I read this news article with no small degree of amusement:
MTI says no to excluding doctors' Guideline on Fees from Competition Act
SINGAPORE: The government has thrown out the Singapore Medical Association's (SMA) request for its guidelines on fees to be excluded from the Competition Act.
After consulting the Ministry of Health (MOH), the Ministry of Trade and Industry (MTI) has determined that the guidelines could create anti-competitive behaviour, and cannot be excluded from the Competition Act.
The guidelines were introduced in 1987 by SMA and the Association of Private Medical Practitioners of Singapore (APMPS), following the MOH's calls for a guide on medical charges.
This was to equip patients with pricing information on consultation and surgical fees, and to prevent private doctors from overcharging.
In April 2007, the SMA removed the guidelines voluntarily on legal advice that they could contravene the Competition Act.
It then sought to have the guidelines excluded from the Act.
The MTI said in a statement that in the absence of other information, the guidelines would have been useful in providing information to patients on medical fees.
But the MOH is already publishing actual medical fees at hospitals on its website.
In May this year, the government announced that all hospitals making Medisave claims will have to submit basic billing information from early next year.
Public hospitals have been doing so for the last seven years and this is part of the government's plans to make pricing more competitive and realistic in the private sector.
Dr Chong Yeh Woei, president of SMA said: "We hope that the mechanisms to protect the patients will be sufficient, but the downside of this is that there will be a risk that there'll be an erosion of trust between the public and the profession.
"Now, it doesn't matter whether it's the private sector or public sector, the public will perceive it to be an industry-wide sort of situation."
While he admits that there are black sheep in the industry, Dr Chong pointed out that most doctors still charge reasonable fees.
SMA said it will continue to publish data on specialists' fees to give patients some information on pricing in the private medical sector.
It had filed a separate notification with the Competition Commission of Singapore in February last year, and the commission said it hopes to conclude its evaluation shortly.
Now it seems to me that if the government was truly anti-anti-competition, then perhaps we shouldn't just be looking at the competition between the private sector and non-subsidised healthcare in the public sector, but at the more unequal competition between subsidised and non-subsidised healthcare, shouldn't we?
More importantly, why would the Ministry of Health want healthcare costs in the private sector to be lower?*
* - Those of you who know the answer, please do not reply - it will be our little secret...
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48 comments:
Lower the private sector prices, and you lower the private sector doctors' fees.
This makes it less lucrative for public sector doctors to go private.
Ha! Ha! Ha! Lower the price of the private sector doctors' fees! I am continually amused by the kind of bright ideas that fellow Singaporeans have. Maybe I should throw in a free massage and a hot towel along with my consultations as well.
Oh and I suppose that MTI doesn't consider the fact that MOH will be the sole employer of all residents as anti-competitive? Even though MOH will have a monopoly over all the trainee doctors, giving MOH complete control to lower their salaries and employment terms as they see fit to "lower healthcare costs"?
hey I dont understand.
If MOH is sole employer, it will be competitive as healthcare costs can be lowered, which is good for us patients.
Doctors should be paid fairly and not excessively and one reason why doctors work in public sector is they want to help the poor and needy patients.
Isnt it good that wages are kept low so the public sector can compete with the private sectors who have more resources to attract patients?
Before I comment on the post from Anon 16/6 17:52, I should just state that healthcare cost in Singapore is already one of the lowest in the world. It is only 3% of GDP (compared with 8.7% in the UK and 16% in the US). In other words, healthcare in Singapore is not expensive if compared to other similar systems. Yes, people will feel the pinch when they get a $900 CT scan or pay $80 at A + E. But people do not pay the sort of taxes like they do overseas. For example, in the UK, the basic tax rate starts at 20% and goes up to 40%. In addition, there is a national insurance contribution of another 11% (approx, depending on salary and other circumstances). So, though people overseas are not paying for healthcare upfront, they are paying for it in "monthly installments". Comparing them with us, we are getting healthcare pretty cheap.
