Why impoverise them then try to buy them with comcare?

last SG · 2006-04-08T08:14:15+00:00

I fear we might have hijacked Robert's thread which is about comcare. I have opened a thread to carry on the discussion on healthcare: http://www.sgforums.c...

robertteh SG

(as posted to Feedback Unit on 4.4.2006)

f by the tax-and-recover system of government costs of essential services are driven skyward, and as a result, people cannot survive any more, government will end up having many many poor people on their lap.

Why not moderate government charges and change the system of government so that fees will not be that high and people can survive and look after themselves without the need for comcare.

If government understand what is "ci piao bu ci pern", we would not impoverise so many people and go to the dog today to have to start all these comcare.

oxford mushroom SG

The problem is transparency.

I do understand that the cost of services must be reclaimed somehow, either through fees or by taxes. In the medical field, I am only too aware that as patient expectations rise, medical costs will only continue to rise as new drugs, new treatments and new diagnostic tests become available. The costs have to be reclaimed if we are going to continue serving Singaporeans...either through higher medical fees or higher taxes.

What Singaporeans are not clear about is whether the fees levied are appropriate with respect to the costs of service provision. Is there double charging as Robert asserts?

Where medical costs are concerned, I dare say the fees are more than reasonable. If you compare the costs of similar diagnostic tests and operations in Singapore compared to those in US (performed and reported by doctors with equivalent qualifications), our fees are more than competitive indeed. The same is true if you compare with Hong Kong (Malaysia and Thailand are not appropriate for comparision, as most of their public hospitals are not accreditated with internationally recognized agencies, unlike ours). Therefore the only solution is to either outsource services, raise taxes or increase fees.

But I do agree with high land costs...it does seem to be double charging especially when the government has acquired land at low costs for redevelopment.

Atobe SG

The assumption that is constantly made by the Government aka the Ruling Political Party is that the rising expectations of Singaporeans must be met with advance in new technologies that must necessarily be costly.

Somehow, you seem to accept the same thought process without any consideration as to WHY SHOULD RISING EXPECTATIONS be met with NEW ADVANCED TECHNOLOGIES that must NECESSARILY BE COSTLIER ?

Surely the Principle of Economy of Scales are as applicable in this area as it is in the manufacturing processes ?

With a critical mass that is not necessarily limited to our own population, but counted on a Global Basis, is there any justification for high costs that need to be charged to the patient ?

Where medical costs are concerned, I dare say the fees are more than reasonable. If you compare the costs of similar diagnostic tests and operations in Singapore compared to those in US (performed and reported by doctors with equivalent qualifications), our fees are more than competitive indeed. The same is true if you compare with Hong Kong (Malaysia and Thailand are not appropriate for comparision, as most of their public hospitals are not accreditated with internationally recognized agencies, unlike ours). Therefore the only solution is to either outsource services, raise taxes or increase fees.

But I do agree with high land costs...it does seem to be double charging especially when the government has acquired land at low costs for redevelopment.

In your comparisons of hospital charges - what is your standard of measure in comparing hospitals in Singapore with that found in the US, and Hong Kong ? Are you comparing apples with apples ( red and red, or green with red ), or have you been comparing apples with oranges ?

Why have you generalised that the hospitals in Malaysia and Thailand do not qualify - by simply referring only to Public Hospitals in these countries ?

If all hospitals in Singapore are now based on a common standard level similar to Private Hospitals - even with Government Hospitals now measuring themselves against the Private Hospitals as a benchmark; why are you not including similar Private Hospitals in Thailand and Malaysia ?

Bangkok International Hospital and Columbia Asia Medical Centres are recognised as Private Hospitals operating respectively in Thailand and Malaysia; and the quality of services in these respective hospitals are available at much lower costs then in Singapore.

ShutterBug SG

Oohh.. but THEY say they are VERY TRANSPARENT.

Yes indeed. Transparent in every thing they do and in all ther policies.

And that we should all be grateful that we're in a safe, clean, advanced, and peaceful country, wherein the government give us money every now and then.

