Healthcare: Tale of two nations

last SG · 2006-04-12T21:15:58+00:00

Originally posted by oxford mushroom 12 April 2006 04.20AM I wonder where Atobe isCongratulations for some good responses to your thread, and surely you c...

fymk SG

You forgot the part about enhanced lithigation as well. And more nurses might run off since the pay for nurse practitioners are premium elsewhere compared to Singapore.

In Australia, nurse practitioners earn about 3.5k -4k per month after taxes. Try beating that.

oxford mushroom SG

Both fymk and snow leopard are right... By increasing the responsibilities of our nurses we can reduce the workload of the doctors and lower healthcare costs, since doctors are paid more. We already have nurse practitioners but most nurses in Singapore are not prepared to accept a bigger role because of greater legal liabilities.

Fymk is right in that nurses will have to buy malpractice insurance if they are to have a bigger role. Incidentally, doctors in high risk specialties such as obstetrics and cosmetic surgery pay an annual premium as high as 10k, so it is not feasible to expect them to lower their fees too drastically either. If we pay nurse practitioners 3k a month like those in Australia, we will raise, not lower healthcare costs.

In any case, I doubt getting more Singaporean nurse practitioners will be any cheaper than bringing in more Indian and Chinese doctors, who are willing to work for around 2-3k a month. If you are willing to lower your standards, you can get them at below 2k as well. Doctors can take on more operative procedures but in the context of rehab medicine, geriatrics and convalescence wards, yes...it will be cheaper to get nurses and we should do so.

Along this vein, I understand that in some hospitals nurses are doing less than what they used to do when I was a houseman some 20 years ago. Following a few instances when nurses were found negligent for administering wrong dosages of medication, many nurses now refuse to give intravenous medications. Compared to the duties of nurses in the Uk, certainly our nurses can do more, but they would want more money.

We are already short of nurses and globally there is a shortage of trained, English-speaking nurses. If if we want them cheap, we have to get them from China and give them on the job training.

oxford mushroom SG

Originally posted by snow leopard:
[b]it will. the great majority of the population are already feeding families and paying HDBs with monthly pay of around $3,000. if this is all the doctor needs to be satisfied, then there is a lot of room to slash from his current $20,000 a month paycheck. with that we can have a lot more doctors and still give them HDBs and food for their families.
b]

You must be joking! $20k a month paycheck? Where have you plucked your figures from? As a consultant with nearly 20 years' experience I barely get half that amount. But you have brought up the issue of doctors' pay, which I will address.

First of all, you are advocating a communist system whereby highly trained professionals like doctors are paid not more than the 'great majority of the population'. I have seen the effects 50 years of communist rule has done for China. Instead of attracting the best and brightest to medicine, the best of each cohort went into politics and nowadays, into business. Doctors in rural China are so poorly paid that many are corrupt and standards have remained what they were in the 1950s.

Why bother to slog so much, spend 6+4+2+5=17 years (2.5 years more for the boys in NS) of your life to qualify as a doctor (if you pass the first time)? Do not forget also that medical students now pay 18k per year for 5 years in NUS (again, provided they pass every year). During the additional year as a houseman they are paid just below 2k and if at the end of it all, you will not be paid much more than the average Singaporean and with a 100k debt from NUS, why would anyone bother with medicine?

It is too late to turn back the clock in any case. If we were to place a cap on doctors' salaries at the 50th percentile as you suggest, we will lose a large proportion of our doctors. Our qualifications are recognized in the UK and other Commonwealth nations where there is a shortage to meet the needs of their aging population.

There is another fallacy: that medicine obeys the economic principle of demand and supply. It does not....in fact, quite often, we see a supply induced demand in medical practice. We used to take out gallbladders by making a long incision in the abdomen but I do remember the days when we started doing laparoscopic surgery, making a few holes instead of a long cut. The patient could also go home earlier but it also costs more. The moment one patient in the ward had it, all the other patients waiting for the operation also wanted it. The more surgeons who can do this operation, the more such expensive procedures are undertaken.