Firstly, if we are going to cut the already low wages of healthcare workers in the public sector, healthcare workers will simply leave. Let's be realistic - doctors work long hours, on anti-social shifts, sacrificing a lot of their personal life, deal with demanding pts/families, spending off days studying, etc .... And if you cut their already low public sector pay, what do you think they will do? Did I hear "go private"? And what's left will be less doctors, each with more work on lower pay. Is this sensible? Is this fair?
Secondly, the public healthcare system in Singapore exists to help those who cannot afford private healthcare. We are not a system like the NHS in the UK where you pay a national insurance contribution monthly in exchange for free healthcare at the point of access. Hence, it is not sensible for the public sector to compete with the private sector.
At the end of the day, we got to put things in perspective. We pay low taxes and enjoyable highly accessible healthcare. Why do people keep going on about cutting public sector doctor's wages? Would you like the alternative of "free" healthcare at higher taxes (like the UK)? Oh by the way, I used to work in the UK and was paid a lot more in that "free" healthcare system.
Hi Perspective
I still think healthcare in Singapore is expensive.
This is reflective of many people fear that can die but can not fall sick in Singapore.
Of course, to the rich, healthcare is affordable.
Most healthcare workers will not leave if their pay is cut. They choose to stay because they want to help the poor and needy.
I dont think their wages are low especially for specialists.
http://www.salary.sg/2009/100-best-
jobs-in-singapore-2009/
1. Specialised surgeon – $27,977
2. Managing director – $26,444
3. Personal banker – $20,238
4. Commodities futures broker – $19,098
5. General manager – $18,068
If 27K is lowly paid, then I think the whole Singapore is lowly paid.
Furthermore, PAP subsidise the medical education of those who study in Singapore.
We spent more than 400K on one NUS student and thus we should either lower their salaries or make them pay us back.
By lowering the wages of those in public sector, we help to push greedy drs to the private sector and they will have to reduce their fees to survive because of competition.
PAP has done a great job in recruiting foreign docs to Singapore. More than 2/3 of new drs are from overseas.
We should step up the recruitment to ensure that there is enough drs to replace greedy drs who leave for higher wages.
This way, only cheap and good drs remain in public sector and we poor patients can achieve healthcare at a lower cost.
Secondly, the public sector is competing with the private sector because of the need to pay greedy doctors in public hospitals.
That's why there is A class ward.
I think by lowering the salaries of doctors, we can get rid of class a and ensure poor patients can have access to specialists.
Nowadays for subsidised referral, we have to wait for months.
At the end of the day, cut doctors pay and channel this cut to help the poor and needy patients.
This is how to make healthcare in Singapore cheap.
Anon,
Have you ever wondered why no one in the Ministry of Health has ever come up with the brilliant proposal you have made for making healthcare in Singapore cheap?
To Anon 18 June 2010 09:20,
I would like to clarify a few assumptions in your comments.
1. "Most healthcare workers will not leave if their pay is cut." I doubt this is true. I work in the public healthcare sector and many of my colleagues (good guys whom I can trust to look after me when I fall ill) have left. Though pay is not a sole factor in their decision to leave, it does play a part. In fact, MOH recognises that pay is an issue and has recently rolled out a "talent retention bonus scheme", which basically gives us a bonus to stay on in the public health sector. Pay is NOT the sole issue. But when it becomes a push factor along with the other issues, it can possibly become the last straw that breaks the camel's back.
2. Salary: "Specialised surgeon – $27,977" Please note that the figure is the salary of the top 1/4 of best-paid surgeons (i.e. 75% percentile). Where are the best-paid surgeons? Yes, you got it - in the private sector! The salary here does not reflect the true pay of most public sector surgeons and definitely not the salary of your average public sector doctor. The average base pay of a junior doctor is about $3500 - and they work horrendous hours! It has been said that in some postings, the aunty at McDonald's earns more per hour than them.
