Some of the commentators have extreme opinions regarding the state of S’pore’s healthcare system. Perhaps they can view from the economics perspective, and they will realise that S’pore’s healthcare system is not that terrible. In comparison to other countries such as the USA, Singapore’s healthcare system can be said as efficient and covering most of the population from cradle to grave, albeit with major individual responsibility.

Dear Gilbert Goh & Tan Kin Lian

I have been very busy with my work and hardly have time to read the articles on TOC till now and I am happy to write that we have one of the best health care in Singpore including CPF-Medishield and Medisave, and there are rooms for fine tuning especially helping the genuine very poor who does not have enough CPF-Medishield and Medisave, it is only a very minute drop in the ocean if we can take this from our GDP, and these genuine very poor need not have to die and can seek the best treatment and get well. As I said, we don’t need to just simply dismantly everything the PAP government has established and what we just need is to fine tune these policies and institutions established by the PAP government since Singapore independence, ie should one day the Singapore Opposition forms the government of the day. We Singaporeans have been so dependent on these policies and institutions which now have flaws and this which we must recognise and hope that they can be fine tune for better for all Singporeans.

Regards
Andrew Chuah

The argument about wastage is made by economists and by our Government. A national health insurance scheme which if given “free” is likely to lead to abuse by consumers in getting more than is necessary … i.e. described as the “buffet syndrome”. It also extends to insistence on expensive treatment beyond economic justification, e.g organ transplant.

I am personally in support of a national health care system, available to all, but will provide the medical care to a certain level which I shall describe as “necessary”. We need competent people to decide on what is “necesary” and the issue of cost and wastage will have to be considered. I don’t think that it is “all” or “nothing” and it is not possible to fix all the rules in advance.

I am not a medical expert, so I can only lay out the broad principles. I will let the experts work out the details.

Some people think that the health care system in UK and Taiwan is better. I also agree. But it does cost more to the country (to be funded by taxation) and is subject to wastage and abuse. I personally prefer this type of system, but this is a separate matter.

This is a general philosophical case made to everyone who is reading this comment not just TKL.

TKL alluded to this notion of “wastage” in the healthcare systems.

What is wastage in this context?

(a) If there is no cure for some disease, let’s say Cancer, would it be a waste to give treatment?

(b) Doctors can make wrong diagnosis. So if the doctor say, wrongly, that a person cannot be cured, so no point giving treatment. Is the doctor avoiding wastage?

(c) Using in order to avoid people abusing something, you have to put in place system to check. Now if the cost of having a system the check abuse is more than what could be lost by abuses, is that avoiding wastage?

(d) In the case of means testing, there is cost involved in administering means testing. If the cost of administering means testing is more than saving one gets from means testing, is means testing a wastage?

(e) If a patient that could be cure but is not given treatment because the patient can’t pay or can only pay for less effective drug, is that avoiding wastage?

(f) Insurance-based healthcare system typically expects to persons to be responsible for their own health. But insurance have to be administered and in some cases profit goes to insurance providers. So is giving profit to insurance providers a waste?

This list can go on-and-on-and-on.

Anyone has any definition of what is waste? Personally, I don’t.

Firstly, I want to point out that if you read any of my comments, I have in no way suggests that you are not entitle to your opinion. Having said that, it is worth noting that when people start debating with you about your argument it does not mean nor even imply that you are NOT entitle to your opinion.

A debate is basically where different people come and give their view points and in some cases, give counter points, and even point out discrepancies. Again I hope you DON’T take this to mean that your are not entitle to your opinion.

Secondly, as I may have in my eluded to in my previous comments about your statistics, I am getting the impression that you have been misinterpreting my argument. Here I am going to say what I said again.

(a) My impression of your statistical presentation of “cost” is, as part of your argument, may be flawed. In other words, you may have inadvertently brought in evidence to suggest that health care cost by taxation, especially, may be NOT be worst than Singapore’s case. In fact, on face value, the UK systems seemed for efficient than Singapore. And in Singapore’s case there seemed to be more wastage. Here again I want to emphasise that the argument I raised about the UK is NOT whether it is better or worst than Singapore. I was merely pointing out that the statistics you provided show a case that was at odds with your argument.