When you want to buy a dress, you shop around for the best price and you decide what you need and pay what you consider to be a reasonable price. With medicine, it's different. Your doctors tell you what needs to be done and does it, you pay him whatever he charges. We know that the rate of caesarian deliveries and all surgical procedures is higher among private patients, if doctors get a cut of the operating fees. As medical students, we could almost predict who will need assisted delivery by just looking at the ward class of some patients.

With more doctors we will have more expensive procedures being performed, because everyone wants to earn more money as long as it is legal. That's a fact.

Wouldn't hiring cheap foreign doctors give rise to this problem as well? Not if we restrict them to work in public hospitals. They will not be licensed to work in private clinics/hospitals and so we can control their pay packet. In my proposal, primary and secondary healthcare institutions will only provide basic healthcare...no keyhole surgery until such time when the cost of such procedures is equivalent to older techniques. This will leave poor patients an avenue for treatment, even though it is not going to be the best available (and should not be).

I would indeed expect alot of Singaporean doctors to leave, because with the cheap foreign doctors, our local doctors have only two options left in Singapore:

1. Go private and compete with the ever-increasing pool of local doctors in the private sector if they want to earn more than the 2-3k a month paid to the foreign doctors

2. Upgrade, specialize and try to get a job in the ever competitive tertiary institutions, which will do high-tech medicine for the wealthy, private patients and foreign patients.

In other words, we will create a bigger gap between the salary scale of our doctors. Currently GPs earn anything between 3k to 10k, but I would think the average is about 5-7k a month. If we flood the polyclinics with foreign doctors, GPs will see their salary drop to probably 3-5k a month. Top doctors with skills that are highly sought after will still command salaries above 10k in tertiary institutions. But you have to be the best to be there...

Back to your point about 20k salaries. There is a big problem in the wage discrepancy among doctors. Your neighborhood GP is probably getting 5k a month and the hospital consultant psychiatrist will be extremely luckly if he can manage 10k with performance bonus added in. But surgeons in Singapore are paid more highly than their counterparts in the UK, and that is not linked to their skills or experience either. The pay scale for surgeons is much higher and yes, they get a cut from the operations they do.

Remember when Dr Ng Eng Hen joined politics, the PM pointed out that he lost a big chunk of his salary by becoming a cabinet minister. Now we know the salary of a cabinet minister is close to a million or so, if Dr Ng has lost a huge chunk of his salary, he must have been earning at least a million a year as a brea_st surgeon.

I think by bringing in foreign doctors, we will force local GPs to lower their fees to some extent (but not much as their pay is not as high as Snow Leopard suggests). However, the biggest impact will be to increase the competition for tertiary institutions as we have never seen before. Surgeons in tertiary institutions will also have to lower their salaries in that case.

If it is at all possible, I would propose that the salary scale of various medical specialities should not vary so much. When a consultant psychiatrist gets 10k a month and a surgeon gets 100k a month, we will see a diversion of our best talents in one or two specialties. There will be good people who specialize in poor-paying discipline because of passion, but we are not being fair to them.

oxford mushroom SG

Healthcare funding

How do we find the funding for our heathcare system so that Singaporeans can afford it despite an aging population that will consume more services?

Medical insurance is the way to go to even out risks and make it affordable for all. For this to work, we need a compuslory system that everyone has to buy into. The reason is simple: unless it is compulsory, why should the young want to pay in to support the old? Why should the healthy athlete want to pay in for the benefit of the neighbour with renal failure?

Premiums for a national medical insurance scheme have to be paid through the medisave and we already have that to some extent. The problem is that the coverage is not enough. The reason for that is the pot of money for premium is not sufficient and healthcare expenses can rise exponentially. For this to work, we have to curb the expenses as well.

If we define primary and secondary healthcare institutions in the manner I have mentioned...cut out all the patented drugs and new surgical procedures that are expensive, hire loads of cheap foreign doctors and nurses, it might be possible to make a medical insurance policy cover say, 80% of all costs in primary and secondary healthcare institutions. I say 80% because I do agree with co-payment to discourage abuse of the system. Patients must pay something out of pocket, unless they are truly destitute.

