Friday, February 23, 2007

Doctor numbers- WHO statistics














1.WHO Statistics on Number of doctors per capita by countries
(NB: the doctor figures from different countries may be from different years- as reported to WHO)

Countries/ Drs Nos./ (Dr. numbers per 1000 )
Singapore 5,747 (1.4) )

Europe (Advanced countries)
Belgium 46,268 (4.49)
Denmark 15,653 (2.93)
Finland 16,446 (3.16)
France 203,487 (3.37)
Germany 277,885 (3.37)
Ireland 11,141 (2.79)
Italy 241,000 (4.2)
Netherlands 50,854 (3.15)
Norway 14,200 (3.13)
Sweden 29,122 (3.28)
UK 133,641 (2.3)

North America
USA 730,801 (2.56)
Canada 66,583 (2.14)

Oceania-Asia Pacific
Australia 47,875 (2.47)
NZ 9,027 (2.37)
Japan 251,889 (1.98)
S Korea 75,045 (1.57)
Malaysia 16,146 (0.7)
Philippines 44,287 (0.58)

Other City States
HK 11505 (1.7)
Taiwan 34093 (1.52)

Addendum: 24.2.07 HK and Taiwan's statistics I just got from

HK: http://www.yearbook.gov.hk/2005/en/app_06_27.htm
Taiwan: http://www.gio.gov.tw/taiwan-website/5-gp/yearbook/16PublicHealth.htm#Heal

2.My comments

Hi Friends,
I manage to get the statistics for Doctor numbers and Doctors per capita ( ie per 1000) figures from the WHO website.

I do not have the time to analyse the figures yet, but it is pretty much self-explanatory.

I do not want to give a knee-jerk reaction to the Ministry of Health's sudden disclosure that we have about the advanced nations' lowest doctor-population ratio ( now suddenly we count ourselves amongst the 1st world! Anything to win an argument?) .

Anyway, the statistics do not lie. ( but then again wasn't it Disreali who said, " There are 3 types of lies- Lies, damned lies and statistics" ?)

But somehow, my impression and my doctor-friends impressions also do not bear out that we are short ( esply in the private sector).

I wonder how being a city-state skew the stats? I wonder what would the doctor per capita of cities be? Any statisticians or maths whiz out there? I just added in HK's and Taiwan's figures.
Theirs are closer to Sg's numbers ( but still a tad higher).

Let's chew on the statistics ( and dig up your books on t-test/ chi-square test/correlation coefficient etc) and let me have your comments.

Cheers

Dr.Huang Shoou Chyuan

PS: I apologise for the poor quality of graph ( I did it with my elementary MS Excel skills all by my lonesome self)

Also the figures keep bunching up. Given up trying to space and line them out.

3.About the WHO website for statistics (Core Health Indicators)

For those who want to look at the statistics yourselves please go:

http://www3.who.int/whosis/core/core_select.cfm

Then select (all countries)---> (all years)

select physicians ( numbers) and physician per capita.

Then of course press submit ( in case there are technology virgins here) :)

4. This is the thingaling that started the whole debate

Singapore has worst patient-doctor ratio: report
(21 Feb 07 Channelnewsasia.com)

Singapore has the worst patient-to-doctor ratio among developed countries and has embarked on a global effort to entice doctors, a report said Wednesday.

Top health ministry officials went to Australia and London last year to convince Singaporean doctors studying or working there to return, and to encourage top foreign doctors to practise in Singapore, the Straits Times said.

It quoted the health ministry's permanent secretary Yong Ying I, who was dispatched to London last year, as saying Singapore has the worst patient-to-doctor ratio among developed countries.

"We have very efficient doctors and they work very hard. But somewhere along the way we also don't have enough," the newspaper quoted Yong as saying.

"If you want to bring down waiting times, we need to recruit more doctors, much more than a few percent."
The city-state is faced with an ageing population but is also seeking to bolster its role as a top provider of quality healthcare services for patients from abroad.

Singapore, Southeast Asia's most advanced economy, had a population of about 4.4 million with 6,748 doctors registered in 2005, according to official statistics.

The goal is to have one doctor per patient in public hospitals, up from a ratio of one per every two, the report said.

The country needs to produce 400-600 locally trained doctors annually, up from the current level of more than 200, the paper quoted Health Minister Khaw Boon Wan as saying.

