There are probably many others, but I shall just focus on two today:
Alex Au blogged about the hospital bed crunch today, almost one year after his last post on this topic. His father, who apparently had a UTI, had to wait for four hours at the Emergency Department before being admitted. This is indeed a problem that is disturbing not only because it wasn't anticipated (or at least deemed not to matter), but because all the signs were present and the feedback available for the past several years. Restructured hospitals have become increasingly creative in dealing with this issue (mainly in terms of improving the time to actual care delivery and reducing the time where patients are stuck "in transit" in the ED observation rooms) - like NUH's aptly-titled "The Big Squeeze" - but the hospitals can only do so much with the limited number of beds relative to the growing population.
In the Temasek Review Emeritus, a Ms Serene XM Cai complained about the delays in her treatment at SGH, questioning whether she received 2nd class service because she was a B-class patient. Poor Dr Bok (her primary physician) must be wondering why he's suddenly notorious! But... I could not really find anything wrong with the way she was managed. She received an MRI within 24 hours of admission, and the ultrasound (TENS?) on the following day. How is that for speed of service in a public sector hospital for a subsidized patient?? Very few public hospitals worldwide can achieve this. Sure, Mt Alvernia specialists reached the diagnosis rapidly and prescribed treatment that was presumably successful, but then again, the last set of doctors patients see generally gets things right because of all that has gone on before. This is a case where the patient's expectations were much too high and they were perhaps not managed well.
55 comments:
It's all about KPIs and their promotions.
Expectations go so high it is impossible to meet without ramping up the costs.
It is like I open a coffeeshop in Toa Payoh and say it is WORLD CLASS restaurant. Fast food. Gourmet cuisine. Classy drinks. Speedy service.
And the chicken rice costs $1 a plate.
Errr.....you believe me?
The trouble is that the patients believe. But then again, the old argument about how there is no choice but to go to the coffeeshop will come back.
Bottomline reality is that you can have a good coffeeshop with good food at good prices but don't expect all the razzmatazz.
*Gasp!*
But food is a basic human right!
If the gahment doesn't subsidise coffeeshop and give the people affordable quality food, people will starve to death on the streets!
In Singapore, can die, cannot go hungry!
Nobody wants to be hungry, so it's not their fault when they need food, and so the gahment should provide... use tax money to pay! There won't be any abuse.
The gahment should ban cooks from working at high-class restaurants when there are still people who cannot afford coffeeshop food. They should also cap the pay of cooks so food remains affordable to the average Singaporeans.
(And so on and so forth...)
Capping the pay of cooks - sounds like an idea :)
Why not make the cooks more , cook faster and ensure gourmet quality while at it ?
And to ensure quality of food through generations make them teach apprentice resident chefs too.
This would ensure cost effective gourmet food for everyone .
In fact pay has been capped - with some exceptions, but definitely much lower than outside.
Pay less work more. Allocate the 25th hour of the day for the cooks to teach new chefs.
I think the cooks will quit .. en masse. .
And since only cooks can train new cooks. Like only pandas have baby pandas we can prob apply for endangered species listing for cooks soon.
Then everyone will have to eat sushi.
Well, let them quit then!
These cooks who will only cook if we pay them to do so are doing it for the wrong reasons anyway - cooks should only be cooking to alleviate the hunger of mankind; it's a calling, not just a job!
Only those people with a caring heart should be allowed to become cooks.
Oh, and let's ban foreigners from eating at our coffeeshops! They are obviously driving up the prices of food here.
In fact, let's close all restaurants. Everyone will eat from one big pot of rice... that's the only way to ensure equality in our society. No one gets left behind!
Angrydoc - err u cook for free ah ?
Cooks also must eat - except for the notable few , those who stay on in public do not make much. And pay has not been increasing at the same rate as inflation. In fact from unverified word from my seniors the absolute pay grade for grade actually dropped.
They also need to sleep and rest n family time.
Why is it that you mention pay with such vehemence all the time ? And you seem to focus the top earners. Most of us are strictly middle class and are sandwiched in the "can't but HDB and can't quite afford condo but no choice"
Perhaps you have a different background but your view seems quite skewed IMHO
I am sorry
How can cooks ask to be paid more when food is a basic human right and so many Singaporeans are already struggling to put food on the table?
They should all take a pay-cut! Better still, make them all pledge not to raise prices over the next few years...
Angry Doc
LOL, not sure whether the commentters know what minefield they are stepping in.
It's simple, isn't it?
The more valuable a commodity or service is, the cheaper it should be to the consumer!
In fact, things which are vital for one's survival should be free to the user!
Take air for example: we all need air to sruvive, and air is free. Even Nature agrees with me!