Patients who want to take one capsule instead of 8 a day can get a prescription to buy out of their own pocket. But those who cannot afford any medication otherwise will get it. And no, HIV patients will not get the anti-retrovirals and brea_st cancer patients won't get Herceptin...not for another 10-20 years at least.

The medisave currently covers only hospital inpatient expenses but this is clearly inadequate. I welcome the recent news that the Minister for Health has opened it to chronic illnesses such as hypertension and diabetes. It is certainly a very big change and indicates that he is aware of the limitations of medisave. Obviously he is concerned that patients might exhaust their medisave accounts quickly and that is also quite possible with chronic illnesses. That's why I would advocate a national insurance scheme paid through medisave that will cover all basic hospitalisations and outpatient treatment in primary and secondary healthcare institutions.

For this to work, it is essential that our basic healthcare is truly basic although extensive. If you need to get that colon cancer out, consider the cheapest way to do it...from the type of suture you use to the kind of bowel preparation. Although a truly efficient conveyor-belt type surgery is not possible, if we can hire alot of cheap foreign surgeons from Eastern Europe and the Indian subcontinent, they can be made to specialise in just one type of surgery. You gain lots of expertise quickly if you only remove colons and nothing else, day in and day out. Local doctors will not want to do that because they quickly become incompetent in other types of operations but with hired foreign surgeons, we can forced them to do that.

If the expensive surgeons we have currently are worth their salt, we may see higher failure rates and infection rates when these operations are handled by cheaper, less skilled foreign surgeons who cannot get jobs in the UK or the US. But they are cheap and as long as the drop in standard is not too much, perhaps Singaporeans will accept it rather than not being able to afford the operation at all? Who knows? Perhaps there will not be a drop in standard...perhaps surgeons like Dr Ng, Dr Balaji and Dr Balakrishnan were overpaid for their services.

I wonder where Atobe is. If Singaporeans are prepared for this sort of system, it will be possible to lower healthcare costs. But it will not be reasonable to ask for cheap hospital fees and demand that Ng Eng Hen removes the brea_st lump!

snow leopard SG

Originally posted by oxford mushroom:

You must be joking! $20k a month paycheck? Where have you plucked your figures from? As a consultant with nearly 20 years' experience I barely get half that amount. But you have brought up the issue of doctors' pay, which I will address.

i saw the paycheck myself (won't tell u whose) and it is $20k. a few years ago i met a dentist during ICT, a young chap who already earns $15k. even an old bird pilot told me he earns $20k. figures are not at all surprising when you consider specialists who earn millions each year.

First of all, you are advocating a communist system whereby highly trained professionals like doctors are paid not more than the 'great majority of the population'.

not true. i quote myself "they'd probably need at least $10,000 a month to be happy." so i'm actually advocating that they be paid the premium that society accords them ... but not overly so.

Why bother to slog so much, spend 6+4+2+5=17 years (2.5 years more for the boys in NS) of your life to qualify as a doctor (if you pass the first time)?

for any local graduate with honours, they would be spending 6+4+2+4=16 (2.5 too for boys). so what's with that one extra year?

Do not forget also that medical students now pay 18k per year for 5 years in NUS (again, provided they pass every year). During the additional year as a houseman they are paid just below 2k and if at the end of it all, you will not be paid much more than the average Singaporean and with a 100k debt from NUS, why would anyone bother with medicine?

but if you look at the future stream of income, it more than makes up for the initial investment.

It is too late to turn back the clock in any case. If we were to place a cap on doctors' salaries at the 50th percentile as you suggest, we will lose a large proportion of our doctors. Our qualifications are recognized in the UK and other Commonwealth nations where there is a shortage to meet the needs of their aging population.

i quote myself again "they'd probably need at least $10,000 a month to be happy." so on the contrary i'm not limiting their pay to 50% percentile. i'm putting them right on top although i am advocating that between top and the rest, the gap shouldn't be like $17k ($20k - $3k).

