"There is no abuse" 2

Just to re-iterate a point I made earlier...

Why health care is like water

DEPUTY Prime Minister Tharman Shanmugaratnam's proposed review of improved financing, regulation frameworks and clinical programmes to better integrate private and public health-care services bodes well for both health professionals and users ("Private sector to ease health care load?"; July 10).

While the mainstay of health care remains within the public sector, the private sector has reservoirs of reserves locked within, awaiting deployment once the Government can integrate the two with policies to overcome the major obstacles of cost containment and efficiencies.

Health care is a commodity that should be treated the way the Government treats water: essential and affordable, but with a price commensurate with its worth.

Like water, it starts with conservation of health through a conducive lifestyle.

Primary health care that is priced too cheaply and used as a political tool to garner popularity will be abused and fraught with wastage. Tertiary health care in hospitals will also be saddled with unnecessary and frivolous referrals.

However, the removal of the fee schedule for doctors, because it was deemed anti-competitive, has moved the cost of private health care sometimes to stratospheric levels.

A middle ground is sorely needed where general practitioners can practise good medicine without the price pressures generated by insensibly subsidised polyclinics; where private specialists can act as a valuable release valve from heavily utilised public hospitals, if only patients are assured that charges are capped at a fixed premium.

Dr Yik Keng Yeong


Well, I don't think that healthcare is like water - for one thing, healthcare doesn't fall from the sky like water, and I don't agree that the government automatically has rights over all the healthcare that falls onto Singapore...

But I certainly agree with Dr Yik's observation that:

Primary health care that is priced too cheaply and used as a political tool to garner popularity will be abused and fraught with wastage. Tertiary health care in hospitals will also be saddled with unnecessary and frivolous referrals.

Dr Yik recognises that abuse is a problem, and he diagnoses correctly (in my opinion) the reason why abuse is not tackled. However, by proposing that we solve this problem by re-siting patients to the private sector and making it attractive for the patients to want to be re-sited by capping how much doctors there can charge is merely punishing them for the lack of moral courage on the part of the politicians.

The problem, as Dr Yik has pointed out, is the "anti-competitive" "price pressures generated by insensibly subsidised polyclinics"; so if you cap GPs' charges at equal to or below that, then how will they make any profit? Or, if you cap the charges at higher than the polyclinics', then why would patients then choose to see a GP and pay more?

The way I see it, the real reason why abuse occurs is because we have a system where people are not required to pay for what they consume. As long as you are not willing to change that, you will have abuse; until you are willing to change that, or until you are willing to police for and stop abuse if you find it, the problem will remain with you.

Talk vs Action

The exodus of doctors from the public sector continues to draw attention, as evidenced by recent Straits Times articles and Forum Page letters.

I'm glad that the ST's original feature - which suggests that money is the predominant draw to private practice - was quickly rebutted.

An invitation to a "physician engagement" luncheon 2 weeks ago helped debunk the myth further. With approximately 12 clinicians and 5 senior administrators ( also medically trained ) in attendance, it was a candid affair, allowing us to share concerns from the ground and suggest changes to ensure equal recognition for all areas of expertise.

While institutions currently favour those who conduct research, others who perform clinical duties full-time should not be overlooked. After all, without the latter serving as the department's backbone, the former may not be able to continue with what they're doing in the first place. What's the use of pioneering some new-fangled therapy, when there's no-one left to see patients in the wards and clinics?

Another issue that was highlighted: constraints imposed by the new residency programmes, especially in high-volume areas like polyclinics. Due to the stipulated limits on patient loads and working hours, it's obvious that non-residents will be required to bear the extra burden of clearing the backlog. This may in turn breed discontent among colleagues, resulting in more resignations.

One surgeon even remarked that the narrow scope of training for residents might render them less competent in the long run, compared to their predecessors who underwent the proverbial baptism of fire. And I agree with his prediction. Seeing few patients = less experience = poorer clinical judgment and procedural skills = suboptimal patient care.

And for the benefit of the administrators and corporate communications personnel: suboptimal patient care = more complaints = more lawsuits = hospitals lose more money settling out of court.

While the luncheon was attended by consultants, I hope that registrars are or will be included as well. Because they're the ones who tend to be treated like slaves, working inhumane hours, getting arrowed for everything, and unable to say no as they're the most junior in the department and are too afraid to offend their seniors.

As for the medical officers, they generally have it pretty good these days. Even the non-residents get to do half-calls, so instead of working 24- to 30-hour stretches, they come in at 9pm and go home the next morning. House officers also benefit from ECG technicians and phlebotomists in the wards. I never enjoyed any of these luxuries!

So it remains to be seen whether changes will be made, and how soon they will be implemented. I'd like to stay optimistic for now, and have faith in at least one of our leaders ( who was present that day ).

Let's hope it won't be another case of "all talk, no action".