3. "We spent more than 400K on one NUS student and thus we should either lower their salaries or make them pay us back." The issue on subsidies have been discussed at length in the comments column of an earlier post. See here: http://singaporemd.blogspot.com/2010/05/private-sector-allure.html
The gist of it is that the government claims that they are subsidizing each med student to a tune of $400k but it does not take a genius to realise that the true value of the subsidy is much less. I graduated from a UK university and it was cheaper for me to study there (inclusive of airfares, accomm, food, holidays during term breaks, etc) than in Singapore based on the officially published NUS medschool fees before subsidy. In other words, an overseas med education in a country with a higher cost of living works out to be much much cheaper than a NUS med education. And this was years ago when the British pound was going at £1= S$3. Can you believe the figures on government subsidies?
Having these facts before you, I urge you to reconsider your position. You are right in one sense - doctors want to help patients and it shouldn't be about the money. If I was after the money, I would have followed a lot of my university mates into investment banking where the starting pay for a fresh graduate is £72,000 per year inclusive of bonuses (approx SGD 150,000 at today's FOREX rate). I stayed in medicine because I want to help people and I remain in the public sector because I specifically have a heart for the poor and marginalised in society. But when people keep saying that public sector doctors should be paid even less than the pittance we earn now (despite the high workload, personal sacrifices and other difficulties), it really deals a blow to my morale and makes me think hard about what I am still doing in the public sector.
I blame you, Perspective.
Subsidised healthcare distorts the true cost of healthcare, breeds an entitlement mentality, and as you have experienced yourself, destroys the morale of healthcare providers.
By being a part of this system, you are perpetuating it.
Worst of all is your reason for remaining in the public sector: "to help people... specifically... the poor and marginalised in society.".
Well, you know as well as I do the current subsidised healthcare system does not specifically help the poor and the marginalised - it is rife with abuse by those who CAN afford healthcare, but who don't WANT to pay for it.
If you want to help people, you should do so on your own time and money - open a private clinic and charge subsidised rates for poor people and take the loss on your own margin, for example. Let's be honest: your reason for remaining in the public sector is actually to make yourself feel that you have helped the poor by using other people's money, not your own! (specifically in this case tax-payer's money).
That's the problem with subsidised healthcare: people thinking that other people's money should pay for their healthcare, and providers who derive a sense of satisfaction from their 'sacrifice' of other people's money to provide them.
***
You our readers can say that I am heartless or mercenary, but I don't think you can say that I am wrong.
And if you think that I'm the only one thinking like this, ask yourselves:
1. Has the government's share of healthcare expenditure increased or decreased over recent years?
2. Has healthcare subsidies become more or less targetted over the past few years?
Then Anon can understand why MOH hasn't adopted her brilliant solution to lowering healthcare costs in Singapore.
Thank you.
Hi Angry doc,
I can understand your anger at those who can afford private healthcare and yet, shamelessly, choose to scam the public healthcare system - thereby increasing overall waiting times, doctor workloads, public healthcare cost etc. I am, like many of my colleagues are, disgusted by these selfish and kiasu people. I think a comment in another post calls these people "cheapskate". However, this does not mean that we should take away the whole subsidized healthcare system which does help the poor and marginalised. Without the subsidized system, many poor people would suffer the complications of uncontrolled diabetes, hypertension, hyperlipidemia, etc. As it is, they are already struggling to make ends meet. And it would be heartless to allow their legs to rot away or their eyes to go blind because they cannot afford treatment for diabetes.
Wouldn't a more practical solution be making the subsidized system more "watertight" against those who can afford private healthcare but choose to take advantage of a system that is not meant for them?
I would love to open a free clinic for the disadvantaged in our society if I have the financial means. Unfortunately, on my public sector doctor's pay, I can only treat a very limited number of patients in this manner. Remaining in the public sector still allows me to help more people than if I open my own free clinic (unless I become as rich as Bill Gates or the Sultan of Brunei). Since you raised the issue of using my own money, yes, I do donate part of my public sector doctor's pay to charity each month hoping that I can make a difference. But since I am faced with so many ungrateful patients who still want to cut my pay, I might just stop donating part of my pay and go private. Let's see what the next generation of patients are like ...
Hey angrydoc, what is wrong with you?
MOH is made up of doctors who protect the high salaries of their colleagues.
Luckily, we have Mr Khaw who is NOT a doctor and is helping to bring healthcare costs down but it is a losing battle as doctors still have a lot of power in MOH.