There is another fallacy: that medicine obeys the economic principle of demand and supply. It does not....in fact, quite often, we see a supply induced demand in medical practice. We used to take out gallbladders by making a long incision in the abdomen but I do remember the days when we started doing laparoscopic surgery, making a few holes instead of a long cut. The patient could also go home earlier but it also costs more. The moment one patient in the ward had it, all the other patients waiting for the operation also wanted it. The more surgeons who can do this operation, the more such expensive procedures are undertaken.

this is similar (though not entirely the same) as when the iPod was first launched. before the iPod, nobody wants to buy an MP3 player but when the iPod arrived, everybody started buying it. so what happened really is that an innovation created a whole new market.

When you want to buy a dress, you shop around for the best price and you decide what you need and pay what you consider to be a reasonable price. With medicine, it's different. Your doctors tell you what needs to be done and does it, you pay him whatever he charges. We know that the rate of caesarian deliveries and all surgical procedures is higher among private patients, if doctors get a cut of the operating fees. As medical students, we could almost predict who will need assisted delivery by just looking at the ward class of some patients.

i think if we better educate the public, publish prices and set up a forum for people to comment about services and skills of doctors, and infuse the arena with sufficient numbers, there will be quality of choice at affordable prices.

finally i just want to say that i am not against you and i enjoy our discussions. you have shown yourself to be a gentleman who doesn't resort to insults or crude language.

fymk SG

~~double post~~

oxford mushroom SG

i quote myself again "they'd probably need at least $10,000 a month to be happy." so on the contrary i'm not limiting their pay to 50% percentile. i'm putting them right on top although i am advocating that between top and the rest, the gap shouldn't be like $17k ($20k - $3k).

I might have misunderstood you then. I think most doctors will be happy with about 10k a month. As I said, there is a huge gap in salaries among doctors as it is. As I said, we have surgeons who earn close to a million dollars a year and on the other hand, a young doctor in the public hospitals 5 years after graduation is getting about 5k to 7k. Unless they specialize, their salary will remain stagnant for a long time. Highly trained consultants get as little as 9k to as much as 30k for surgeons. So far I have been talking about doctors in the public sector. The pay in the private sector is at often 2-3 times higher.

If you look at the average salary of doctors as reported by Asiaweek, the figure of USD 4386 per month is closer to the 10k you spoke of.
(http://www-cgi.cnn.com/ASIANOW/asiaweek/features/salaries/2000/popups/content/sing.html).

However, what the average figure does not reveal is the huge discrepancy in pay between doctors. The doctor you quoted with a salary of 20k a month is definitely not the usual, he is in the minority. Many of your neighborhood GPs can only dream of a 10k monthly salary.

As a result of the wide gap in salary between doctors in the public versus those in the private sector, about half of doctors registered in Singapore are working in the private sector but the public sector sees double the number of patients. Low pay and heavy workload are the two main complaints of doctors in the public sector and as you might have read in the papers in recent years, there has been a continuing exodus of senior doctors to the private sector. To make medical fees lower than they are in the public sector, there is no other way apart from hiring cheap foreign doctors. Lowering doctors' salaries in public hospitals will drive far too many out in the private sector and overseas that we will have to replace them with foreign talent.

BTW, if you are talking about the big gap in salary between Singaporeans, why gripe about doctors? The difference between 20k and 3k is big but what about the difference between the pay of a cabinet minister and the 3k you spoke of?

In a globalised economy and when our doctors have qualifications that are recognized internationally, we have to pay competitive rates to keep the best people. If cheap healthcare is more important than quality (which fymk opposes), then the only way is to bring in cheap foreign doctors and accept lower quality medication and treatment. Mind you, the quality is lower but still high compared to many third world nations....but we must be willing to accept one form of treatment for the rich, another for the poor.

However, I do agree that the salary of some doctors are just far too high. If someone posseses a unique skill then he can certainly command a high salary...I have no issue with that. If he is the only person in the world who can do heart transplants and we need this operation, then we have to pay whatever price he calls. But why should all surgeons be paid more highly than say, psychiatrists of equivalent senior and experience?

oxford mushroom SG

I do agree with you, fmyk that quality comes at a price and the government in Singapore is already subsidizing alot, especially relating to hospital treatment for C class patients.

However, for some Singaporeans that is not enough. Perhaps they have difficulty holding to a job that pays reasonably well, perhaps their jobs have been outsourced to China and India, perhaps they are just too weak and ill to work...whatever..