Khaw cautioned that "much as we will try to recruit as many as we can, we will be lucky to half-succeed," which was why he sent his top two ministry officials to scout for doctors abroad, the report said.

http://sg.news.yahoo.com/070221/1/46tr4.html

9 comments:

Aaron said...

I think my bigger question is, what kind of doctors are we short of? Even among doctors, there are different kinds. We might be extremly short in certain areas, thus contributing to a low doctor/population ratio overall. However, if a certain segment skews the statistics, then we shouldn't be making such a big fuss.

Besides, when I see the number of clinics around my estate and their level of business, I would hardly think there's a shortage of doctors at all. Going by MOH's arguments, I should be seeing the clinics packed to the brim. What I am seeing however is that there are many clinics, and they're empty most of the time.

aliendoc said...

Dr Huang, here's the correct link to my entry on the numbers (of doctors).
http://aliendoc.blogspot.com/2007/02/numbers.html

Apologies for the erroneous link previously :)

Gerald said...

I too don't think there is a shortage of docs in the private sector. But what about polyclinics and restructured hospitals? Aren't they bursting at the seams? Or is it just poor human resource management? Either way, my understanding is that docs in the public sector aren't the happiest people in the world.

nofearSingapore said...

Hi:
aaron/gerald: There is definite a maldistribution of doctors.

The question to ask is if we can properly redistribute the docs to where they are needed ( ie to govt hospitals & polyclinics) or get the patients to see the GP's at subsidised rates ( someone has to foot the bill- either govt or GP's),whether the numbers will be enough when we get 6million?

I think we should try small steps-1. redistribute health manpower
2.open the gates slowly, and watch and tweak the system along the way.

What you guys say?

aliendoc: thanks , got it.

Also, HK and Taiwan's stats are closer to ours. Maybe city-states should not be compared to countries with rural population?


Dr.Huang

Anonymous said...

Our government is very good with numbers and statistics. The news presented make it sounded so drastic, as if a major crisis is coming. This is the prelude to a major song and dance. Get ready for the greatest show on earth.

Again, where is the consultation among all Singapore doctors in this situation? Where is the inclusive society we have been promoting?

Music, please...

Anonymous said...

Basically the papers report that MOH's Perm Sec says that Singapore has the lower doctor:patient ratio among developed nations. That is correct.

However they missed out reporting how much Singapore's TOTAL HEALTHCARE EXPENDITURE (THE) is as a percentage of our GDP.

In 2003 it was reported as 4.5% of GDP. That is definitely the lowest among all developed nations. The highest was USA at 15.2%. Switzerland 2nd at 11.5%. Australia spent 9.5% of GDP on THE. Canada 9.9%.

Singapore's 4.5% is half or less than half of these nations!!!!

It is even lower than that of Vietnam (5.4%)! It is lower than that of China at 5.6%. The only countries that had lower THE % of GDP were Indonesia (3.1%), Malaysia (3.8%), and Thailand (3.3%)

What is also not reported is how much Singapore's GOVERNMENT HEALTHCARE EXPENDITURE (GHE) is as a percentage of TOTAL HEALTHCARE EXPENDITURE (THE).

In 2003 this was reported as 36.1%. Again where Singapore's figure of 36.1% ranks on the table is rather interesting.

ONLY THREE COUNTRIES in the list of 19 were lower than the figure of 36.1% And they were India (24.8%), Vietnam(27.8%) and Indonesia (35.9%).

GHE as % of THE is probably an indicator of how much the government spends on healthcare for the people. A patient of mine confronted me saying that health care in Japan is so much cheaper than Singapore especially if you consider their cost of living. Well Japan's GHE as % of THE is 81.0%! That's how much Japan's government spends on healthcare.Little wonder why people pay much less in Japan isn't it?

Interestingly here are the figures for the other less developed countries in the list of 19 : Malaysia (58.1%), Thailand (61.6%). As for the other developed nations : Australia (67.5%), Canada (69.9%), UK (85.7%), USA (44.6%)

If you look at the figures together you will realise that although Singapore's doctor: patient ratio is low, the TOTAL amount of expenditure on healthcare in Singapore is rather low. And what is even lower (in absolute quantum) is the government expenditure on healthcare (a low percentage of a low percentage = very low). Another way of looking at it is that the expenditure per doctor in Singapore is considerably lower than all the developed nations. Why aren't such facts reported and appreciated?