Therefore the more valuable a person's skills are, the less he should be paid, so that his products or the services he provides can be made available to the users as cheaply as possible.
(Wang, I wonder how many people these days even get the reference to 'big pot rice'...)
http://www.hooptywagon.com/img/macros/cant-tell-if-stupid-or-trolling.jpg
Angry Doc
Do get your comments especially on big pot rice ROTFLOL.
Noted your apt description however you should know the thoughts of Tranzi's and the modern day commentators think themselves intellectual equals see prime example "lacite" on evils of capitalism.
I have no doubt that they are intellectual equals if not superior - the problem is they think themselves morally superior.
We do not think ourselves as morally superior, just a different set of morals from you.
Sure.
angrydoc,
you are obviously.....angry.
Anyway I feel sorry for you. Obviously the government in Singapore is not treating doctors with the respect they deserve and the people took that lead.
Both have a part to play because in some countries, healthcare is nearly free for all the patients and the state foots the bill. Doctors in turn are paid their worth and given the respect they deserve.
But of course you feel that you should not have to pay taxes but do accept it because it is as you say "impractical".
If you think about it, your line of thought is THE SAME as the government's and the people.
NOBODY WANTS TO PAY. Not the government and not the people.
You can't have your cake and eat it. Well at least if everyone is thinking that way there simply won't be any cake in the first place.
"you are obviously.....angry."
Wow. Your powers of observation are astonishing! What gave you the clue? My name?
"If you think about it, your line of thought is THE SAME as the government's and the people.
NOBODY WANTS TO PAY."
That's not true - I am happy to pay for what I use, and I don't mind paying a premium for things which I value. I just object to not having a choice over paying for what other people use.
angrydoc,
you don't get it. But these self centred, selfish values are what makes societies become the kind that you now live in.
Another society that is like this is USA.
Don't miss the forest for the trees.
No, what make society the way it is now are people who think it is their right to make others pay for what they need, and a government that tells them they have that right.
"I am happy to pay for what I use, and I don't mind paying a premium for things which I value."
Patients demand high level of service and they are demand subnsidy as well, as they feel that they have already paid for it (via tax). Hence in a sense, they are using what they are paid for.
angrydoc,
can you elaborate how your statement "what make society the way it is now are people who think it is their right to make others pay for what they need, and a government that tells them they have that right." applies to what is happening in Singapore?
As far as I can tell, Singapore has a low tax strategy and operates on a budget surplus on most years. There are few public assistance programs. And this is the government that most people in Singapore choose.
You live in Singapore don't you?
"... they feel that they have already paid for it (via tax). Hence in a sense, they are using what they are paid for."
If they pay more in taxes than they receive, then where is the subsidy?
"can you elaborate how your statement... applies to what is happening in Singapore?"
The 'subsidy mentality' is evident in the comments here and on other forums, and of course in the daily practice of healthcare workers.
So to them it is NOT a subsidy, it is using what they have paid for. And based on what you said in another post, not all returns are in dollars and cents, some comes in the form of homeland security.
"Since I cannot be sure that those dollars I paid in tax went to healthcare instead of defence (I mean, after all, defence sucks up sooo much money!), my statement may be wrong!some comes in the form of high security of our country."
"So to them it is NOT a subsidy, it is using what they have paid for."
They may say so, but they know they are getting more than they pay.
If we offered the people the option of cutting their taxes by 8.7% (the percentage healthcare takes up in the total government budget) but in exchange they don't get any healthcare subsidy, what proportion of people will take it up?
Will *you* take it up?
Will *you* ?
Does this 8.7% makes a difference to how you would utilise the health system ?
Yes.
To those who feel that they are paying "more than what they are receiving", the only impact the 8.7% tax cut have on people like you is that they feel happier. Happier that the level of healthcare everyone receives is dependent on how much you are willing to pay. *Cheaper clinic, longer crowds, longer waiting time - simple supply and demand theory)
But you said you would utilise the healthcare system differently. So currently you are using "what you are paid for (via tax)" ?
I don't utilise the subsidised healthcare system. I pay for the healthcare I use at non-subsidised rate.
Healthcare is a luxury, not a basic right la. Once you see it that way things become clearer!
Healthcare is a need.
Problem is, most people confuse "need" with "right". They think that just because they "need" something, other people have the obligation to provide it for them.
"No, what make society the way it is now are people who think it is their right to make others pay for what they need, and a government that tells them they have that right."
That is not fully accurate. The angrydoc chooses not to utilize the subsidized healthcare services by not attaining a particular income level. Subsidized healthcare services are available to any Singaporean provided that he/she has a certain income level. For example, if angrydoc meets with an accident and is left unable to work full-time, he does qualify subsidized healthcare, however meagre.