Look at recent policies.
1. increasing foreign drs
This help to increase medical manpower and reduce healthcare costs.
Medical fellows earn less but local doctors put a lot of restriction on them.
I suggest to have more clinical fellows and reduce restrictions on them so they can help lower healthcare costs.
2. Liberalizing medisave overseas
This help to let poor patients choose to see doctors in Malaysia which is cheaper and is just as good as Singapore doctors who are overpaid compared to Malaysian doctors.
I propose to allow outpatient costs to be covered by medisave because doctors and medicines are cheaper in Malaysia than Singapore
This help to lower healthcare costs.
3. Increasing specialists in Singapore and reducing medical training for residents.
This help to increase the number of specialists and help to lower healthcare costs in Singapore.
Reduce training = cheaper training and it is obviously a legitimate reason to cut costs.
4. Centralising employment of doctors under MOHH
This help to control healthcare costs as doctors can no longer demand large salaries or quit to join the other cluster.
This reduce Hr costs as there is less HR under MOHH
MOH under the enlightened leadership of Mr Khaw is doing the exact things that annoymous is proposing to reduce healthcare costs in Singapore.
Shame on you for not keeping up with latest policy changes. Stop making a fool of yourself :(
Really?
1. increasing foreign drs
How much change to local doctors' salaries has there been since that happened? How much has ward and treatment charges been reduced?
2. Liberalizing medisave overseas
So does the government lose more money or save more by letting the people use their medisave overseas?
3. Increasing specialists in Singapore and reducing medical training for residents.
I would argue that the primary reason for introducing the residency scheme is not financial; in any case we have to wait a decade more before we see how that pans out.
4. Centralising employment of doctors under MOHH.
For 5 years. And does the savings to the government translate to lower cost to patients at this point in time?
Look at your points again. Learn that there is a difference between a lower cost to the government and a lower price to the people.
And ask your friends in the public sector whether their pay has gone down due to these measures, and ask the patients whether their spending has gone down.
I used to have friends who work in public hospitals but stop going out with them ever since they grumble about their "low" salaries all the time.
1. More foreign doctors have reduced workload so less call mean less income for doctors.
2. The move just announced only.
We will only see the impact after some time.
Look at lasik
Now cheaper ever since newspaper publish the price in Thailand
3.I agree with u
It takes some time but obviously more specialists mean more competition and soon u see consult fees drop
Good move to ban doctors from setting a cartel.
4. After 5 yrs, no more bond so we cant control the greedy doctors :(
But we can screw them for their early years and stop them from becoming greedy gps and specialists in future.
At the end of day, we must remember that there are always needy patients who cant afford private healthcare and we must continue to subsidise them :)
Dear perspective
I support you.
We should have more mean testing so only poor and needy patients can enjoy subsidised healthcare.
To sustain this system, we need healthcare professionals to be realistic in their wage expectations and not always threatening to leave.
It is like running a charity, we cant pay everyone high wages or the system is not sustainable.
Look at NKF, Renci and City Harvest Church.
"It is like running a charity, we cant pay everyone high wages or the system is not sustainable."
No, NKF, RenCi and CHC were very successful and could have sustained their operations and even grown, until people realised that there were problems with their funds management.
They had plenty of money, and still have a lot of reserves. The problem wasn't with getting money, but how the money was handled.
In any case their money came predominantly from donors who gave willingly, not tax-payers who have little say in the matter.
The government can easily afford to double doctors' pay or half the price of healthcare in the public sector - the question is whether or not they should and will.
Subsidised healthcare is immoral in principle because it forces people to pay for other people's healthcare; however, you can still argue for its existence if the subsidy is targetted and you have the moral courage to ration the subsidy. The way we practise subsidy is far too untargeted and there is no moral courage in its rationing, which results in rampant abuse.
Subsidized education/policing/firefighting/national defence is immoral in principle because it forces people pay for other peoples' education/policing/firefighting/national defence.
Having said that, the rationale for subsidized healthcare is not to be moral about anything. It is to induce an optimal amount of healthcare consumption. Conversely, we tax alcohol/tobacco products. Left on their own, people tend to consume too little of healthcare and too much of alcohol/tobacco products. That is why governments tax alcohol/tobacco products and subsidize healthcare.