For Atobe and others who demand a cheaper healthcare system comparable to hospitals in JB and Thailand, I cannot see a solution unless we offer a more basic level of healthcare and import foreign labour. Like the factory workers from Maxtor whose jobs got outsourced, our doctors will have to upgrade their skills to offer a premium service for the wealthy, emigrate or accept a much lower salary with the influx of foreign talent.

However, I suspect that Singaporeans will also complain. The fact that the rich get Herceptin and the poor do not will be a source of unhappiness. I fear that there are those who want the best at the lowest price and still think it is the government's job to get them that impossible deal. Even if the governmemt agrees, they will have to raise taxes to finance a cheap, high quality healthcare system but then the citizens will also complain about paying more taxes..

Damned of you do...damned if you don't.

fymk SG

This is where I disagree. Surgeons have a technical skill and a certain set of physical criteria they have to have. They have to have steady hands to operate. Now a psychiatrists sit and talk to patients - prescribe medications etc . Surgeons are different - they are at risk of being exposed to biohazards especially when they doing their jobs in a body cavity full of blood, serous fluid etc.

Depending on what type of surgery they do as well. Cosmetic surgeons come pricey because they do mostly aesthetics on the human and fine sewing . let's say if a person's hand get sawed off by accident - who do you think will be doing delicate microsurgery? a psychiatrist?

Not forgetting their personal equipment like those magnifying glass googles etc . How about maintenance or even sterilisation ?

blackchickenahkai SG

You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well

wtf...
12 pills of that costs 70 bucks?
OMG...i rmbr seeing the price on the tablets..
250mg costs like 30 malaysian cents...

the pharmecuticals must be making a big killing there..
* faints *

70 bucks..does it includes treatment too?..
or consultation?

snow leopard SG

Originally posted by fymk:

No such thing as cheap healthcare for all - everything comes with a price tag. Either through taxes or through a private system.

i never used the word 'cheap', i said 'affordable'. if we resign to the fact that health care has to be expensive, then it will forever remain expensive. but ingenious businessmen didn't stick to that thinking but sought ways and means to bring down costs, like outsourcing. perhaps we should put on our thinking caps as well?

sure , go fight the patents set on those new and fancy and EXTREMELY PRICEY life saving medications/technologies etc. Herceptin for *#$*^@ cancer at market price is at least 60k for the whole treatment, interferon A and ribavirin ( for hep c treatment) is at least 12k per 2 months . Linezoid ( stronger than vancomycin - an antibiotic to kill a type of super bug ) costs at least 3k per treatment without subsidy . One video gastroscope costs AT VERY LEAST 16 k and 2k per year to maintain at a good condition. Colonscope costs 26 k or so depending . You know the fancy automated blood pressure machines they have in SGH triage and wards? At least one is worth 15k. Not even including in biomedical maintenance . Oh yeah let's not forget surgical sterilisation - ethane oxide , gamma radiation etc

but these are rare illneses that consitute only a small percentage of total hospital / clinic visits. Mr Oxford has already helped us categorise illnesses and specifically targeted the common diseases like cough and flu for cost cutting. i think so too and in fact made the same suggestions in another thread much earlier. we can't save on the expensive procedures nevermind, but we can do something about the expensive doctor being used to diagnose our coughs and flus right? surely these can be performed by the nurse or the phamacist or in Mr Oxford's opinion, doctors from low cost countries?

You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well )

it doesn't matter how much the govt is subsidising. it is still a costly issue, otherwise it wouldn't have been so fervently debated both in and out of parliament. we need to do something and not say "oh, we actually have more subsidies than USA therefore we should shut up".

