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Why does a private clinic charge less for consultation than the unsubsidised cost of the same at a public polyclinic?

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5 years ago

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Healthcare is a major point of concern for Singaporeans. It’s a universal issue that is constantly debated on by both citizens and politicians alike. In fact, much has been said about how splendid healthcare is in Singapore and how citizens and PRs enjoy affordable healthcare here.
The Ministry of Health (MOH) has consistently maintained that healthcare is affordable thanks for the 3Ms – MediSave, MediShield and MediFund – which helps keep out-of-pocket medical costs low for individuals.
In fact, MOH has said on their Facebook page that “Singapore has come a long way as we work to build a healthcare system that is accessible, affordable and provides quality of care.” The website notes that the healthcare system in Singapore is designed to ensure that “everyone has access to different levels of healthcare in a timely, cost-effective and seamless manner.”
However in recent years, there has also been plenty of talk about strategies and approaches to deal with the spiralling increase of healthcare costs. The Singapore Business Review noted that “The rising cost of healthcare in Singapore is increasingly diminishing the city’s attractiveness as a medical tourism hub with patients opting to turn to neighbouring countries for their medical needs.”
Back in 2014, then-Deputy Prime Minister Tharman said that the government’s projected healthcare spending is expected to triple by 2020 to S$12 billion from S$4 billion in 2011. In 2018, the government’s healthcare expenditure was S$9.29 billion, up over S$600 million from the previous year’s S$8.64 billion, according to the MOH website.
One of the reasons cited for this ballooning of healthcare costs is Singapore’s ageing population. But as Business times SG said, costs have risen sharply among the working population as well. . HSBC added that the fact that Singapore will have only half the number of working-age adults to every senior by 2030 has significant implications for future health costs.
Constantly, DPM Heng Swee Keat has said that Singaporeans needs to focus on living a healthier lifestyle to avoid incurring hefty medical bills later in life, putting the responsibility of reducing the financial burden squarely on the shoulders of citizens.
It’s also been suggested by Prime Minister Lee Hsien Loong that the government has to be careful about how much it subsidises healthcare, “not just to save taxpayers’ money, but to avoid encouraging over-treatment by doctors and over-consumption of healthcare services.”
But the fact remains that while pivoting towards a more health-conscious lifestyle would benefit Singaporeans in more ways than one, the rising costs of healthcare is outside of the average citizen’s control. Many are still left to pay off hefty sums for the sake of their health or their parent’s health as the compulsory public insurance scheme (MediSave etc) and Community Health Assist Scheme (CHAS) don’t really provide much assistance.
The recent case of 82-year old Seow Ban Yam is an extreme example of how the can end up being a burden. The octogenarian was stuck with a bill amounting to S$4,272 as his MediShield only covered S$4.50 of his subsidised bill. The calculations involving his MediSave premium, CPF, and MediShielf payout was enough to baffle any working-class Singaporean, let alone an 82-year old retiree.
In recent years, healthcare has undoubtedly become increasingly expensive. The Singapore Department of Statistics indicates that healthcare inflation is much higher than overall inflation by about 9.5% and has been so for the past five years. The cost of medical visits and treatments have also increased by 8% and 9% respectively since 2015, noted Asia One.
Despite these rising numbers, Singapore continues to use private companies to run public healthcare which inevitably results in additional costs. After all, private companies’ primary responsibility their stakeholders is to generate a profit, not provide social welfare.
To illustrate just how much more public healthcare actually costs with private operators, let’s look at these two receipts showing how a clinic providing subsidised care charges its clients when compared to a private clinic with no subsidies.