Angrydoc is not getting the services but he does qualify for its coverage.
So the 8.7% cut would NOT have an impact on how you utilise the healthcare. It just makes you feel contented about the way the healthcare system has changed.
Hopefully you would be one of the anonymous donars who would help those who are in genuine need.
"If we offered the people the option of cutting their taxes by 8.7% (the percentage healthcare takes up in the total government budget) but in exchange they don't get any healthcare subsidy, what proportion of people will take it up?
That defeats the purpose of risk pooling and the economies of scale from public provision. Sure you want to opt out but why limit that to healthcare? Let's also do that with the police, the military, the fire services, the roads, infectious disease control, etc.
Agree with Fox.
Anyone who are unable to work full-time, due to injuries or illness, and medical expenses have become unaffordable, would thank the government for the subsidy and medifund. It is ours AND the restructured institutions' security blanket
We all hope we do not fall into that situation. We do not want to see the returns back to us via this way.
"The angrydoc chooses not to utilize the subsidized healthcare services by not attaining a particular income level."
"Anyone who are unable to work full-time, due to injuries or illness, and medical expenses have become unaffordable, would thank the government for the subsidy and medifund."
Actually, a citizen can get subsidised healthcare at the polyclinics and specialist clinics regardless of his income level. Even when hospitalised, a person can still choose a C class bed - he just has a lower subsidy if he 'fails' means testing. Right now, our subsidy is not being limited to those who cannot afford healthcare, but tho all those who do not want to pay the full amount for their own healthcare.
"Let's also do that with the police, the military, the fire services, the roads, infectious disease control, etc."
If you have a practicable way of doing so, do propose something on your blog, Fox. As I told you many times before, my focus is on healthcare. Having said that, aren't we already doing it for telcos and 'public' transport?
'Right now, our subsidy is not being limited to those who cannot afford healthcare, but tho all those who do not want to pay the full amount for their own healthcare.'
Because.... they feel they have already paid for it.
"Because.... they feel they have already paid for it."
But... they haven't.
via tax
Right. And everyone pays as much taxes as they receive in subsidy? Why bother collecting taxes then?
Because healthcare is not the only thing we are taxed for.
'That defeats the purpose of risk pooling and the economies of scale from public provision.'
"That defeats the purpose of risk pooling and the economies of scale from public provision."
By that argument everything should be nationalised. Big pot rice, anyone?
Is the concept that each man pays for what he uses so vile?
And every insurance policy holder gets as much as they pay in premium? Why bother having insurance policies then?
"Right now, our subsidy is not being limited to those who cannot afford healthcare, but tho all those who do not want to pay the full amount for their own healthcare."
They have paid for the 'premiums' in the form of taxes. Public healthcare is a form of social insurance. Any form of insurance means that some people will always get payouts exceeding their premiums. You're not paying for the actual services when you buy insurance. You're paying for the *coverage*.
"Is the concept that each man pays for what he uses so vile?"
By that argument, we should not have fire insurance, home owner's insurance, auto insurance, medishield, etc.
Not everything should be nationlised, but there are something that needs to be (eg homeland security).
I am not saying the concept is vile, but you have only gave a broad statements so far. When pushed for a proposal, you admitted that it is 'impractical'.
It is nice to have dreams, hopefully you make it a practical reality someday.
I think we all agree that the ends of the spectrum are either undesirable or impractical - we differ over at what point of the spectrum healthcare should lie.
Angrydr : I wish to rebut your point
You seem to equate Doctors' pay with Healthcare cost.
In reality, I think they are separate. Even if all doctors were to be paid $0 health care is unlikely to become suddenly affordable.
The moment a patient is admitted to the hospital, he is attended to by a veritable army of nurses, healthcare attendants as well as admin clerks who help with the paperwork. The administrators help ensure everything is in running order and cleaners/ maintenance engineers make sure all is in running order. The radiographers and the lab technicians run tests ordered. The paramedical staff - dieticians, physio and occupational therapists take care of their respective tasks.
Finally, there is the doctor.
Even if doctors' total pay were to be zero, there are a host of other things that make healthcare too costly for many Singaporeans and I am not even touching on the ever rising costs of drugs yet.
In the outpatient setting, Consultation charges at specialist clinics are charged at ~ $21.
How much more savings is that ?
Case in point - figures from the MOH website
ALOS for cardiac failure in a B2 ward at CGH ( first in the list) is 4.7 days, median bill size $861
Without govt subsidy of 60% that's ~ 457 per day.
