The ageing population in Singapore has created daunting challenges for its healthcare sector, and the impact is increasingly being felt today.
According to a DBS healthcare report published on July 4, healthcare expenditure for the ageing republic is set to triple to S$44 billion by 2030, and hospital admission is targeted to hit 791,000 yearly, up from the current 520,000.
The increase in hospital admissions and ensuing demands on intensive medical care will trigger the need for more hospital beds: 6,000 in public hospitals and 1,000 in private hospitals, according to the report.
However, newly completed and planned hospitals, such as Ng Teng Fong Hospital and Sengkang General Hospital, would add only 2,000 beds by 2018.
Though sufficient to meet Singapore’s Healthcare 2020 target, it is barely a quarter of the total number of beds required by 2030.
To meet the required quota, more hospitals would have to be built within the next decade. By then, they would also need to be operationally ready.
“We will have one new acute or community hospital on average coming every year until 2020,” the state’s Ministry of Health (MOH) has assured. There were also plans to build Singapore’s next integrated hospital development in Woodlands, which will add some 1,800 beds.
Failing that, the bed crunch crisis in 2014 may recur. During that time, patients were housed in tents due to a severe shortage of beds in several hospitals.
While cost has never been an issue for our affluent city-state, time certainly is for its rapidly ageing population.
Ageing Population, Slow Economy
Singapore’s Population and Vital statistics have seen an upward trajectory in the number of citizens aged 65 and above, despite a sluggish growth in other age groups.
If the figures are anything to go by, this group of citizens will increase to some 900,000 by 2030.
Foreseeably, demand for healthcare services will spike. However, manpower in the healthcare sector will correspondingly shrink and age with Singapore’s greying population.
The demographic shift has raised concerns about the republic’s future economic growth and labour force participation.
“We are going to be growing older faster than nearly any other society in the world,” said Prime Minister Lee Hsien Loong during his speech at the Singapore Management University last year.
“By then, 1 in 5 of us will be 65 and above as compared to 1 in 9 today. Our society in 50 years’ time will be a very different society from today.”
It does not take an economist to postulate that an inverted population pyramid favours no economy built exclusively on human capital.
With no natural resources to exploit, Singapore’s ageing and shrinking workforce must ramp up its productivity to grow and compete in the global market. Failing that, its economy will stagnate or decline. The same applies to the healthcare sector.
As PM Lee puts it: “[The] whole tone of the society, instead of being young and forward-looking, will be pessimistic, oriented to the status quo or even looking towards the glorious past and I think that’s a sad place to be in.”
The ageing population in Singapore and a possibly slow economy by 2020 can create a huge healthcare burden, if managed poorly, according to Minister of State for Health Chee Hong Tat.
While healthcare has largely weathered the economic downturn (led by the fall in oil price) and has consistently emerged as the most resilient and best performing sector, nursing jobs continue to be vacant in both the private and public sectors.
There are currently some 36,000 skilled nurses in the healthcare system, with a third, or 13,000, in the private sector.
According to the Ministry of Manpower (MOM), vacancies for registered nurse and assistant nurse that have gone without takers for at least half a year were the highest among the PMET jobs.
MOM noted that Singaporeans shun a nursing career due to the unattractive pay and irregular working hours.
There was also “too much competition from other employers”, including situations where nurses left public institutions for private ones in search of better pay and less hectic work.
The government’s continual tightening of the supply of foreign workers also does not help.
The republic’s position as the regional medical hub and the setting up of more hospitals and clinics have likewise led to high turnover rates for nurses and caregivers – the backbone of its healthcare system.
Machines have replaced workers in other labour-scarce industries, but it seems unfeasible to use machines as substitutes for healthcare providers, especially for a profession powered by humility and compassion.
“Patients attach great importance to the human touch. It helps in their recovery. Robots cannot empathise with a terminally ill patient or tell when he needs a shoulder to cry on or to be left alone… at least for now,” said Mr Chris Yang, a patient who shares his observation of nurses who attend to older patients.
“Technology cuts registration and waiting time in hospitals, or even assists in data administration, but I don’t see it [working] well with patients, at least not with the seniors,” said Mr Robin Chin, a hospital visitor.
Experts have warned that without a sustainable pool of nurses, healthcare labour shortages will further deteriorate.
In mitigating the shortage of nurses and an ageing nursing workforce, MOH has rolled out extensive benefit packages for nurses, which include pay increments, flexible work hours, and more autonomy for senior nurses.
MOH now re-employs older nurses who have reached their retirement age to tackle the manpower shortage.
The ministry has also awarded scholarships to attract students (both local and foreign) into the nursing workforce across the healthcare spectrum, from disease prevention and care coordination to acute care and palliative care.
Last year, it gave out a record 301 healthcare scholarships, an increase of six percent from 2014 and 20 percent from 2013.
According to Health Minister Gan Kim Yong, nurses will also be supported by technology to ease their workload.
“Khoo Teck Puat Hospital (KTPH) has also eliminated the need for nurses to do manual charting of vital signs, as the medical device interfaces now allow the data to flow directly into the Electronic Medical Records system,” he said.
“Besides investing in automation and use of technology, we will also invest in upskilling support care staff to better support the nurses by taking over work delegated from nurses.”
Minister of State for Health Chee Hong Tat said Singapore is on track in expanding its healthcare workforce by 20,000 between 2011 and 2020
“Looking beyond 2020, Singapore will face an increase in projected healthcare demand and also a smaller local workforce due to our ageing population,” Mr Chee said.
It remains to be seen how much of a difference a decade can make to the demands of hospital beds and nurses between 2020 and 2030.
But one thing is for certain: the outcome will not be determined by any demographic variation, but by the preparedness of the authorities in answering these challenges.