Wink

oxford mushroom SG

Somehow, you seem to accept the same thought process without any consideration as to WHY SHOULD RISING EXPECTATIONS be met with NEW ADVANCED TECHNOLOGIES that must NECESSARILY BE COSTLIER ?

I can only speak about medicine, which I am more familiar with.

You have 2 questions in your above statement:
1. Why should rising expectations be met with new technology? Because patients demand it. With the internet, patients demand newer surgical techniques, better drugs and more accurate diagnostic tests.

2. Why should new technologies be more costly?
These are all expensive because drug companies have to reclaim the cost of their investments, doctors want to reclaim their investment of their time and money in acquiring new technology. Most important of all, in a global economy, you have to pay more for new technology that can be provided by a small group of people. As technology matures and the circle of providers increase, prices will drop

oxford mushroom SG

I am comparing the costs of similar diagnostic tests and surgical operations. I know my facts are right because I have been comparing our fees for certain diagnostic tests with those in private hospitals here in UK and also in the University hospitals in Stanford, USA. The charges in the US are more than 10 times our charges for certain tests. They are paid for by medical insurance...those who do not have medical insurance simply don't get the tests..

Most hospitals in Malaysia and Thailand do not offer these tests. You have to consider public hospitals because you have to compare like with like. Unless you are talking about private hospitals like Mt E, Singapore hospitals have to treat subsidized patients as well. In places like TTSH, subsidized patients form the bulk of the clients. The cost of lab tests and operations are capped and are heavily subsidized by the government. Despite the subsidies, however, our hospitals cannot recover the full cost of providing these services because the government imposes a cap on the charges for subsidized patients. Private hospitals in Malaysia and Thailand do not have to work with these constraints.

Hospitals in Malaysia and Thailand also enjoy significantly cheaper infrastructure costs (rentals, utilities) and cheaper manpower. If I can establish a lab in JB, I can charge much lower fees than a similar lab in Singapore. Of course, that means I may be less responsive to patient needs and I will be employing cheaper technical, administrative and support staff from among Malaysians and more Singaporeans will lose their jobs.

oxford mushroom SG

As for the two top foreign hospitals you mentioned, you might also want to look at the accreditation status here:

http://www.competitionishealthy.com/page3b.htm

The Bumrungrad Hospital (Bangkok, Thailand) is the closest to Singapore in that like SGH and now NUH, this Bangkok hospital is JCI accredited. However, SGH labs (as well as labs in TTSH and NUH) are also accredited with the College of American Pathologists. There is no mention of similar accreditation with the Bangkok hospital labs.

Atobe SG

Originally posted by oxford mushroom:
I can only speak about medicine, which I am more familiar with.

You have 2 questions in your above statement:
1. Why should rising expectations be met with new technology? Because patients demand it. With the internet, patients demand newer surgical techniques, better drugs and more accurate diagnostic tests.

With the exception of the few internet savvy and educated community, do most patients who are ignorant of pharmacological and medicinal developments - make any demands on the Doctors attending to them ?

Is it not a fact that new technologies are introduced by the Medical Community to raise efficiency and supposedly to help in reducing costs ?

2. Why should new technologies be more costly?
These are all expensive because drug companies have to reclaim the cost of their investments, doctors want to reclaim their investment of their time and money in acquiring new technology. Most important of all, in a global economy, you have to pay more for new technology that can be provided by a small group of people. As technology matures and the circle of providers increase, prices will drop

In your extract of my question, you left out the other critical statement from my post :-

Surely the Principle of Economy of Scales are as applicable in this area as it is in the manufacturing processes ?

With Economy of Scale from a World Wide demand of a proven medicine or material or medical technique - one would expect costs to be made lower, except for the greed of the Medical Community to take advantage of a niche specialty and to accelerate the time duration to recover the cost of Research and Development.

We will need to look into the other aspect of Government misguided Principle of Profitability in Medical Services that result in huge annual surplus.

