Step inside Khoo Teck Puat Hospital (KTPH) for a breath of fresh air. Literally, because the buildings are designed with gaps and fins, allowing winds to ventilate all open spaces. And they were spacious indeed. Yet the first impressions were formed earlier. The fashionable glass exterior is fronted by potted plants. Along with Yishun Pond and plenty of lush greenery, one would be forgiven for bypassing it when locating a hospital. It just doesn’t feel like one.
If this is the future of healthcare services, it’ll be pale comfort to impending infrastructural challenges. The global population is rapidly ageing. With one of the world’s highest life expectancies and the world’s lowest total fertility rate of 0.80 in 2014 (CIA 2013), Singapore will certainly be among the most affected countries. With healthcare infrastructure well-developed, infectious diseases are mostly under control. Chronic patients, however, will place an increasing burden on the limited healthcare facilities, potentially causing bed crunches.
In response, the 428-bed Yishun Community Hospital (YCH) is slated to open by end-2015. It will provide step-down care for chronic patients, lessening the burden on acute care resources at 590-bed KTPH. With the hospitals situated beside each other, it will be convenient to transfer patients without much hassle. And with a polyclinic a short distance away, the integrated system is well-placed to meet the varying needs of citizens living in northern regions.Apart from such diversionary measures, KTPH also takes pre-emptive ones that can reduce the inflow of patients. One, Community Nurse Posts are set up in heartland areas, providing convenient access to basic health services and geriatric assessments. This facilitates early detection and personalized advice. By intervening early, individuals can exercise their agency by modifying unhealthy lifestyle habits. Two, the Community Nurse Home Visit Programme identifies frequently-admitted patients and assigns nurses to interact with them, to better understand and address underlying causes for their repeated admissions. This initiative is notable because it considers social, environmental and behavioural factors, which are non-medical in nature. Both of these approaches in the Ageing-in-Place (AIP) Programme will help to ease burgeoning demand for hospital beds.
Nonetheless, all institutions require a sustainable economic model. Hospitals, serving public needs, must achieve this without blocking anyone from access. KTPH adopts technologies such as Automated Guided Vehicles (AGVs) to move heavy food and clothing trolleys to different storeys. Solar panels are used to convert natural energy to electricity, while the building is designed to allow natural lighting in the daytime. These increase energy efficiency up to 30%. Yet the primary means has to be price differentiation for primary services. Patients can choose among A, B and C class wards with finer sub-divisions. Patients can also obtain public referrals to enjoy subsidies.However, don’t these still differentiate access to healthcare services?
Link and Phelan (1995) argue that “social factors… embody access to important resources… and consequently maintain an association with disease even when intervening mechanisms change” (80). In other words, higher socioeconomic standing equates better health outcomes. Yet this does not negate the power of interventions. This “fundamental social cause” can be partially offset by tackling mechanisms, through responsive policies and practices.
Andrulis (1998) contends that “action that successfully decreases financial barriers will… [produce a] substantial reduction of socioeconomic disparities in health” (412). While Singapore’s 3M (Medisave, MediShield and Medifund) financing framework insures access to health services regardless of socioeconomic status, it cannot address differences in the quality of health services necessitated by financial needs. Those with greater financial resources can enjoy shorter waiting times, more personalized care and a greater variety of food menus.
As it turns out, KTPH is managing this disparity better than most. While class A wards are air-conditioned, other wards are well-ventilated by incoming winds. While class A wards have personal TVs, fridges and closets, other wards can access a common relaxation area for entertainment and pond viewing. Nurses are rotated every few months, so one can be certain that “good nurses” aren’t reserved for select groups. It’s like comparing First Class and Economy Class seats in a top airliner. Sure, they will differ in relative comfort, but there’s little to complain about.If anything, KTPH is a high-flyer among hospitals – not a budget service. Geriatric clinics are more spacious and colourful, catering to those with disability or eyesight issues. Outpatients can opt in for group art enrichment sessions. Each ward has message boards full of written notes of encouragement. Terminally ill patients will be moved to an end-of-life care room (Lily Room) without equipment or painful treatments, and where their last days will be spent in the company of loved ones. Unlike typical hospitals, KTPH offers a comprehensive patient-centric system that, in Andrulis’ words, “successfully decreases financial barriers”.
As KTPH has demonstrated, hospitals can shed its labels and antiseptic smells. With holistic consideration of patients’ needs – beyond the medical – hospitals can also serve as significant sites of social support. One need not suffer unduly. If more hospitals follow suit, perhaps the refrain that “one can die, but cannot fall ill in Singapore” can be put to bed. Ageing, then, will not be all doom and gloom.
I left KTPH feeling as refreshed as when I entered it.
The above is a reflection essay I wrote back in Mar 2015, following a brief guided tour with fellow students. Getting there wasn’t easy, so I opted for a short bus ride from Yishun Interchange. But I left on foot, fully glad.
Frankly, I’ve forgotten most details by now. This reminds me of how knowledge is hard to gain, but easy to lose. It also informs me that there is much value in pursuing a higher education in Sociology. I hope I can replicate such detail and insight more regularly, here on SmartCasualSG.
Andrulis, Dennis P. 1998. “Access to Care is the Centerpiece in the Elimination of Socioeconomic Disparities in Health.” Annals of Internal Medicine 129 (5): 412-6.
Link, B.G. and Jo Phelan. 1995. “Social conditions as fundamental causes of disease.” Journal of Health and Social Behavior 35: 80-94.
2013. The World Factbook 2013-14. Washington, DC: Central Intelligence Agency. Retrieved March 1, 2015 (https://www.cia.gov/library/publications/the-world-factbook/index.html).