Is the angrydoc in favour of removing taxes on alcohol and tobacco products? To be consistent with his anti-subsidy/anti-tax principle, he ought to be. I would like to see him try to sell it to his fellow medical practitioners in Singapore. I am sure it would be a popular as removing medical school subsidies which he has stated that he is in favour.
@perspective,
I wonder if you realize that workers, and not just healthcare workers, in Singapore are generally paid much less than their counterparts in the UK. Engineers are paid less, lawyers are paid less, teachers are paid less, waiters are paid less, mechanics are paid less, electricians are paid less, and, of course, doctors are paid less.
Hey Anon, please learn a bit of economics. As a civil servant and not a doctor, I believe you have a very distorted view of the way the government works. I think you should sit back and better appreciate what the doctors are doing for us so far. Your beloved ministers that you are so clearly infatuated with aren't as loving as you would think. They're definitely far less altruistic than the doctors you love to malign.
And please don't bother to reply. I'm not returning.
"More foreign doctors have reduced workload so less call mean less income for doctors."
How does this translate to lowered healthcare costs for the patient? Do they pay less for the nights when foreign doctors are on call?
Do you have any idea how many hours of locum work one night's call money translates to?
Haha, interesting forum to follow.
Typical Singaporean forums.
People who comment don't even dare to leave their names or email address for replies.
Dear "angry doc", i feel for you. I'm a houseman working in a large hospital.
And i can completely understand how singaporean's perspectives are really distorted. But blame them not. This is what happens when there is only one media and one newspapers in singapore.
People think they have their own "opinions" which unfortunately are not their own, probably is that of the "media". And they love to complain and not even daring to leave an email for us to reply.
Its going to be an uphill job to try to change people's perspectives in this climate and i have to completely agree that healthcare is expensive , but heck living in singapore IS expensive, what do people expect? And i really do agree singaporeans earn too little, even doctors included. (BTW our base pay is 2700, not 3500 contrary to what some guy wrote)
And to defend my colleagues, we are certainly not GREEDY when we leave private.
Many other reasons i.e
1) We have more space and TIME to practise medicine the way we want it. Medicine in the hospital is "risky" with heavy patient load, little time with each one and a good chance for us to miss something cos of the strained resources.
2) Work life balance
No matter how altruistic we can be, to be honest, my wife and my child is still my blood, and to sacrifice so much till i have completely no time for them is just not something i want to do for the rest of my life.
and many other reasons...
So please stop labelling private doctors greedy. They certainly are not.
And yes i do agree with angry doc. TO be a real philantrophist, set up a really successful private practice/business then run a "free" clinic. That should be the way, not slave urself and "try" to practice subsidised care...and make urself so unhappy.
Frustrated at the thought of being marginalised when you can’t get into the training position of your choice?
Tired of empty promises of being accepted into an Advanced Trainee job – till the cows come home?
Keen to be able to practice real medicine instead of being tied down in endless cough and cold medicine or being under pressure to do 5 minute consults?
keen for a change in professional lifestyle?
keen for a change in workplace environment where verbal abuse and bullying is not tolerated by the Health Minister and Hospital Administrations?
doctors, nurses and other allied health professionals are desperately needed in australia now.
The current Health Minister Roxon is pumping in a lot of money into health care positions.
do check up this website from the Australian Government department of Health and Ageing for medical practitioners
http://www.health.gov.au/internet/m...
Dear Soon
Mos pay is 3.5k
HO should be seen and not heard. U are not a dr until you complete yr housemanship.
If leaving for private for more pay and less work is not greedy, I wonder what greedy is.
If not for the bond, public hospitals will cease to function and we will be held random by greedy doctors.
If you think I am sprouting rubbish, look at new zealand, australia and uk where junior drs are paid much higher.
is it wrong to be "greedy" for more time with family?
is it wrong to be "greedy" to be able to spend more time to tend to your children who need you?