As you can see, the receipt on the left from a National Healthcare Group Polyclinic shows a final bill of S$13.20 after deducting the government subsidy of S$34.90. That means the total price for a consultation before subsidisation is actually S$48.10.
On the right is the consultation fee incurred when visiting a private clinic with no subsidies – S$29.90. That’s about 38% lower that the full cost of a consultation at a so-called public healthcare facility. While the final total is much lower after the subsidy, the initial fee is much higher at the polyclinic. This means that healthcare cost at the polyclinic is in fact much higher than in the private sector. Why is that?
Also, the doctors you see at polyclinics tend to be junior doctors. Many are also from foreign countries. On the other hand, private clinics are usually run by senior doctors with decades of experience. Given this disparity in experience, aren’t polyclinics simply overcharging their patients and/or the government with their high costs?
Now, according to NHG’s annual report, their polyclinics attended to approximately 2.88 million patients in 2017 and 3.39 million patients in 2016. The NHG run polyclinics in Woodlands, Yishin, Ang Mo Kio, Toa Payoh, Hougang, and Geylang throughout 2017 (as well as in Bukit Batok, Choa Chu Kang, Clementi, and Jurong up to September 2017). So this one company alone provides healthcare services to millions of Singaporeans.
According to their annual report, the group generated over S$2,602 million in the 2017 financial year. Of course, this includes more than just their polyclinics. Even so, NGH Polyclinic clearly operates on a much higher economic scale than an average private clinic in terms of the number of patients they attend to.
Clearly, the healthcare system in Singapore is in dire need of restructuring. Singapore Democratic Party (SDP) Chairman Prof Paul Tambyah pointed out in his speech at official launch of SDP’s healthcare plan on in May 2019 that the current healthcare system runs as “a profit-making venture which consistently collects surpluses far in excess of the money spent taking care of patients.”
“Healthcare is treated like a commodity where people avoid important primary healthcare services because of the costs and end up spending a lot of money treating complications that could have been prevented,” Prof Tambyah said.
The alternative, Prof Tambyah suggests, is a model based on equal treatment for all individuals, “care based on clinical need and not on ability to pay.” as healthcare should be treated as a fundamental right to citizens and not something that only the wealthy can afford and be granted.

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Current Affairs

Hotel Properties Limited suspends trading ahead of Ong Beng Seng’s court hearing

Hotel Properties Limited (HPL), co-founded by Mr Ong Beng Seng, has halted trading ahead of his court appearance today (4 October). The announcement was made by HPL’s company secretary at about 7.45am, citing a pending release of an announcement. Mr Ong faces one charge of abetting a public servant in obtaining gifts and another charge of obstruction of justice. He is due in court at 2.30pm.

Published

2 hours ago

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4 October 2024

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SINGAPORE: Hotel Properties Limited (HPL), the property and hotel developer co-founded by Mr Ong Beng Seng, has requested a trading halt ahead of the Singapore tycoon’s scheduled court appearance today (4 October) afternoon.

This announcement was made by HPL’s company secretary at approximately 7.45am, stating that the halt was due to a pending release of an announcement.

Mr Ong, who serves as HPL’s managing director and controlling shareholder, faces one charge under Section 165, accused of abetting a public servant in obtaining gifts, as well as one charge of obstruction of justice.

He is set to appear in court at 2.30pm on 4 October.

Ong’s charges stem from his involvement in a high-profile corruption case linked to former Singaporean transport minister S Iswaran.

The 80-year-old businessman was named in Iswaran’s initial graft charges earlier this year.

These charges alleged that Iswaran had corruptly received valuable gifts from Ong, including tickets to the 2022 Singapore Formula 1 Grand Prix, flights, and a hotel stay in Doha.

These gifts were allegedly provided to advance Ong’s business interests, particularly in securing contracts with the Singapore Tourism Board for the Singapore GP and the ABBA Voyage virtual concert.

Although Iswaran no longer faces the original corruption charges, the prosecution amended them to lesser charges under Section 165.

Iswaran pleaded guilty on 24 September, 2024, to four counts under this section, which covered over S$400,000 worth of gifts, including flight tickets, sports event access, and luxury items like whisky and wines.

Additionally, he faced one count of obstructing justice for repaying Ong for a Doha-Singapore flight shortly before the Corrupt Practices Investigation Bureau (CPIB) became involved.

On 3 October, Iswaran was sentenced to one year in jail by presiding judge Justice Vincent Hoong.

The prosecution had sought a sentence of six to seven months for all charges, while the defence had asked for a significantly reduced sentence of no more than eight weeks.

Ong, a Malaysian national based in Singapore, was arrested by CPIB in July 2023 and released on bail shortly thereafter. Although no charges were initially filed against him, Ong’s involvement in the case intensified following Iswaran’s guilty plea.

The Attorney-General’s Chambers (AGC) had earlier indicated that it would soon make a decision regarding Ong’s legal standing, which has now led to the current charges.

According to the statement of facts read during Iswaran’s conviction, Ong’s case came to light as part of a broader investigation into his associates, which revealed Iswaran’s use of Ong’s private jet for a flight from Singapore to Doha in December 2022.

CPIB investigators uncovered the flight manifest and seized the document.

Upon learning that the flight records had been obtained, Ong contacted Iswaran, advising him to arrange for Singapore GP to bill him for the flight.

