新加坡卫生部长王乙康国会答复议员：医疗保健支出占比GDP5％，人均寿命74岁

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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医生的培养，以及医生占人口比例的问题。

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以下内容为新加坡眼根据国会英文资料翻译整理：

（续上一篇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）扩大医疗能力的另一个关键是加强人力资源。洪维能先生和陈有明医生询问我们是否需要培养更多医生以满足需求。是的，我们过去已经这样做了，而且将继续这样做。事实上，过去10年，我们本地医学院招生规模增加了约30%，现在大约有500名学生。如果考虑每一届，现在略超过30,000人。其中大约一半，约15,000至17,000人上大学；在这一群体中，有500人正在接受医学培训。【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。】

同时，更多的人正在接受综合医疗保健人员和护士的培训。因此，我们正在吸引大量人才。我们还提供奖学金和资助，吸引从海外医学院毕业的新加坡人加入本地公共医疗系统。

在医生与人口比例方面，新加坡的情况如何？就执业医生而言，我们的比例约为2.6（每1000人2.6名医生）。让我们将这个数字放在一些背景下来看看。

与发展中国家相比，我们处于领先地位，我们的比例更高。与亚洲发达经济体相比，我们的情况相似。韩国、中国香港和中国台湾的比例都在2.6左右。日本也是2.6，尽管他们实际上比我们早老化，约有30%的人口年龄在65岁及以上。

与发达的盎格魯-撒克遜国家（英国、美国和加拿大）相比，我们只是略微落后。

与欧洲国家（欧洲大陆、澳大利亚）相比，我们确实落后一截。为什么呢？我认为有各种的原因。这可能是福利国家的后遗症，也可能是欧洲国家并没有真正制定人力资源规划的传统。

我们可以进一步探讨是否需要进一步增加，但我们必须认识到，各行各业的人才都供不应求。在医疗保健领域，我们应该吸引到我们应该的人才份额，而不是过多的人才份额。超过这个公平的份额，各国可能会自食其果。

为什么会这样呢？首先，这并不是简单的数字游戏。医生的合理组合与医生的数量同等重要。如果医生注册了但没有开业，那也无济于事。如果医生在行医，但却从事美容等领域，那也没有太大帮助。

在新加坡，医学院的毕业生已经发现，接受专科培训获得住院医师的竞争更加激烈，因为在许多专科领域并不缺少医生。另一方面，我们在家庭医学、内科医学、老年医学和康复医学等领域面临着医生短缺。

这是因为，随着新加坡成为一个超老龄化社会，有更多的病人患有复杂和多种病症，需要这些具备更广泛技能的医生。因此，卫生部一直在增加这些专科领域培训的岗位数量。

我们也看到，在许多国家，医生的供应是如何产生自身需求的。随着更多医生参与竞争生意，医生们就会有倾向于开出更多的检查、扫描、药物和手术处方。患者不太可能拒绝，因为这关系到你的健康，尤其是如果医疗保健是免费的或者保险覆盖了所有费用。

因此，尽管洪维能先生提供了数据显示，新加坡的医生人口比低于一些经济合作与发展组织国家，但这并没有导致新加坡的医疗成果更差、可及性更低或者可负担性更差。例如，我们知道美国的医疗保健系统并不是最方便的，除非你有合适的保险。

英国比我们拥有更高的医生人口比，但他们有800万患者在候诊名单上，并且长期受到医疗能力不足的困扰。德国的医生与人口比也远远高于我们，但在满足各州老年人的医疗需求方面却面临着巨大挑战。反观新加坡，我们的医疗保健成果相当不错。

一个普遍接受的广义指标是国人的预期健康寿命。在新加坡，人们预期能够健康地活到74岁，是世界上寿命最长的国家之一；相比之下，美国为66岁，英国为70岁，德国、法国、丹麦、荷兰、澳大利亚等国为71至72岁。

新加坡在医疗保健方面的支出约占国内生产总值（GDP）的5%，而大多数发达国家则占比10%至13%；美国占比17%。简而言之，与许多经合组织国家相比，我们用更少的支出、更少的病床和医生与人口比取得了更好的成果，这并不仅仅是一个数字游戏。

医生的素质和组合、国家的地理分布、整个系统的运作方式以及患者的行为等因素都有很大的不同。我们还有很大的改进空间，但没有理由自怨自艾或羡慕他人。事实上，我们的情况很好，因为我们不断向他人学习并努力改进。