PM says must spend more time with famileeeeeee!!!!!
public hospital junior doctors in australia/nz/uk are paid higher, so they are greedy? wow! it means that these public hospitals will cease to exist lor.. LOL ...
i am not surprised that lots of our junior doctors and nurses are seeking greener pastures in NZ where it is very easy for them to get a medical job with minimal hassles.
greedy doctors? LOL .. who is more greedy? management people or doctors and nurses?
management people get paid >>S$700 thousnad per annum .. who is more greedy?
LOL .... management guys love to push the greedy tag to doctors and nurses .... LOL ....
the old haggard pot calling the young silverware black
To anonymous above,
Do not just take the high moral ground and condemn doctors for being "greedy". I will say it's natural for anyone to aspire for more pay and better work conditions, it's part of self improvement. So why not take a good look at your ownself and ask yourself these questions.
1. Do you want better pay and better work conditions?
2. Are you willing to take a pay cut or forfeit your bonuses?
3. Are you willing to work a lot more hours than your current for no extra pay?
So if your answer to the 1st question is yes and your answer to the 2nd and 3rd is no, can i label you "greedy" as well?
I think all of you miss the point
People became doctors to help people not to make money.
They should not squeeze their patients all the time.
Can die but can not fall sick in Singapore.
If doctors can stay in public hospitals without demanding higher pay, there is no need to recruit foreign drs who are here because of money and better working conditions.
It is not cost effective to keep flying to UK, Australia and New Zealand to keep recruiting doctors.
Interesting, Anon.
Are you a doctor?
If so, feel free to "help people not to make money", "not squeeze their patients all the time", and "stay in public hospitals without demanding higher pay".
But whether or not you are, don't presume to tell me how to live my professional life.
dear anon (14 July, 2010 22:57)
not cost effective to fly to australia & nz to recruit doctors?
can you ask the reason why you can't even recruit sufficient ex singaporean and malaysian overseas students (medical and nursing included)to run your units?
you will need to compete hard with Madam Roxon (not that i like her at all- she may be pushed out by her political masters if she doesn't perform) to get our health care practitioners back. Plus she is offering carrots to entice our nurses and drs
when HEALTH administrators and some higher mortals who we know who can take home >$1 million per annum pay ON THE PUBLIC PURSE and they expect doctors and nurses to work for pittance ... LOL ...
Doctors and nurses want to spend more time with their families and if you call that 'greedy' for asking for more quality family time with our loved ones (we know that you are paid a lot more than doctors and nurses - so please don't preach to us that doctors and nurses should be paid pittance and you higher mortals can be featured in society magazines), so be it ........
Using the 'working for the good of the poor' card is outdated ... next please
"Using the 'working for the good of the poor' card is outdated"
Bravo, bersama.
Despite what these people say, they don't really want to help the poor themselves, nor do they want us to help the poor - they just want to have cheaper healthcare even when they are not poor themselves and can easily afford it.
These people just want things cheaper for themselves, it is natural to a certain extent and it is ok if it is kept to themselves. I mean who wouldn't want cheap healthcare, cheap food, cheap entertainment, cheap transport etc etc? However self righteous thoughts like "People became doctors to help people not to make money" sounds really lame. However, would these very same people accept a pay cut for themeselves, hell no! And yes angry doc, they don't really want to help the poor themselves, it's their own bottom line that really matters :)
"... they don't really want to help the poor themselves, it's their own bottom line that really matters"
I believe realising that that is the truth will free our young doctors from the lie that they owe it to society to work hard for a low pay.
don't forget the nurses too, angry doc. without them, things will come to a standstill.
nurses r not slaves and it is time that they deserve the recognition from society.
it is a shame that our administrators are not pumping in enough money to train and empower more local singaporean nurses. who pays? the cash cow which also pays our top administrators and "higher mortals" - who are paid more than President Obama or PM Gillard.
may i remind us that the National Cash Cow had made huge losses in the past and some of these administrators are silent. but when doctors and nurses are perceived to be 'greedy' for asking for more quality time, they will 'nangis ibu nangis bapa"
and who are the beneficieries when our nurses leave singapore? we all know who. it is time for these administrators to do something.
