Service level at Specialist Outpatient Clinics in restructured hospitals for Orthopaedic Surgery and Ophthalmology

07 Sep 2007

With increasing ageing of our population, the demand on healthcare services is growing.  The pace is faster in certain specialties, such as orthopaedic and ophthalmology services.

This impact is evident in the two accompanying information papers on the number of new appointments for subsidised services at the ophthalmology and orthopaedic surgery specialist outpatient clinics.

Information Paper on waiting times for new SOC Appointments in Restructured Hospitals -Ophthalmology

Information Paper on  waiting times for new SOC Appointments in Restructured Hospitals - Orthopaedic Surgery

The publication of these two papers is part of MOH’s on-going effort to publish information on service utilization, bill sizes, clinical outcomes and performance standards to help providers and patients make more informed choices.

The key highlights from the two papers as follows:

Aging population and rising demand

• The demand for both ophthalmology and orthopaedic treatment has increased with an aging population.

• The growth in attendances was driven largely by repeat attendances, and

• The bulk of repeat attendances were by older patients.

From 2002 to 2006, total subsidised SOC attendances grew at 8.6% CAGR¹  and 4.4% CAGR for ophthalmology and orthopaedic surgery respectively.  This led to a huge 39% jump in opthalmology attendances, and a 19% increase in orthopaedic attendances.

For ophthalmology, patients above 65 years old made up a significant proportion of attendances - 30% to 50% across institutions. For orthopaedic surgery, the build up starts earlier with patients 40 years and above forming the main bulk (60%) of subsidised attendances. 

From 2002 to 2006, subsidised attendances generated by these older patients grew by 6.3% CAGR ² (65 years and above) for opthalmology and 9.8% CAGR (40 years and above) for orthopaedic Surgery.

At the Singapore National Eye Centre (SNEC), elderly patients account for a larger proportion of repeat attendances compared to new attendances. Patients aged 65 and above account for 36% of new attendances, whereas for repeat attendances, they account for 52%.  Elderly patients are more likely to have chronic eye conditions e.g. glaucoma and diabetic retinal conditions.

Similarly for orthopaedic treatment, those in the 65-69 years age band generate at least three times the attendances per 1,000 residents compared to those in the younger 40-44 years age band. The peak in the 20-24 age group is likely to be due to sports related injuries.

New SOC appointments 

We are ramping up our capacity to meet the increasing demand.  In the last quarter (Apr-Jun 07), new ophthalmology patients were mostly seen within three weeks at the National University Hospital (NUH), Tan Tock Seng Hospital (TTSH) and Alexandra Hospital (AH).

New orthopaedic patients at AH and KK’s Women and Children Hospital (KKH) were mostly seen within one month. The other SOCs at Singapore General Hospital (SGH), Changi General Hospital (CGH) and TTSH were able to see half of their patients within a month; and at NUH within 40 days.

These are non-emergency elective outpatients; as emergency cases were served at the hospital emergency departments. 

SOCs in various institutions have different patient loads 

SNEC saw the highest number (ie. 42%) of subsidised ophthalmology attendances. AH which had the smallest market share in both specialties saw its attendances for ophthalmology rise by 44% CAGR – the fastest across all institutions.

Similarly, in Orthopaedic Surgery, SGH (27%) , CGH (22%) and TTSH (22%) had the larger market share but attendaces at institutions elsewhere such as NUH and AH have been growing at faster rates.  AH’s patient load grew fastest at 8.9% CAGR over the 2002-06 period. KKH started an orthopaedic clinic for women in 2005.

Steady stream of healthcare professionals to meet rising demand

The number of opthalmologists in the public sector rose by 55% from 56 in 2002 to 87 in 2006. Another 56 doctors are training to become Ophthalmologists.

Similarly the numbers of orthopaedic surgeons, physiotherapists and occupational therapists are being ramped up.  The number of orthopaedic surgeons in the public sector grew by 31% from 62 in 2002 to 81 in 2006.  Another 28 doctors are undergoing training to become orthopaedic surgeons.  The combined number of public sector physiotherapists and occupational therapists grew by 10% from 287 in 2002 to 317 in 2006.

Managing Chronic Patients & Right Siting

The growth in repeat attendances underscores the need to better manage patients with chronic conditions.

Once diagnosed and stabilized by a specialist, many common and degenerative conditions such as arthritis or back pain could be monitored and managed adequately by family GPs or through physiotherapy. Orthopaedic SOCs will educate patients with chronic conditions to work with their family GPs to proactively manage their conditions through observing a strict regime of regular rehabilitative or preventive exercises. This will enable the SOCs to take on more new patients and further shorten the waiting time for new appointments.

¹CAGR - Compound Annual Growth Rate

²Based on a study of SNEC attendances only.