Don't forget doctors most likely want to do postgrad studies and get fellowship of some society i.e. Royal College of general practitioners ,American Society of Cosmetic Surgeons etc. To acquire skills of a surgeon or any specialty is long and tedious work . To achieve fellowship of a reputable organisation means alot of hardwork placed in by the medical specialist . He probably won't have time to socialise when he was just starting out unlike other grads in business etc , won't have much sleep at home , he will have been continually updating himself on new knowledge , new treatments etc . Everything is run on an evidence based type of decision. In fact his life since med student to training to consultancy would have meant he has made a personal sacrifice - his social life, his leisure time gone. By then he is wanted all over the world and offers come in . Do they deserve such pay? Yes.

you sound as though doctors are the only ones who work long hard hours while people from other occupations laze around and sleep. a fresh accounting grad who works in the audit line will easily work past midnight for months on end for a miserable pittance. a software engineer may have to camp in office during project milestones. a teacher has to stay at home and mark books while his / her friends are out partying on weekends. come on, who doesn't work hard?

as for whether or not he deserves his pay, your opinion is as good as mine. but in case you're thinking that i don't think they deserve their pay, i would like to repeat again that society accords them a premium and prestige and no one, not even me can take away from them. however, market forces of supply and demand needs to be in place to bring about a fair price and hopefully and affordable one for all.

I rather pay the premium to see my current specialist than some cheap doctor because he was the only doctor who managed to figure out my problem out of the other 15 doctors I have seen. I have a rare condition . That's quality for you. So if you rather get quantity instead of quality - too bad.

that's the thing, you have a rare condition. no one else has that. it is right that you pay a premium for your conditions but it is not alright for us to be paying the same price to see the same doctor.

Oh yeah by the way , demand for doctors are very strong all over the world especially oncologists , pathologists , O&G etc- they get snatched up like hot pies . So if you want a choice of how much to pay your doctor - don't worry , there is another country waiting to offer him a place with a pay to better what he might get. Same goes for nurses . Same goes for physiotherapists . Same goes for speech pathogists.

that's why i said from the beginning that if we can, lower the cost of doctor's wages up to a level where they can still feel proud about their profession.

Alot of people think just because a health professional ( be it doctors or nurses) want to be a health professional , it should mean that they should get paid poorly for their hardwork and long hours and the pressure because of their perceived calling. Why don't you apply the same principle to the pharmaceutical companies and medical technology companies and see if they give a hoot.

i'm not quite sure about that. on the contrary, most people i know expect doctors to be highly paid.

The real issue is how much is the government really willing to subsidise you and yet be able to retain quality staff with some incentives.

you see, that's all you see. try and go through the level 1, 2, 3 proposal by Mr Oxford ...

one of my my ex-bosses is a private specialist with 20 years of experience as well and he earns 26k per month on average. And slightly more than half of his 26k goes back into upgrading his own equipment (medical equipment are good for at least 5 years but after you better have the money to replace them) or maintenance or insurance for equipment and himself or paying to go for professional development courses to upgrade his skills which cost around the figure of 2k-3k per module /workshop etc . Sometimes he would see patients who are really really poor and charge them nothing. He is very well off ,yes , no doubt about it but he worked hard to be where he is today , for years of sleepless nights, on call duties , plus working as a student while studying in medical school to support himself etc . Why would I know all this? Because I once wanted to be a doctor and he told me what to expect : "Once you graduate , you don't expect to just go YIPPEE I AM A DOCTOR - you have to constantly upgrade knowledge or else you are not being fair to your patient. it is a lifelong commitment and you cannot expect to slacken in any areas because you are responsible for your patient's life "

he's a good doctor no doubt. i understand what you're saying, for it is the same with my brother, although he is perfectly happy with it.

i too once sat in front of a panel of interviewers for enrolment into medical school. i'm happy it didn't come through, not because i could avoid all those late nights and long hours, for meaningful work is a fulfilment in itself, but rather, it simply wasn't my calling ...

snow leopard SG

Originally posted by oxford mushroom:

I might have misunderstood you then. I think most doctors will be happy with about 10k a month. As I said, there is a huge gap in salaries among doctors as it is. As I said, we have surgeons who earn close to a million dollars a year and on the other hand, a young doctor in the public hospitals 5 years after graduation is getting about 5k to 7k. Unless they specialize, their salary will remain stagnant for a long time. Highly trained consultants get as little as 9k to as much as 30k for surgeons. So far I have been talking about doctors in the public sector. The pay in the private sector is at often 2-3 times higher.

no problems, i don't know many doctors but in general, what i'm saying is that if we really have a situation whereby some doctors are grossly overpaid, then the disciplines where these doctors come from can surely afford to take in more market forces to bring about a balance between pay excesses and public healthcare quality and costs ...