Atobe SG

Originally posted by oxford mushroom:
I am comparing the costs of similar diagnostic tests and surgical operations. I know my facts are right because I have been comparing our fees for certain diagnostic tests with those in private hospitals here in UK and also in the University hospitals in Stanford, USA. The charges in the US are more than 10 times our charges for certain tests. They are paid for by medical insurance...those who do not have medical insurance simply don't get the tests..

Most hospitals in Malaysia and Thailand do not offer these tests. You have to consider public hospitals because you have to compare like with like. Unless you are talking about private hospitals like Mt E, Singapore hospitals have to treat subsidized patients as well. In places like TTSH, subsidized patients form the bulk of the clients. The cost of lab tests and operations are capped and are heavily subsidized by the government. Despite the subsidies, however, our hospitals cannot recover the full cost of providing these services because the government imposes a cap on the charges for subsidized patients. Private hospitals in Malaysia and Thailand do not have to work with these constraints.

Hospitals in Malaysia and Thailand also enjoy significantly cheaper infrastructure costs (rentals, utilities) and cheaper manpower. If I can establish a lab in JB, I can charge much lower fees than a similar lab in Singapore. Of course, that means I may be less responsive to patient needs and I will be employing cheaper technical, administrative and support staff from among Malaysians and more Singaporeans will lose their jobs.

Why do you compare cost of procedures that are not available in countries such as Malaysia and Thailand ?

Limit your comparison of costs on general medicine and medical procedures in all countries, based on a similar standard of best professional practices, and the entire comparison chart will take a different perspective.

Standard medicine and medical practises - dealing with orthopaedic, paediatrics, pregnancies, heart surgeries, and other general medical practices - will cost far cheaper in Malaysia and Thailand when compared to the same being conducted in Singapore or Hongkong.

Your bias comments - tainted with preset prejudices - should not see the light of day, if you are a professional and commenting on the service level of those in the professional profession in JB or anywhere else.

You will be surprised that even in a backwater town like JB, service attention can be conducted on a very personal basis - it depends on where you go, the level of service you are looking for, and how much you are willing to pay.

All things being equal, Singapore will come up higher for the illusive 'brand name' that Singapore pride itself with - and yet we hear of brickbats being thrown by the average Singaporean using the same service Laughing

Atobe SG

If you will like to know, SGH and NUH also pride itself as being comparable to the best Private Hospital in Singapore - such as Gleneagles, Thomson Hospital, Mount Alvernia, Mount Elizabeth.

SGH and NUH even attempt to beat these private Hospitals in offering similar services at prices that are not too far away from that being charged by these private hospitals.

The only difference is that Singaporean patients being tended at SGH and NUH is allowed "government subsidies" for the services charged at PRIVATE HOSPITAL RATES that carry HIGH PROFITS - instead of the lower rate of Government costs of operation.

Is the Bumrungrad Hospital (Bangkok, Thailand) not comparable to the best private hospitals in Singapore - when you compare them to SGH and NUH, who are claiming themselves to be as good as the Best Private Hospitals in Singapore - if not, even better ?

oxford mushroom SG

do most patients who are ignorant of pharmacological and medicinal developments - make any demands on the Doctors attending to them ?

Singaporeans are more educated than you think and it is becoming common to have patients coming with an armful of data downloaded from the internet when it affects their health. Are you suggesting that doctors should not tell less IT-savy patients about more effective but expensive treatments? In fact, that was perhaps what the Minister of Health meant when he said doctors should not raise patient expectations too much.

But do you think it is right to offer one level of treatment to private patients and foreigners who can afford it, and another for locals?

Is it not a fact that new technologies are introduced by the Medical Community to raise efficiency and supposedly to help in reducing costs ?

That's a major misconception here. Doctoring is not the same as manufacturing die casts. IT and automation of some lab processes can raise efficiency but that constitutes a small part of healthcare costs. You cannot automate surgery or looking down a microscope. The new technologies that have transformed medicine are mainly in newer surgical techniques/treatment regimes and more accurate diagnostics. All of these are more expensive as there are few skilled professionals who have the skill and the techniques are covered by expensive patents.

