Outpatient care eases pressure on Singapore hospitals

Hospitalisation is more expensive due to room charges, nursing care, and other fees.

The hospital bed crunch in Singapore, where more than 80% of beds are in government-owned medical facilities, is forcing more patients to seek faster, affordable treatments at outpatient care centres.

Public hospitals are now running at full capacity as more elderly patients suffer from falls, strokes, and other health issues, Gerald Tan, CEO at Advanced Urology Associates, told Healthcare Asia.

“These patients often have prolonged stays,” he said. “The Ministry of Health is constructing new hospitals, but these will take a few years to be completed and staffed.”

Like many countries, Singapore’s population is ageing, and critics argue that the country’s long-term care facilities and palliative care programs have not kept pace with the rest of the healthcare system, according to Massachusetts-based International Citizens Insurance.

Outpatient care helps address these challenges by expediting procedures across different specialisations, including urology in Tan’s case. “For surgeries, like kidney stones or obstructed prostates, patients stay no longer than a full day.”

Aside from surgeries, outpatient care centres also act as a one-stop facility. “Patients can come for checkups, blood tests, and CT scans.”

This also applies to both ophthalmology and cardiology.

Besides glaucoma and retinal detachment treatments, Val Phua, a consultant ophthalmologist at Eagle Eye Centre, said eye care centres now offer intravitreal injections and laser treatments, helping patients avoid additional hospital-based fees.

“Inpatient care is generally more expensive due to costs associated with room charges, nursing care, and additional facility fees where applicable,” said Phua, who specialises in cataract and refractive surgery.

Patients with chronic heart failure can also now receive intravenous diuretic treatments to drain excess heart fluid at these centres, instead of being admitted to the hospital, said Reginald Liew, director at The Harley Street Heart & Vascular Centre.

“We are also establishing centres for early detection,” he said. “Diagnostics like CT coronary angiograms, heart ultrasounds, and specialised stress tests are readily available.”

Singapore’s outpatient care market is projected to grow 11% annually to $3.95b by 2029 from $2.33bn this year, according to Hamburg-based online data platform Statista.

Liew, a cardiologist, said doctors also benefit from outpatient care’s focused nature. “Unlike hospitals, where physicians manage large volumes of both in-patient and outpatient cases, this allows them to concentrate on specific areas of care.”

“For instance, doctors can conduct specialised tests like treadmill evaluations, and immediately review results with patients, developing a treatment plan on the same day,” he added.

Advanced technologies have led to a shift toward outpatient care, whose facilities now rival traditional hospitals in quality and efficiency.

Phua said this aligns with patients’ growing expectations and awareness of rarer conditions like myopia and age-related macular degeneration.“Many patients wish to be glasses-free, which is now possible with newer intraocular lens technologies, such as multifocal lenses.”

“The current treatment standard for cataracts is phacoemulsification, which uses ultrasound energy to remove the cataract through a small self-sealing wound,” he said. “This technique aids in safer surgery and faster recovery times.”

Tan, meanwhile, cited the use of high-powered holmium or thulium lasers that can vaporise kidney stones. “We don’t need to spend as much time removing stone fragments, resulting in less bleeding.”

“The same laser is also used to remove prostate tissue with minimal bleeding,” Tan said. “We call this procedure holmium laser enucleation of the prostate or HoLEP. It has become very common in Singapore.”

Not a ‘quick fix’

But outpatient care has limitations, including the fact that it might not be appropriate for all patients, especially those with complex conditions, Liew said.

"Individuals with severe symptoms may require hospitalisation for closer monitoring and treatment, as these could indicate life-threatening conditions,” the cardiologist said.

“Doctors must be very cautious when choosing suitable candidates for day surgery,” Tan added.

Phua said follow-up care is another challenge. “Frequent clinic visits may place significant stress on caregivers, requiring time off work and other adjustments,” he said. “In some situations, inpatient care can help alleviate this burden by providing continuous monitoring and treatment in one location, depending on the patient's needs.”

Misconceptions about the effectiveness of outpatient care persist, he said. “Some patients believe these procedures are merely quick fixes and, therefore, may not be as effective as inpatient surgeries.”

Phua said many outpatient procedures have been refined over decades and have become highly effective. “I often reassure patients by discussing success rates, expected outcomes, and the rigorous safety and quality standards that outpatient procedures must meet.”

Tan added that most common conditions are managed using evidence-based and internationally accredited guidelines. “Simply put, there is now a set procedure for handling these conditions.”