BTW, if you are talking about the big gap in salary between Singaporeans, why gripe about doctors? The difference between 20k and 3k is big but what about the difference between the pay of a cabinet minister and the 3k you spoke of?

well, i've always taken issue with ministerial pay right from the day i stepped into this forum ...

In a globalised economy and when our doctors have qualifications that are recognized internationally, we have to pay competitive rates to keep the best people. If cheap healthcare is more important than quality (which fymk opposes), then the only way is to bring in cheap foreign doctors and accept lower quality medication and treatment. Mind you, the quality is lower but still high compared to many third world nations....but we must be willing to accept one form of treatment for the rich, another for the poor.

i agwee with you about the common flu and cough category (i can't remember the terms u used). in addition, i also feel that nurses and pharmacists have a role to play in this respect.

However, I do agree that the salary of some doctors are just far too high. If someone posseses a unique skill then he can certainly command a high salary...I have no issue with that. If he is the only person in the world who can do heart transplants and we need this operation, then we have to pay whatever price he calls. But why should all surgeons be paid more highly than say, psychiatrists of equivalent senior and experience?

well ... i wouldn't stop at that, if there is only one doctor who can perform that operation, then surely we're not training enough?

fymk SG

[/b]

oxford mushroom SG

That is not true...actually surgeons are the easiest to replace precisely because their work is more about skill with the hands than knowledge-based. You can train an Indian surgeon to do a colectomy as well, if not better, than our local surgeons. Psychiatrists have to understand the local culture and background cos mental illnesses are culturally coloured. So it is easier to replace our surgeons than psychiatrists.

That's probably the first thing we will do to lower healthcare costs. We will continue to pay high fees for those with skills that cannot be replaced easily, like some transplant surgeons but the bulk of our surgeons can be replaced.

And in case people don' know, the surgeons do not make the diagnosis of a tumour. That's often detected by the radiologists or physicians and the diagnosis is made by a pathologist, whom people don't know about or see. The surgeon is just like the plumber who takes out diseased parts and straighten out the plumbing.

No intention to denigrade the surgeons here but our surgeons are paid far too much compared to those in the UK, when their skills are replaceable by those in Indian in the large part.

oxford mushroom SG

Originally posted by blackchickenahkai:
[b]You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well

wtf...
12 pills of that costs 70 bucks?
OMG...i rmbr seeing the price on the tablets..
250mg costs like 30 malaysian cents...
[/b]

30 malaysian cents? must be generics lor

oxford mushroom SG

well ... i wouldn't stop at that, if there is only one doctor who can perform that operation, then surely we're not training enough?

You have to get the person with the specialized skill to train your new doctors right? So if I am the only one in the world with a particular skill, why should I train you unless I can paid an obscene amount for it? So that's where patents come in...without patent protection of some kind, we will not get the transfer of knowledge that we need to bring our medical treatment to world class standard.

So we will always have to pay a premium for specialised skills. Just as Singapore doctors must acquire higher skill sets than doctors from third world countries. Patients who only require and are happy with more basic medical treatment can get it cheap from cheap foreign doctors. Those who require and are prepared to pay can have access to cutting edge medicine provided by doctors with the specilaised skills.

blackchickenahkai SG

sorry..
it's rm1.20
got y stats wrong Laughing

oxford mushroom SG

Fymk has a point about CEO though. We seem to be quite happy for CEOs and fund managers to earn mllions of dollars a year but people object to doctors getting rich in their jobs. I wonder why? The talent, training and responsibilities of a doctor are more than those of a CEO and fund manager. Of course you can lose millions if a fund manager makes a mistake, but a doctor who makes a mistake can lose a human life.

Yet perhaps we think we need to pay more to safeguard our millions rather than a single human life...

oxford mushroom SG

The doctor, the nurses are exposed to a sick environment , a life to save , a life to treat, they have to think on their feet , they are exposed to lithigation , they are exposed to the risk of HEP C , HIV , HEP B during a procedure , they are exposed to abuse from relatives or patients. Doctors have to pay medical indemnity insurance - they don't come cheap.

