Subsidy - the cure for all woes?

The problem with the 'subsidy mentality' is that after a while, it becomes so ingrained that people begin to look at 'subsidy' as the solution to what we perceive to be a social problem. Now, it seems that a doctor (dentist?) is calling for doctors and dentists to be subsidised too!

GPs and the elderly bear brunt of foreign doctor influx

HEALTH Minister Khaw Boon Wan believes that his ministry's current 3M (Medisave, MediShield and Medifund) health-cost strategy facilitates even expensive procedures such as a heart bypass with minimum cash outlay ('Opposition has strange ideas on health care: Khaw'; last Wednesday).

Regarding doctors, Mr Khaw's present strategy seems to be to leave market forces to equilibrate. This means that doctors are left to fight for their survival, causing many general practitioners (GPs) to practise aesthetic medicine to supplement their income.

The influx of foreign doctors to fill places in government hospitals and polyclinics has resulted in a communication breakdown between elderly patients and their doctors. Our health-care system is in a lose-lose situation in which doctors and patients suffer.

Such a fire-fighting strategy could be avoided with proper planning. Our health-care system is well-developed, so why have health-care needs for the next 10 or 20 years not been forecast?
The full social impact of the influx of foreign doctors will be felt in a few years but local GPs and elderly patients are already feeling the pain.

As GPs cope with rising costs, the cost of medical care will rise with inflation. Lowering medical fees artificially will only result in poorer quality of care.

To help GPs contain operating costs, the Government should consider offering subsidised rentals in Housing Board neighbourhoods.

GPs and dentists must now compete with the likes of cellphone traders and bubble tea sellers for the same shop space. Which is a greater public service? Is return on investments more important than health-care affordability?

Dr Ng Yong Kheng


Now the thing is, if you fail to identify a problem correctly, you are not likely to come up with the correct treatment for it. Or even worse - if you begin by deciding on a treatment and then go back and try to frame the problem so it fits your treatment...

The first misconception here is that GPs do aesthetics to make ends meet. While GPs may initially go into or dabble in aesthetics to "supplement their income", my experience is that they soon find it so lucrative it becomes the main source of their income. I have had colleagues who started doing aesthetics "out of interest" or to "supplement income" or whatnot, and for a while even as they expanded their aesthetics practice they continued to keep a foot in primary care "as a form of social responsibility" or "to stay in touch with the basics" - but now they are in full-time aesthetics, operating out of full-fledged aesthetics clinics. Ask yourselves this: You have seen 'normal' GP clinics turn into 'aesthetic clinics' or the 'aesthetic branch' of a clinic chain - has the reverse occurred? Has a clinic ever turned from being an aesthetic clinic to a 'chronic disease clinic'? Have you ever had a doctor refuse to take on another botox case because he has made enough for his rent this month, and would rather spend that time slot looking after a patient's diabetes?

GPs may start aesthetics to supplement their income, but they do not stop once the overheads are all covered. The resources, in terms of training and equipment, once invested, just makes it economically more sensible to convert one's entire practice into aesthetics.

So will lowering rental for clinic spaces make GPs turn from aesthetics to primary care? Well, as I asked in the comments section of a previous post: if you are selling tea for $2 a cup when HDB halved your rent, and people are still willing to pay for your tea at that price, will you lower the price to $1?

And that brings us to the next point Dr Ng brought up when he asked: Which is a greater public service - GPs, or cellphone traders and bubble tea sellers?

I think the question to ask instead is this: Does the average Singaporean spend more on primary care each year, or more on handphones and bubble tea? What about cigarettes and alcohol? Hairdo, nails, spas? Now the fact that all these service providers can compete for the same shop spaces as the GP tells you something - they can turn a profit at the same rental. And the reason why they can do it is because Singaporeans are willing to spend money on what they have to offer. Granted the people whom we normally associate with spending on such things may not be your typical picture of a patient with chronic diseases, but you cannot deny that many will become such, and that the money not spent on those discretionary expenditures now can be saved to pay for one's healthcare needs later in life. If Singaporeans are willing to spend as much on primary care as they do now on all these things and on aesthetics, will GPs have any incentive to go into aesthetics or to let their spouse run a bubble-tea stall out of the same shop space? The players in this equation are not just the landlords and the tenants, but also the consumers. The consumers' choices determine to a large extent whether a business model is successful or not - just ask any Luohan fish seller.

I believe that this 'problem' of GPs doing aesthetics rather than primary care cannot be 'solved' if we continue to deny the economic realities, which is that patients help create that market by the choices they make, and they make those choices because of the perceived value of primary care to them, and because our subsidised healthcare system allows them to abdicate responsibility for their own healthcare.