The average team of a consultant , registrar and MO sees on a "light" day ~ 15 patients and total cost per month for all these patients before subsidy is 205k. The combined salaries of all these doctors are at most 10% of that. And that's not including the amount they "earn" seeing outpatients.
So cutting doctors' pay to $0 saves for the outpatient $21 and the inpatient $86. I dont think that's enough. It just does not address the problem. Particularly for outpatients where the consultation charge accounts for a even lower percentage of the bill.
The issue I think is the distribution of wealth.
Our GDP grew 14.5% last year - our country has sufficient resources to provide for the needy.The problem is how to get it there, as well as the perennial question if GDP spending on healthcare should be increased beyond the current 4% - very low by developed country standards.
As mentioned earlier, though I was anonymous since I don't have a google account, most doctors are strictly middle class. Its the odd person that makes a million a year and truly extraordinary to bill for 25 million. Saying all doctors make a lot is like saying all provision shop owners operate a chain like 7-11.
The workload is increasing and the pay doesn't rise with the inflation. While not too uncomfortable there are times where we are also a little stretched, because actual buying power is dropping. Dropping doctors pay further could make this uncomfortable and provide a push to the private sector. I am concerned about that.
I am just asking that doctors' pay be commensurate with inflation. I think that is reasonable.
When you work ~70hr per week you have little time for financial planning and you do not want doctors distracted by their finances while seeing patients.
Finally I do not believe you are a doctor, and I challenge you to prove it.
Most of what I mentioned should be painfully obvious to anyone in the medical profession - that we do not make piles of money and the the main part of healthcare cost come from drugs and investigations. In fact much of the debate in the public ( lay people) is about the cost of drugs - not consultation fees.
You are angry - claiming that doctors who work for money should quit. Doctors should work without pay for the care of populace since it is essential.
This is both shallow and full of duplicity and bias.
You see a doctor at most a few times a year,
You drink everyday - water essential for life - is it free ? Do you demand that of PUB ?
You eat 3 times a day. Do you walk to the chicken rice store and demand free food ?
While in an utopian world everyone should receive all he/she needs, giving freely of ourselves, the selfish refusal of humans to share resources equitably precludes this. The failure of communism proves that this is not possible.
It seems to me you are just a someone with a bad case of iatromisia, targeting doctors just because its easy.
angrydoc,
fox brought up a good point.
Does angrydoc have any insurance policy of some sort? Mortgage insurance? Life insurance? Auto insurance? Does angrydoc believe in insurance schemes?
anyway it is not vile to think of every man for himself and pay for what you use.
However you will NOT say that idea is a gracious one either.
It is also hard to argue against someone who will say that angrydoc is selfish with his money and not generous and has no concern about the larger society and less fortunate. Nothing wrong with that, but nothing much good to say either.
I suppose the situation is such that those who have want more and want to keep all of it. Those who don't have, wish they could have some shared from those who have.
I leave you with words from the great book; The Bible :
"Whoever has two tunics is to share with him who has none, and whoever has food is to do likewise."
Angry doc/Fox
Agree with comment 16/6/11 14:46
Likewise would comment that definition of basic services even as simple as healthcare/education/home security
Why would anyone bother to read the Temasek Review? Seriously its full of the whiny same crap over and over again without any substance or constructive comments, i would rather spend some time reading TOC if i wanted some alternative media..
None the less the said patient in your post really dosent know the fantastic treatment she is getting!
In the UK, a severe lumbar disc herniation with pronounced sciatica gets an URGENT mri done at earliest 4 weeks.. When i saw that case, i guess i learnt to be grateful to our healthcare in Singapore
"Does angrydoc have any insurance policy of some sort? Mortgage insurance? Life insurance? Auto insurance? Does angrydoc believe in insurance schemes?"
Do we really want to spend another 50 threads arguing about how subsidised healthcare through "progressive" taxation is not the same thing as insurance?
"I leave you with words from the great book..."
And I leave you with these:
"Thou shalt not covet thy neighbour's house... nor his ox, nor his ass, nor any thing that [is] thy neighbour's."
"Angrydr : I wish to rebut your point"
"Finally I do not believe you are a doctor..."
Anon, I am a doctor. I was also being a troll.
Of course, no one is suggesting that the public healthcare system is exactly like auto insurance. That's a mere strawman. But schemes like auto insurance have features that the Angrydoc finds so objectionable, that some people pay more into the system than they get out of it. As with any insurance scheme, there would be people who pay into the system but get considerable less payout and others who pay the same but get more paid out.
Hong Kong has a single payer subsidized public healthcare system that is much more generous than Singapore's. Does it look like a communist society to anyone?
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