That is why when I queried your use of the statistics, I DON’T mean to say that your argument is wrong. What I was saying is that you might want to read the statistic again make sure you are aware what they mean. Otherwise, the statistics you presented have a danger of undermining rather than strengthening your argument.

(b) Also you have used a lot of anecdotal (Personal experience) evidence to support your argument. In particular, the issue about “acceptability” or otherwise about the ward. Again, I am NOT suggesting that you are not, entitled based on your personal experience, to come to your own conclusion about the Wards.

But if you want people to appreciate why you found something to be “acceptable”, it would be helpful to explain with more detail why you came to the conclusion you did. You don’t have to write a thesis about your decision making process but take the reply you gave to me on that issue:

The issue is both affordability and satisfactory standard. Some people say that the subsidised ward is not satisfactory, so they are forced to pay for the more expensive treatment. This is not the case here, as the subsidised wards are of a good standard. – 13) Tan Kin Lian on December 14th, 2008 11.01 pm

As you can see there was not attempt to explain why you found something to satisfactory. So basically, you have open the way for people to guess what you are trying to say.

You could have pointed out with some EXAMPLES, like you found the nursing care to be responsive, or that the doctors did not act differently in C class as they would in A class, etc. At the very least, then there is clear measures of acceptability that one can debate on WITHOUT getting personal.

I am also entitled to my opinion. I believe that our current health care system does deliver fairly satisfactory health care at an affordable cost. It is a good balance. This is seen by the international comparison and study quoted in my paper. I believe with these independent findings.

Some people think that the health care system in UK and Taiwan is better. I also agree. But it does cost more to the country (to be funded by taxation) and is subject to wastage and abuse. I personally prefer this type of system, but this is a separate matter.

I accept that the Singapore system still has its drawbacks, as pointed out by some readers, including the high cost of medication and the high cost of post hospitalisation care (which cannot be paid by Medisave). No health care system in any country is perfect.

In my paper I suggest that the public can save money by making the right choice under the current system. Let me address some of the points that have been brought up:

1. If you have been warded in a subsidised ward previously, you are entitled to buy the post-hospitalisation medication at a subsidised rate (which is much cheaper than the non-subsided rate). However, it is restricted to the generic drugs, and does not cover your choice of branded drugs. One has to accept any benefit with its limitations.

2. After means testing is implemented, you are still entitled to be treated in a subsidised ward, but the level of subsidy is lower (ie 65% instead of 80% for C and 50% instead of 65% for B2). Some people argue that the cost in C has increased from 20% to 35%, a 75% increase. I do not agree with this way of seeing things.

3. People who prefers private Shield coverage and is aware that the estimated lifetime cost is $100,000 (compared to $43,000 for Medishield) are entitled to their views, They do not need to justify their decision and does not have to attack my view.

I do not have the time (due to many other commitments) to debate with readers who hold a different view. Each person is entitled to his own opinion, and it does not matter to me that it is different from my view.

There are some insurance agents who does not like my advice to consumers to avoid spending premiums on unnecessary and duplicative coverage/ They find any opportunity to attack me, using quite unfair arguments. I have learned to ignore these malicious attacks.

You’re welcome. Cannot answer you last question though, not without a face ;).

Hi smallvice585 #90),

Now where do I start? OK, medical records. There is a misconception that since I paid my medical fees, I am entitled to everything that goes into the provision of my healthcare during my stay in the hospital. This is not so, because the fees are for consultations, treatments and medications during your stay.

All the other items that does not directly go into your healthcare are not covered in the bill. Examples are medical records and post-discharge medications and theraphies.

They do not belong to you. Yes, you paid for your medical treatments, consultations and all other forms of tests but the notes, which later form part of your medical records, are written by doctors for their own perusals. These are notes written by the doctors who treated you during your visits and for which will be used by other doctors for your subsequent visits.

So, they do not belong to the patient. They are however, available to the patient should he require them but this is subject to a re-read by the doctor and thereafter a summarized one will be offered, not in any way a replicate set of original scribbled notes. Therein lies the extra effort required by the doctor to review your notes and to write up a summary and therefore the added fees.

Why do I have to pay for copies of my medical record which I had already paid for when I pay for medical testing and medical consultation?