Administrators are working very hard to attract doctors and nurses to stay in the public hospitals.
It is doctors who refuse to stay as there is no way to we can match the salaries of private sector.
Most of our patients in public hospitals and not well to do and there is a limit to how much we can raise the medical fees.
Hospital administrators earn less compared to private sectors. So if we can accept lower salaries to help improve public healthcare, why cant doctors do the same.
Life is not all about money and we should remember a higher calling.
The older generation of doctors are not like that. They stay in public hospitals and guide their juniors.
Nowadays, newly appointed specialists demand to be given a 1 yr fully paid holiday overseas (HMDP) in exchange for them to stay.
If this is not greedy and self serving, I wonder what is?
"... doctors who refuse to stay as there is no way to we can match the salaries of private sector."
"Administrators are working very hard to attract doctors and nurses to stay in the public hospitals."
Er... if you believe the problem is that doctors are leaving because of money and you can't/won't increase their pay, how is "working hard" going to change things?
"Life is not all about money and we should remember a higher calling."
"Hospital administrators earn less compared to private sectors. ... we can accept lower salaries to help improve public healthcare..."
Sounds like you have your dream job! But why do you insist other people share your aspirations?
"Most of our patients in public hospitals and not well to do and there is a limit to how much we can raise the medical fees."
That's a meaningless statement without some figures and definition of what "well to do" means. How many percent of patients pass or fail means testing?
So, do and should we have means testing for medical school subsidies? Or is medical school exempt from that sort of self-righteousness?
To fox:
The issue of "subsidies" has been discussed quite vigorously in the comments section at http://singaporemd.blogspot.com/2010/01/consumerist-healthcare.html, I suggest you read to understand more about the "subsidies".
anonymous in 16 July, 2010 12:02
Aiyo ... doctors and nurses have to "pay back" for HMDP ... please do not delude the public that they get their expenses for HMDP fully paid for.
nothing is for free (liar liar)...
hey what about one of your big admin bosses who gets paid more than S$400k per year (he is the one who made major changes to the salary scale/work conditions/leave policy changes) of doctors and nurses, physios in the last 3 years) - no names mentioned and i am sure you know who - is he greedy? please answer
is the minister of health greedy for receiving more than S$2 million per year?
wow , wanting to spend more time with my family is 'greedy' in your vocab ... LOL ....
wow, i want to be 'greedy' too lor .. hahahahahhaha
so what about those doctors and nurses who leave our public health care system and migrate overseas to other public health care systems? are they greedy?
administrators can afford to pay doctors , nurses, physios, more in order to retain them. why can't we adopt the HK system?
who pays? isn't it obvious. DEFINITELY NOT the public ...
it is the same paymaster who dishes out the grant to you. ;)
To Anon 17 July, 2010 01:15,
I've read that thread. It was about whether the subsidies add up, not how they are given out.
Subsidies given to medical students are not varied according to ability to pay. Everyone pays the same fees. If we had means testing, then that wouldn't be the case.
For example, if you had come from a rich family, then NUS could have charged you more for the non-subsidized portion of the school fees and still impose a 5-year bond for the subsidized portion. Conversely, if your family were of modest means, then you would be charged less.
If you believe that strict means testing should be imposed to public medical services, then explain to me why public medical education (or more generally, any kind of public education) should be exempt from that.
Dear bersamakita
Are the doctors paid while undergoing HMDP? Yes! Full salaries!
Are they paid when they come back to serve? Yes and it is likely they get promoted too!
How do they pay back?
Stop lying to the public.
It is free to them and they blackmail us HR to give them HMDP or they quit?
It is tiring as there is a limited budget for HMDP and worse come worse, some actually go and never come back.
They just pay up the bond.
I think we should just sponsor nurses, allied health and medical administrators for HMDP since we are more loyal to hospitals and stop sponsoring greedy doctors who threaten this and that.
Yup
I agree with FOX.
We should stop subsidizing rich medical students since there is obviously a demand to get into medical school.
Eg it costs $500k to train one medical student and they pay $100k.