Now if our doctor:patient ratio is to go up, is the THE and GHE going to go up as well? Or is the THE and GHE going to remain the same?

The sad thing though is that the report from the papers about lowest doctor:patient ratio gives the public the impression that Singapore doctors are earning *** of a lot compared to the other countries. Lower numbers of doctors = earn more per doctor?

Well they forgot to see what total expenditure of health care is ie how much is the whole pie that is shared among the doctors? Is it lower?

Well yes it is.

People are going on and on about how much doctors earn, running us down, saying we should have more doctors etc. But is that really the problem? A shortage of doctors? Or is it the reluctance to accept that you pay for what you get?

I don't even have to ask to know what people expect :

BEST DOCTORS, MOST DOCTORS, BEST MEDICINE, BEST SERVICE, AND ALL THAT FOR FREE

Take a look at the table below :

Country THE as % of GDP(2003) GHE as % of THE (2003) Physician per 1,000 population

Australia 9.5 67.5 2.47 (2001)
Canada 9.9 69.9 2.14 (2003)
China 5.6 36.2 1.06 (2001)
France 10.1 76.3 3.37 (2004)
Germany 11.1 78.2 3.37 (2003)
India 4.8 24.8 0.60 (2005)
Ireland 7.3 78.9 2.79 (2004)
Japan 7.9 81.0 1.98 (2002)
Netherlands 9.8 62.4 3.15 (2003)
New Zealand 8.1 78.3 2.37 (2001)
South Korea 5.6 49.4 1.57 (2003)
Switzerland 11.5 58.5 3.61 (2002)
UK 8.0 85.7 2.30 (1997)
USA 15.2 44.6 2.56 (2000)
Singapore 4.5 36.1 1.56 (2005)
Indonesia 3.1 35.9 0.13 (2003)
Malaysia 3.8 58.1 0.73 (2003)
Thailand 3.3 61.6 0.37 (2000)
Vietnam 5.4 27.8 0.58 (2003)

References

2003 statistics from WHO website www3.who.int/whosis/core (accessed 29 January 2007)

http://www.moh.gov.sg/corp/publications/statistics/manpower.do

http://www.wpro.who.int/NR/rdonlyres/135A09A2-E83E-4CB3-B771-3C5529DB878B/0/annextable2005.pdf

http://www.sma.org.sg/sma_news/3902/Forum.pdf

nofearSingapore said...

Hi anon;
Thanks for your indepth analysis about THE(tot healthcare expenditure) as % of GDP and GHE (Govt HE)as % of THE.
Let me be the devil's advocate here:
What say you if this low THE actually is used by the govt to bolster their case that we are getting good value for healthcare spending. That we are paying less but getting good healthcare? That is what the govt is saying whenever they boast about our low THE.

I was surprised the GHE/THE % is so low. That means the rest ie (THE-GHE) is from private sector?

Without indept analysis , my gut feeling is that GHE should increase but THE should not necessary increase if we can efficient in the ulitisation of healthcare resources.

But of course we know they is massive wastage of resources in the public sector.

If they ever allow the private sector run the public hospitals, much fat will be trimmed yet the result will be better service.

The downside, may be retrenchment of excess clerks and excess white collar admin staff.

What say you all?

I read Dr. Wong Chiang Yin ( Pres SMA) article the foreign docs issue and I mostly agree with him.
I wonder if I can paste the article here without copyright problems?

Dr.Huang

Aaron said...

We can say let's redistribute the manpower. However, are the physicians in private practice willing to be a doctor in the polyclinic/hospital? I think there must be reasons why these doctors decide to leave the public sector.

I agree with Gerald that perhaps we need to look into human resource management. Numbers do not tell everything. So what if you get the ratio up if the doctors are not happy enough and provide substandard service?

Dr Huang,

I think you can repost things as long as you put down where the source is from (with a hyperlink if possible). As long as you are not wilfully trying to pass off another person's work as your own, it should be ok. The most is that you'll be issued a take down notice by MDA I think.

Gerald said...

Hi Dr Huang,

I have a question to ask you but don't want to post it here. I don't know your Do u mind emailing me at sgpatriot[at]gmail.com, please? Thanks!

Gerald