half of this year, we will also expand MediSave coverage to telehealth consults for preventive care services, such as follow-up reviews after regular health screening. This represents another 10% of polyclinic attendances.

With this change, telehealth is treated almost the same way as physical consultations in terms of financial support. The only difference is telehealth for common illnesses, that is, when patients experience symptoms, like cough, cold and fever. Patients still cannot use MediSave for such consults for common illnesses. Also for a good reason. We are holding this back as many people have been using such teleconsults as an easy way to get medical certificates (MCs). So, there will need to be greater discipline in issuing MCs before we consider this final move.

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新加坡国会丨来源

新加坡国会丨图源

新加坡卫生部长王乙康国会答复议员：到2030年，公立医院床位将达1.5万张