Iswaran subsequently paid Singapore GP S$5,700 for the Doha-Singapore business class flight in May 2023, forming the basis of his obstruction of justice charge.

Mr Ong is recognised as the figure who brought Formula One to Singapore in 2008, marking the first night race in the sport’s history.

He holds the rights to the Singapore Grand Prix. Iswaran was the chairman of the F1 steering committee and acted as the chief negotiator with Singapore GP on business matters concerning the race.

 

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Current Affairs

Chee Soon Juan questions Shanmugam’s $88 million property sale amid silence from Mainstream Media

Dr Chee Soon Juan of the SDP raised concerns about the S$88 million sale of Mr K Shanmugam’s Good Class Bungalow at Astrid Hill, questioning transparency and the lack of mainstream media coverage. He called for clarity on the buyer, valuation, and potential conflicts of interest.

Published

2 weeks ago

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23 September 2024

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On Sunday (22 Sep), Dr Chee Soon Juan, Secretary General of the Singapore Democratic Party (SDP), issued a public statement on Facebook, expressing concerns regarding the sale of Minister for Home Affairs and Law, Mr K Shanmugam’s Good Class Bungalow (GCB) at Astrid Hill.

Dr Chee questioned the transparency of the S$88 million transaction and the absence of mainstream media coverage despite widespread discussion online.

According to multiple reports cited by Dr Chee, Mr Shanmugam’s property was transferred in August 2023 to UBS Trustees (Singapore) Pte Ltd, which holds the property in trust under the Jasmine Villa Settlement.

Dr Chee’s statement focused on two primary concerns: the lack of response from Mr Shanmugam regarding the transaction and the silence of major media outlets, including Singapore Press Holdings and Mediacorp.

He argued that, given the ongoing public discourse and the relevance of property prices in Singapore, the sale of a high-value asset by a public official warranted further scrutiny.

In his Facebook post, Dr Chee posed several questions directed at Mr Shanmugam and the government:

  1. Who purchased the property, and is the buyer a Singaporean citizen?
  2. Who owns Jasmine Villa Settlement?
  3. Were former Prime Minister Lee Hsien Loong and current Prime Minister Lawrence Wong informed of the transaction, and what were their responses?
  4. How was it ensured that the funds were not linked to money laundering?
  5. How was the property’s valuation determined, and by whom?

The Astrid Hill property, originally purchased by Mr Shanmugam in 2003 for S$7.95 million, saw a significant increase in value, aligning with the high-end status of District 10, where it is located. The 3,170.7 square-meter property was sold for S$88 million in August 2023.

Dr Chee highlighted that, despite Mr Shanmugam’s detailed responses regarding the Ridout Road property, no such transparency had been offered in relation to the Astrid Hill sale.

He argued that the lack of mainstream media coverage was particularly concerning, as public interest in the sale is high. Dr Chee emphasized that property prices and housing affordability are critical issues in Singapore, and transparency from public officials is essential to maintain trust.

Dr Chee emphasized that the Ministerial Code of Conduct unambiguously states: “A Minister must scrupulously avoid any actual or apparent conflict of interest between his office and his private financial interests.”

He concluded his statement by reiterating the need for Mr Shanmugam to address the questions raised, as the matter involves not only the Minister himself but also the integrity of the government and its responsibility to the public.

The supposed sale of Mr Shamugam’s Astrid Hill property took place just a month after Mr Shanmugam spoke in Parliament over his rental of a state-owned bungalow at Ridout Road via a ministerial statement addressing potential conflicts of interest.

At that time, Mr Shanmugam explained that his decision to sell his home was due to concerns about over-investment in a single asset, noting that his financial planning prompted him to sell the property and move into rental accommodation.

The Ridout Road saga last year centred on concerns about Mr Shanmugam’s rental of a sprawling black-and-white colonial bungalow, occupying a massive plot of land, managed by the Singapore Land Authority (SLA), which he oversees in his capacity as Minister for Law. Minister for Foreign Affairs, Dr Vivian Balakrishnan, also rented a similarly expansive property nearby.

Mr Shanmugam is said to have recused himself from the decision-making process, and a subsequent investigation by the Corrupt Practices Investigation Bureau (CPIB) found no wrongdoing while Senior Minister Teo Chee Hean confirmed in Parliament that Mr Shanmugam had removed himself from any decisions involving the property.

As of now, Mr Shanmugam has not commented publicly on the sale of his Astrid Hill property.

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