Remember SARS? It attacks the frontliners too like doctors and nurses in the workplace while the accountant grad , teacher , and engineer can just stay at home safe from the pandemic . Everytime a doctor or a nurse attends to a patient , they run a risk of getting exposed to a disease.
Just funny during the SARS period , someone from MOH called my mom up to ask if I was around to do nursing in Singapore or to come back to help out. WHY? because their health professionals are dropping like flies from SARS. SARS was a big one since it killed young , old , healthy and unhealthy people. I knew ex colleagues and ex schoolmates from my nursing school getting quarantined or hospitalised from exposure. High risk job = better pay .

About paying medical staff more for the risk they are taking, I do agree with you, for we had been involved with SARS patients as well. That is the reason those who work in oil rigs and soldiers in the frontline of battles get extra pay.

Unfortunately, our government does not see it that way. I am not even talking about pay here but medical benefits. It used to be that medical staff (doctors, nurses) in the public sector get free medical care. That is also a remnant from the Hippocratic oath that says that we doctors will treat our teachers and their families for free. In the past, it used to be a professional courtesy to treat fellow colleagues for free.

All that changed when LHL, now our PM, scrapped the free medical benefits for health professionals. When he was asked specifically that since medical staff are exposed to infections and can contract illnesses from their patients, don't they deserve free medical benefits?

His reply was, "Just because you are a gynaecologist doesn't make you pregnant."

Wonder why nobody asked him for a response when our doctors and nurses came down with SARS...

snow leopard SG

Originally posted by fymk:

Worked in an acute clinical setting before?

no. so?

A teacher has to mark her books , a software engineer has to fix something before a deadline, accounting grad has to work for her miserable pittance. Software late only mean profit loss and auditing - but money can be earnt again. Marking books - make a mistake and you just cancel the mark and change it . Lose a life and you remember it for the rest of your life.

you belittle other professions. a teacher molds characters and ultimately help shape lives, not just one or two but many, many lives. a piece of software operating the Boeing 777 cannot go wrong, for the entire aircraft's passengers' lives depend on it. the engineer or architect whose design or construction goes wrong can mean an entire building's collapse, along with the people working in it. i think it is meaningless haggling over whose work is more impt.

Oh WHO IS ACTUALLY MAKING THE MOST MONEY? It most certainly isn't the doctor. It is the CEO who probably has an MBA running the system and his managerial minions.

yes, CEO pays everywhere are shamelessly high. however, there are a lot more doctors than there are CEOs. our quest is to bring down medical costs and high doctors' pay is one consideration factor.

Frankly I think they should pay nurses more but they are controlling the pays because the govt need to keep cost down. There u go - cost cutting!

if i'm not mistaken, nurse pay is quite good now ...

Want to know why Singaporean nurses are going to other countries? They pay better. Same for your doctors. Go and deprive your well qualified doctor of his incentive to stay with you and I am sure foreign countries will welcome him.

its ok, we top up with china nurses, have come across some of them in hospital ...

I am not saying about rare or not rare condition. I am saying I rather pay for quality. Would you be seeing my doctor at all? You could go and see the polyclinic doctors. I used to see polyclinic doctors for mild ailments - they are cheap. Lower the cost of the doctor's wages? Sure . Get lithigation control laws in so that indemnity insurance don't rise. Get indemnity limits on how much the insurance company can raise premiums.

i quote what you wrote earlier:

"I rather pay the premium to see my current specialist than some cheap doctor because he was the only doctor who managed to figure out my problem out of the other 15 doctors I have seen. I have a rare condition . That's quality for you. So if you rather get quantity instead of quality - too bad."

why do you have to pay a premium? because the other 15 doctors couldn't diagnose your problem. why the other 15 couldn't? because you have a rare condition. so you are paying for your rare condition.

yes we should make appropriate changes to indemnity insurances but i have faith it would not be a big problem here. we are not like the US ...

« Previous Page Next Page »