So if they are willing to pay the full rate, in theory, we can increase the number of medical students in Singapore so we do not need to rely on foreign trained doctors and it cost nus nothing since they are paying full rates.
To make it fair for them, we dont impose a bond for them.
U can choose to pay 100k for 5 yrs bond, 200K for 4 years bond and full rate for no bond:)
"It is free to them and they blackmail us HR to give them HMDP or they quit?"
I think using the word "blackmail" here is just juvenile.
If you think the doctor is worth the money, give him the HMDP. If you don't, tell him to go fly a kite. It's not blackmail, it's leverage.
dear anonymous "19 July, 2010 13:49" - we know all who u stand for.
and why aren't you giving the deserving nurses HMDP grants? it seem that the vast majority of them goes to doctors, isn't it a bit out of proportion? we cannot live without the nurses. the whole hospital system will come to a standstill without them. Why aren't you pouring in more funds to recruit more SINGAPOREANISED nurses - not those who hardly speak any proper English from you know where. Why wasn't this done years ago?
look at australia/nz/uk/south korean/japan - most of their nurses are locals born and local trained, compared to our system.
isn't it your own doing or the mis management in your policies, which u don't want to admit?
u certainly have to do a lot more work to compete with say australia or UK hospitals to retain our nurses.
by the way, why do you need to retain the passport of foreign nurses upon recruitment? please answer this. is there a problem with the system? looking at countries like australia/nz hospitals, their HR doesn't retain the foreign nurses' passports.
by the way, you failed to answer my question
1. your coworker (u know who) who implemented those new HR policies that cut the leave of those doctors and nurses in the last 3-4 years and he is paid > 400k per annum, is he greedy?
2. your "father superior" who is paid > 2 million a year is he greedy?
3. doctors and nurses who leave our health care system to migrate to other public health care systems, are they greedy?
dear anonymous
i do agree with angry doc (19 jul 2010 1501 hrs) that if the practitioner is not worth the money, he/she won't even be considered for HMDP.
it is unfortunate that the word 'blackmail' is used inappropriately in this instance.
by the way, are you greedy too? ;)
LOL
2009 NHG will be giving out HMDP Fellowship Awards to 189 NHG staff, a 37% increase from 2008. The awards total S$5.7 million, a 28% increase from last year’s S$4.4 million. The awardees comprise of 75 doctors, 77 nurses, 23 health sciences professionals, and 14 healthcare administrators.
only 14 administrators given the award compared to 75 doctors and 77nurses
So unfair :(
what about nurses?
nurses have been the underdogs of this health care system and their efforts have been under recognised.
we can't live without nurses.
5.7 million? hahahhahaha .. LOL
if you are serious about improving the morale of nurses, you should be pumping in more money to raise the overall pay of the nurses (and you know from who... not from the tax payers definitely - from the General Kitty bank - the same kitty bank that pays your Father Superior and one of that 400k per annum (new) administrator who had edited the leave and pay policies of drs and nurses (that is making it very uncompetitive and unsustainable) in the last 5 years
I am sure you can recall that it was in the last 10 years that this lady who wrote in Lianhezhaobao lamenting that even SIA trolley dollies are paid more (per hour) compared to nurses in singapore - which is such a disgrace, compared to say in south korea or HK or australia.
anyway you seem to know the HMDP figures very well .. and we know your platform.
By the way you have been silent regarding my questions in19 July, 2010 16:26 ,.. and i can draw the conclusion that you do concur with my comments ;) ...
so who is more greedy? me wanting to spend more free time with my beloved ones ? or you who is paid more than me hourly or say even more than a SIA pilot? :P
If u are a nurse, can u stop posting in singaporemd.blogspot.com?
This is a forum for doctors only!
Stop whining about the ill treatment of nurses.
Go get a life and stop arguing with hospital administrators!
To the anonymous whose comment I choose not to publish:
This blog is not limited to doctors, and I am pretty sure you are a troll. I will not publish any of your comments if you continue in this manner.
http://thinkingbetterthinkingmeta.blogspot.com/2010/07/caught-in-bad-romance-day-lee-kuan-yew.html
so angry doc what do you think about this?
I don't.
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