#83. Really appreciate your concern and fine suggestions :-)) I will convey this to my friend.

cheers.
ps: do i know you… ;-)

I do not know if you have already tried these approaches.

1. Ask to speak to a Medical Social Worker; who might be able to assess your sister-in-law’s situation. Be prepared for detailed scrutiny of family income and all financial matters. When it is ascertained that financial help can be extended, your SIL will be given special subsidy for further treatment. Talk to a MSW for further and more accurate details.

2. Approach the CDC of your zone. Again, means testing will be carried out to assess if your SIL meets the requirement for help to be extended. A letter will be issued for use when your SIL visits the hospital for futher treatments. Some patients are able to get free outpatient consultations or heavily subsidised treatments.

Hope you can try out these approaches and see if they help. All the best to your SIL and her family and I’ll be keeping her in my prayers for a speedy recovery.

My sister-in-law has liver cancer in early/mid stage. The drug cocktail is the chemo drug that she is taking. I understand the drug is mixed in the hospital and she received the medication from a drip so buying drug from neighboring country is not possible.

The suggestion of moving her to a neighboring country hospital is also not feasible because she needs to stay at least 1/2 days to 3/4 day in the hospital for this treatment. Putting her through custom jam etc would take about a day and would put additional stress to her physically and mentally. Financially the cash outlay would be more since currently she can pay the $1500 per treatment from her husband and her medisave account. If she move to say a malaysia hospital, the medical bill would be in cash immediately.

Here again is a case where the middle class Singapore is in a fix with no recouse from MediFund and no subsidised medication because the drug is not in the subsidized list.

Any suggestion is welcome!

You have brought up a good common sense arrangement that the Health Ministry should look into.

A common class hospitalization system is a most equitable arrangement for patients, it will also do away with all the complicated administratie procedures.
In short, it simplifies the whole process of providing healthcare services efficiently with cost savings.

It is also posssible to have separate higher class hospital(s) to cater to patients/customers who want/need more privacies, better services and facilities. Again this can be made common class, such as all ‘A Class and all ‘B’ Class etc.

Patients that need special cares or who want better facilities, services/environments and amenities may like to seek treatments in Private(not privatized public) Hospitals.

puppy.

Another way doctors can help patient cut cost is to know what medicine patient is still taking now and not to prescribe the same medicine again unless the medicine is finishing etc.Some medicine are mean to be taken for a period of 1 month or more and it is a waste to buy again ,as you may not be able to finish it before doctor prescribe another type of medicine.
I have many good experiences with CGH C class ward .My late father is always happy when he was attended by the Hokkien speaking Lor Koon.The nurses know his name well as he is in and out at that ward.
If I got a chance to be warded , I will first look for my propose Standard Ward ,pay only on what I use.If BoPian they still want to divide me from the rich ,then I will go for the Class C ward.
Let me remind you hor,I actually want to keep it to myself but for the benefit of those about to be warded,I will reveal to you this lobang that almost all the Class C medical staff like nurses etc at CGH can serve you better than the Class A airline stewardess .But…Shhhhh.dun tell this to Foreigner…let them stay in private hospital because shortage of class C ward.

Hope you friend is much better. Please extend my well wishes to him/her.

If your friend plans to go to a private hospital, he need not have to go through the whole shebang again. He can walk in to TTSH’s Medical Records Office and ask for some of the relevant documents to his case.

a. for old xray films – S15
b. digitalized diagnostic images (cd) – $30
c. Blood test report – $5.35 (Histopathology report needs doctor’s approval for release and takes up to 5 days).
d. If there is a need to get hold of a discharge medical summary, it will also need doctor’s approval for release and can take up to 4 weeks. The cost is $80.25. It’s not worth it, if you ask me.

I would recommend, a or b, and c.

he has been to the A+E and 1 trip cost $80+…i told him to call the uro clinic at TTSH and explain to them, he did…but same reply…fully book and if persist goto A+E…

I do not understand this part of our health system. How can one working behind a counter, without any medical knowledge, be able to fix appointments for patients who are in need of medical attention, based on a system of availability of appointment slots? This is not only wrong but very dangerous. What if a patient is denied immediate treatment because an appointment slot is not available immediately.