Someone who is presumably not a healthcare professional has finally asked one of several pertinent questions in a public forum - the Straits Times.
As far as I understand, the patient is generally billed the cost of all treatment in any hospital in Singapore (although this can be covered a variety of ways, including government subsidy, insurance, etc), which - from the patient's perspective - does seem unfair.
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4 comments:
Of course not. Angrydoc will tell you that getting a nosocomial infection is entirely your own fault and you have to pay for whatever medical expenses you incur yourself! No way should you expect anyone else to pay for you ok!!!
Here's the thing: superbugs are entrenched in most hospitals, a result of both indiscriminate use of powerful antibiotics and patient casemix necessitating escalation of treatment.
In theory, institutions are obligated to minimize nosocomial infections and the spread of superbugs, and every hospital has strict infection control protocols in place.
However, implementation isn't always possible, except perhaps in operating theatres ( where infections can be traced directly to the source/s ), or intensive care units where patient loads are lower and rooms are isolated.
General wards are bacterial cesspools, with severity further affected by discipline, class and staff compliance to hygiene practices.
Making institutions responsible for costs incurred from nosocomial / superbug infections may spur the administrators and healthcare personnel to nip the problem in the bud once and for all, but how far will this rule extend?
Does it cover only patients admitted after a certain date, or will it be enacted in a retrospective manner? How far back is considered reasonable?
In 2003, when TTSH closed its doors to non-SARS patients, the bulk of its cases who were earlier discharged and later deteriorated were admitted to other institutions, causing SARS outbreaks and significant fatalities elsewhere.
In such a situation, does TTSH bear responsibility for not taking its own patients back?
Here's the thing. If healthcare were managed through a collective universal benefit funded by taxes such that every admission by every person is paid through the benefit, then you wouldn't have this individual bill problem. The legal issue will be merely whether there was any negligence on the part of infection control (and I mean serious lapses)
But now the complication is that we even bill the patients for our mistakes.
Given that the hospital is such a dirty place and dangerous, the system is Singapore keeps trying to portray the hospitals as Shangri-La gardens, super friendly service places, etc to almost entice people to go there!
Little wonder where you have people like angrydoc who will say that people choose to be sick and choose to go to hospitals and hence should have to pay for all their expenses incurred to get better THEMSELVES!
How about cutting more of these frills, make the hospitals functional and less like the "hospitality business" (ie hotels) and have some universal coverage for all. If people are really so keen on going to hotels which happen to have medical services, let them go to MT E Novena for $5000 a night stays. Collect a tax on those hospitals to help partially fund the universal coverage for the rest of the population.
As for doctors staying or leaving the public sector, we already have schemes in place where they can practice at both. Also you and I know that the ones who stay will stay almost no matter what. And the reasons for leaving are not always money.
With less of this HOTEL like focus in the healthcare system, we can pay less attention to frivolous complaints and support the medical staff more in their raison d'etre. I believe doctors and nurses will be a more happy lot that way too.
A family member of mine recently developed a surgical site infection after being discharged from a certain public hospital in Singapore. Needless to say, it resulted in an extended hospital stay and a hospital bill amounting to more than 10X more than that of the original surgery. I can completely understand that HAI is an inherent risk in any surgical procedure. But when asked about what the offending organism was, the consultant categorically insisted that the ID-ed species is uncommon in hospitals and persuaded us that it was acquired during the first instance of injury (outside of the hospital). But when I did my own homework, the picture was quite the opposite, the bacteria turned out to be one of the most common causes of HAIs in ICU and surgical theatres in various academic studies. We were not intending to point fingers and just wanted the issue rectified, but I am dismayed that the care provider in whom we trusted would cover his ass in the first instance rather than being forthcoming with the situation.
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