Originally posted by oxford mushroom:
Good...some of you have already made the suggestion I was
going to make, so this makes my life easier.
First, one must understand that there are many levels of
healthcare. For most people, their contact with the healthcare
system is for minor medical problems or chronic illnesses that can
be handled by a primary healthcare attendant, ie. a general
practitioner, either in a private clinic or in the
polyclinic.
There is a secondary level of healthcare, for those who require
treatment in a hospital context but the level of expertise required
is low to intermediate. I would include in this category common
operations like mastectomy without reconstruction, colectomy for
cancer,etc.
Beyond that, we have tertiary level healthcare that is expensive
and labour and technology-intensive. This will include intensive
care treatment, oncology services, transplant services and the
like.
We need different solutions for different levels of healthcare. At
the moment, there is no clear distinction between the secondary and
tertiary levels of healthcare. Hospitals that do separation of
siamese twins also perform breas_t resections, which can be done in
a secondary healthcare facility. My proposal is a clearer
separation between primary/secondary versus tertiary levels of
healthcare.
Singaporeans want cheaper medical services for their flu and common
chronic illnesses like hypertension and diabetes, for which they
need medication frequently. These conditions are simpler to treat
and common complications including amputations for foot gangrene in
the case of diabetes can be handled in secondary level
facilities.
My solution is to greatly increase the number of primary and
secondary level facilities. Open the floodgates to hire more cheap
doctors from Malaysia, Thailand, India and Pakistan; nurses from
China and attendants from Bangladesh. Training our own doctors will
not decrease heathcare costs much, since they also have a family to
feed, a car and HDB flat to pay off in Singapore.
If Singaporeans want cheaper healthcare for 'simpler' medical
ailments, then we have to take in more foreign talent. As the
Minister has already done so, radiology in the polyclinics are
outsourced to India. Alas! we cannot outsource our patients to
Thailand and Malaysia for their monthly checkup, so the solution
must be to bring the mountain to Muhammad...bring in MORE foreign
talent.
Mind you, we will not get the best doctors from India and
Pakistan...those who do well enough in their PLAB or USMLE
examination (qualifications for medical graduates to work in the UK
and US respectively) will move to London and the USA, where the pay
and prospects are better. We will have to settle with 'second rate'
doctors but as these are simpler medical conditions, they should
suffice in most instances.
Singaporeans cannot expect to have a doctor that speaks their
language and there will be initial pain as these foreigners adjust
to the local working environment but in time, they will become used
to our culture. Someone complained to the Forum page recently about
doctors from Myanmar with thick accents. We cannot oblige them
their choice of doctors if this is to work.
Yes, we will have to relax the stringent regulations we now have
that only recognizes top foreign medical schools. You don't
seriously expect a graduate from Harvard Medical School or Oxford
University to settle for a starting salary of below 2k? For the
salary of a local graduate 2 years' post-housemanship, we can
employ two doctors from India or China. But obviously you cannot
expect the same quality...sometimes you get lucky and you hire a
good doctor...sometimes, not so good.
Secondary healthcare institutions will not be required to satisfy
the stringent accreditation standards by which tertiary
institutions have to abide. Lab tests can be outsourced to Malaysia
but obviously you cannot expect their labs to be accredited by
international bodies. Test results may vary more, they may be less
accurate and they will take longer to come back (because it is
economical to batch tests) [b]but they will be
cheaper.
Such institutions will not have intensive care or full emergency
services...but Singapore is small enough for patients to travel to
tertiary institutions.
The range of services will be more limited, only generic
medicine will be prescribed and as a rule, surgical
implants and appliances will be older models where the patent has
run out (generally 20 year patent protection).
Patients have to accept that you may have to take 2 tablets 4 times
a day instead of a capsule once a day. Instead of taking your
gallbladder out with three holes in the abdomen, you will have the
traditional long scar and stay a day or two longer in the hospital
but the fees will be lower. Your prosthesis is more likely to
loosen than more expensive models and you may have to come back for
a revision (repeat surgery) earlier. Obviously, you might be lucky
and yours might give you no problem as well...we are talking about
statistics here...
I will talk about funding for basic (primary/secondary healthcare)
later. The point I am making is that there is a price to
everything. We can make your visit to the doctor cheaper, but you
cannot demand to have the best doctor, the best medication, most
accurate lab results and the most comfortable consultation
room.
If Singaporeans are prepared to accept that, this model can lower
healthcare costs. We will still not be cheaper than a hospital in
JB for the simple reason that even if we were to hire all their
staff, why should they come over unless we pay more than what they
are currently getting? No, we will not be cheaper than a JB
hospital unless (touch wood) our economy falls way behind
theirs.
However, basic medical care will be cheaper...would Singaporeans
accept this?
[/b]
I sense sarcasm . With all due respect, what is the real reason
behind this post and posting the most ludicrous, nonsensical model
I ever read about ? In general whereever you are in developed
nations, people won't accept these type of conditions. Australia
already had have a big hoo ha over some indian doctor of death. So
what is the real issue you are addressing here?
UK NHS is not the best system to quote , neither is the german
system. Of course they are the better known ones to most.
Try looking at the Finnish health system - they have a better idea
and their life expectancy is excellent. In fact , the scandinavians
have a generally good idea of how to run a health care system - it
comes with a price - heavy price tag on taxpayers. However I don't
see much scandinavians moving out of their countries to practice
somewhere - and they can speak english perfectly fine too. They
must be doing something right ....or they could just love their
saunas in finland..
