Wednesday, December 2, 2015

Foreign touch in national healthcare

2 Dec 2015

Singapore is hardly the only country facing a shortage of medical professionals, including doctors. With its population ageing at a rapid clip, a shortfall will remain a challenge in the years to come. Considering the global contest for healthcare support, it is a boon for Singapore that many physicians from abroad have found this an attractive place to work and live. Still, figures showing that the share of foreign doctors in the public sector has now risen to more than a quarter do pose implications worth pondering.

The foreign component of healthcare teams is a welcome addition as it would not do to have a shortfall as the nation ramps up its healthcare infrastructure. However, the large number raises the issue of whether the conservative approach in training local doctors ought to have been reined in earlier. The numbers are now being boosted in local medical schools but it is a game of catch-up.

The longstanding concern had been that supply would create its own demand, driving up overall healthcare costs. The counter-argument is that there are other levers to regulate demand. It is vital for medical training to keep step with demographic changes so there is a sufficient Singaporean core to ensure the long-term stability of services. Today's overstrained medical services reflect the difficulty of both making accurate projections and trying to make up for lost time.

[According to the World factbook, Singapore has 1.95 doctors per 1000 population. New Zealand has 2.74. Australia, 3.27. UK has 2.81, and USA has 2.45. South Korea has 2.14. Norway has 4.28. Monaco has 7.17. For some countries, the sparse and widely distributed population may account for the higher ratio. But some may simply be affluent (e.g. Monaco, Qatar). Of course if we were compared against developing countries, we are quite well provided for (Cuba is an interesting case which I have no explanation for), The point is, based simply on numbers, and compared with leading developed countries, we could do with more doctors. We could argue that as a small, densely populated, completely urbanised society, we can do with fewer doctors than comparable societies, but how much fewer? If the US is at 2.45 (and I have the impression that they could do with a few more), Can we be amply served with 1.95? Of course, this is just comparing numbers/stats. a more detailed analysis would be better.]

Easing foreigners into healthcare services should be done with some care, so cross-cultural interaction will not become an issue whether language or cultural sensitivity is concerned. The ability to communicate effectively is important in healthcare, especially when older patients are involved as they might not be conversant in English. Hospitals must deploy resources to help bridge that gap, for example, by ensuring locals are available to help with translation.

Singaporean patients, on their part, cannot afford to be choosy. After all, the test of a good physician is not his nationality but his knowledge, skills and ability to relate to patients. Some foreign doctors who have been here for decades are well acclimatised and have even become citizens.

Yet, dependence on foreign physicians has its limits. To allow the share of foreign doctors to rise indefinitely might lead to an overdependence on transitory labour. With patient loads highest in the public sector, that is also where the doctor shortfall is felt most keenly. Therefore, efforts will have to be made to retain doctors in the public sector through various strategies. Government funding schemes such as Chas that help channel patient load to the private sector are also welcome. As the need for healthcare services continues to rise, a combination of measures will help maintain standards. Foreigners should be seen as part of the cure to the doctor shortage, rather than an unfortunate symptom to be bemoaned.

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