Kwong Wai Shiu – 100 years old but will it
survive?
Leong Sze Hian / Andrew Loh
/
One hundred years ago,
in 1910, a group of Cantonese merchants founded the Kwong Wai Shiu
Hospital (KWSH) to provide their Cantonese comrades with free
medical care. Originally, the hospital only served Cantonese
members. In 1974, however, its constitution was amended and it
admitted anyone from any ethnic or racial group.
The hospital, located along Serangoon Road and which came about
from an agreement between the British colonial authorities and the
merchants, was built on a 6 hectare piece of land with a 99-year
lease. The British government charged it a nominal annual rental of
S$1.
Fast-forward to 2010.
Kwong Wai Shiu Hospital and Nursing Home has 14 buildings within
its compound. Its facilities include an In-patient Department
(IPD), an Out-patient Department (OPD), a Day Rehabilitation Centre
(DRC) and a Traditional Chinese Medicine (TCM) Centre. It also
operates a 350-bed nursing home facility which is dedicated to the
care and treatment of senior citizens who need daily treatment on a
long term basis.
When its 99-year lease expired in February this year, the land
was returned to the Singapore government. After discussions with
the Ministry of Health (MO) and the Singapore Land Authority (SLA),
the hospital was granted a new 5-year lease – till 2015 – and had
its rental increased from the nominal S$1 to S$1.4 million.
When The Online Citizen visited the hospital, we found out that
the hospital’s licence to operate as a private hospital and clinic
was only for a two-year period – from 01 January 2010 to 31 Dec
2011.
It has been reported by the media that the MOH, under the new
agreement, “has agreed to substantial increase in subsidies” for
the hospital. These subsidies could be up to S$1 million to pay its
rental of S$1.4 million and a further S$4.8 million for its annual
expenses. These figures are, however, just speculation as the
government has not made any such agreement public. Even the
hospital’s management doesn’t seem to know exactly how much the
government will provide.
Inevitably, such non-disclosure by the government throws up many
questions.
As a non-profit
community hospital which has been running as a charity since 1910,
and which depends on patient fees and donations, why is the
hospital’s rent being raised 1.4 million times, from $1 to $1.4
million?
It is puzzling that the SLA would raise its rental to
S$1.4million and then for MOH to say it will subsidise the rental
by up to S$1 million. Even if that were so, its rental would still
rise by $400,000 – in one fell swoop, without any explanation by
the SLA or the MOH.
It is even more curious if you consider that last year, and
according to the Straits Times, “four of the six community
hospitals here raised their charges, some by as much as S$50 a day”
and the MOH did nothing to help them with the costs of operating
the hospitals.
Why the sudden ostentatious generosity towards KWSH now?
In conjuction with KWSH’s rental being increased, we now know
that MOH only gave $170,000 last year to KWSH, which is only about
1.5 per cent of the hospital’s annual expenses.
I find it puzzling that KWSH was able to maintain prices for the
last 16 years with just $170,000 from MOH. Now, however, under an
agreement with MOH last September, the ministry said it would
provide as much as 40 per cent of the hospital’s annual
expenses – expected to be some $4.8 million. Even with this
infusion from MOH, KWSH now says that it does not rule out the
possibility of raising prices next year.
So, previously with just $170,000 (which is just 1.5 per cent of
its annual expenses), from MOH, the hospital did not have to raise
charges, for 16 years.
Now, even with $4.8 million (which is 40 per cent of its annual
expenses) from MOH, the hospital may raise charges?
What gives?
We would like to suggest that the agreement be made public, so
that we may try to understand why KWSH may have to increase prices,
despite a 28-fold increase in MOH funding.
Will the other community hospitals receive similar substantial
increase in funding too?
The MOH said, in
response to a Straits Times query, that “funding to community
hospitals was on a need basis”. What criteria exactly does the MOH
use to determine the amount of funding?
Since the agreement was in September last year, why is it taking
so long, as about six months have lapsed already, for KWSH to
extract financial and patient records for MOH to determine the size
of the subsidy funding, as reported by the Straits Times?
Also, as a result of the agreement, KWSH has begun means testing
to decide the level of subsidy that each patient should get.
What this means is that a Singaporean patient whose family
income is as little as $1,440 (based on a family of four) may have
to pay 25 per cent of the cost, rising gradually to 100 per cent
for higher income families up to $5,600, in accordance with MOH’s
subsidy scale.
This is a departure from KWSH’s 100 year-old tradition of
fulfilling its mission of giving free care to anyone, and serving
patients without the stress of having to be means-tested under MOH
procedures.
In this connection, at least one Voluntary Welfare Organisation
(VWO) had opted out of means-testing in the past, to spare its
beneficiaries the stress of the process for the critically ill.
Since KWSH had a operating surplus of $1.4 mllion (which
coincidentally is what they have to pay for rental now) for the
last financial year, perhaps maintaining the status quo without any
increase in rent or funding may turn out to be better from the
perspective of patients.
As a charity 50-bed community hospital, 350-bed nursing home,
out-patient clinic, day rehabilitation centre and traditional
Chinese medicine (TCM) centre, we understand that its charges are
probably the lowest in Singapore, and most of its patients are the
poor and lower-income.
For example, its TCM general consultation with 1-day
prescription at $2 and out-patient doctor consultation (inclusive
of standard medication) from $8 to $12, are even lower than what
the polyclinics charge.
With a staff strength of more than 250 employees plus
volunteers, its annual operating expenses of $11.5 million is
arguably the most cost-efficient healthcare facility in
Singapore.
To encourage more charity healthcare institutions like Kwong Wai
Shiu Hospital, the Government should give it more financial
assistance, instead of raising its rent.
After all, as we understand, Singapore’s healthcare spending at
less than four per cent of GDP, and public healthcare spending at
about two per cent of GDP, is already one of the lowest in the
world.
Finally, the future of KWSH is uncertain. The hospital’s board
members have expressed hope that it will remain as a hospital and
nursing home when its current lease expires in 2015. However, a
Singapore Land Authority (SLA) spokesman said that it would depend
on the outcome of discussions and consultations with MOH and other
government agencies.
How different will the KWSH of the future be, after its
agreement with MOH for funding?
Perhaps we will only know when its lease ends in 2015.
“My heart was full of pain,” said Ms Ling Bee Sian, director of
operations of KWSH, who signed over the hospital to SLA officials
in February. “It’s hard to imagine that this land does not belong
to us anymore.”
Will poor and lower-income Singaporeans still be able to have
KWSH to go to in five years’ time?
———-
Headline picture from: http://www.panoramio.com/photo/11087819