以下是英文质询内容：

Another key aspect to expanding capacity is to enhance manpower. Mr Ang Wei Neng and Dr Tan Wu Meng asked if we need to produce more doctors to meet demand. Yes, we have been and will continue to do so. In fact, intakes into our local medical schools have increased by about 30% over the past 10 years, to about 500 now. If you consider each cohort, it is now slightly over 30,000. About half of them, 15,000 or so, 15,000 to 17,000 go to university; and out of that group, 500 are training to be doctors. [Please refer to "Clarification by Minister for Health", Official Report, 6 March 2024, Vol 95, Issue 131, Correction By Written Statement section.]

Still, more are training to be Allied Health Professionals and nurses. So, we are taking quite a lot of talent. We are also offering awards and grants to actively attract Singaporeans who graduated from overseas medical schools back into the local public healthcare system.

Where does Singapore stand, in terms of our doctor to population ratio? Ours, in terms of practising doctors, is about 2.6. Let us put that number into some perspective.

Compared to developing countries, we are ahead, we are higher. Compared to developed economies in Asia, we are similar. Korea, Hong Kong and Taiwan are all around 2.6. Japan is also 2.6 and despite having actually aged much earlier than us, with about 30% of their population 65 and older.

Then, if you compare to developed Anglo-Saxon countries – the United Kingdom (UK), United States (US), Canada – we are just slightly behind.

It is really when we compare to European countries – continental European countries, Australia – that we are a notch behind. Why is that so? I think there are various reasons. It could be a legacy of the welfare state. It could be the fact that European countries do not really have a tradition of planning for manpower.

We can explore if further increases are needed, but we have to recognise that talent is in short supply across all sectors. And healthcare, we should attract our fair share, but not disproportionate share of talent. Beyond this fair share, countries can also end up chasing its own tail.

Why is that so? For one, it is not a simple numbers game. The right mix of doctors is just as important as the sheer number of doctors. If, somehow, doctors get registered but do not practise, it does not help. If doctors are practising, but they go into areas like aesthetics, it also does not help very much.

In Singapore, graduates from medical schools are already finding it more competitive to get residency positions to be trained as specialists, because there is not much of a shortage in many of these specialist areas. On the other hand, we are facing shortages in areas like family medicine, internal medicine, geriatric medicine and rehabilitation medicine.

This is because as Singapore becomes a super-aged society, we have more patients with complex and multiple medical conditions, needing doctors with these more broad-based skillsets. Hence, MOH has been increasing the number of training positions in these specialist areas.

We have also seen in many countries, how supply of doctors creates its own demand. As more doctors compete for business, there will be a tendency to prescribe more tests, scans, medications and procedures. Patients are not likely to say no because your health is at stake, and especially if healthcare is free or insurance covers all the costs.

Hence, while Mr Ang Wei Neng provided numbers to show that Singapore's doctor-to-population ratio is lower than some Organisation for Economic Co-operation and Development (OECD) countries, this did not translate to poorer health outcomes, less accessibility or affordability in Singapore. For example, we know that the US healthcare system is not the most accessible unless you have the right insurance.

The UK's higher doctor-to-population ratio than us, has eight million patients on their waiting lists and is suffering from a chronic capacity crunch. Germany, also much higher than us in terms of the ratio, is facing a major challenge meeting the healthcare needs of their seniors across their länders or their states. Conversely, Singapore, we are delivering quite good healthcare outcomes.

A commonly accepted broad measure is the expected health span and lifespan of our people. In Singapore, a person is expected to live up to 74 years old in good health, one of the highest in the world; compared to 66 in the US; 70 in the UK; 71 to 72 in Germany, France, Denmark, Netherlands, Australia and so forth.

Singapore achieved this by spending about 5% of our gross domestic product (GDP) on healthcare, compared to 10% to 13% in most developed countries; 17% in the US. In short, we have better outcomes with less spending and lower hospital beds and doctors-to-population ratios than many OECD countries, because it is not just a numbers game.

The quality and the mix of doctors, the geographical spread of the country, how the whole system is run, the behaviour of patients – all makes a big difference. We have a lot of room for improvement, but there is no reason to feel bad about ourselves or to envy others. We are, in fact, in a good place as we continue to learn from others and strive for improvements.

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