Most new technologies are introduced to improve diagnosis and treatment, not to reduce costs.

Laughing Economy of scale? Can you perform surgery on a conveyor belt as if every appendicetomy is the same? If you do, yes, you get economy of scale. Are you suggesting that instead of performing a rarely ordered lab test, we wait for a month to batch enough requests before running it? That will give us economy of scale but WHAT ABOUT THE PATIENT??

As for pharmaceuticals, surgical equipment and diagnostic reagents/kits, yes, it is the partly the greed of the pharmaceutical industry that has kept the prices so high. But that is not the fault of the government. These are private companies, not charities...and the business does carry high risks. Merck has been sued millions of dollars in a single court case over Viox, with thousands of cases pending. One drug failure can mean billions of dollars lost.

Perhaps you are suggesting that the government should ignore patents and copyright?

oxford mushroom SG

Because you have to compare like with like...You cannot compare the cost structure of a company that makes cheap watches with one that manufactures high-end Rolex watches.

If you can say to Singaporeans, we will only treat diabetes and hypertension, but not cancer which requires high tech diagnostics and treatment, then you can save a lot of money. You will not need to hire expensive, highly skilled oncologists, tumour surgeons, pathologists, radiologists, molecular biologists, histologists and chemotherapy pharmacists etc..

It would be easy to cut healthcare costs massively if we do not offer treatment to cancer patients, especially for the rare cancers. Let's stick with the simple stuff, shall we? Is that what you are suggesting?

In fact, the Minister might well take your suggestion. Let our patients with simple medical problems all go to JB for treatment...the government will have to subsidize less. Singapore hospitals will treat private patients and those with cancer and more complex medical problems, if they can afford it....

It's better on the balance sheet for the government, but I dare say NOT for the patient.
[/quote]

oxford mushroom SG

If you will like to know, SGH and NUH also pride itself as being comparable to the best Private Hospital in Singapore - such as Gleneagles, Thomson Hospital, Mount Alvernia, Mount Elizabeth.

Yes indeed and for good reason. SGH ad NUH are better equipped, better staffed and have more experience than most of our private hospitals and YET they serve a large proportion of subsidized patients from whom they cannot recover the full cost of treatment. These public hospitals will have to compete for private patients in order to balance their accounts.

It is in fact rather ironical that SGH and NUH are the first to obtain JCI accreditation whilst many of our private hospitals have not been able to do so. The only labs in our hospitals to obtain accreditation by the CAP are public hospitals, not private ones. I would argue that our public hospitals are as good as, in fact probably better, than our private hospitals.

The only difference is that Singaporean patients being tended at SGH and NUH is allowed "government subsidies" for the services charged at PRIVATE HOSPITAL RATES that carry HIGH PROFITS - instead of the lower rate of Government costs of operation

Laughing If you are suggesting that subsidized patients are paying the same rate as those in private hospitals, you had better show some evidence. The charges are all on the MOH website...go and look.

Government subsidies are given to help meet the shortfall between the provision of services and the actual fees charged. That subsidy is capped and so the public hospitals still lose money serving subsidized patients. If they do not treat private patients at a competitive price with respect to private hospitals, they cannot obtain profit to balance their accounts. Then you and I will have to pay more in taxes to prevent our public hospitals from becoming bankrupt.

Atobe SG

Originally posted by oxford mushroom:

[b]do most patients who are ignorant of pharmacological and medicinal developments - make any demands on the Doctors attending to them ?

Singaporeans are more educated than you think and it is becoming common to have patients coming with an armful of data downloaded from the internet when it affects their health. Are you suggesting that doctors should not tell less IT-savy patients about more effective but expensive treatments? In fact, that was perhaps what the Minister of Health meant when he said doctors should not raise patient expectations too much.

But do you think it is right to offer one level of treatment to private patients and foreigners who can afford it, and another for locals?

Let us not exaggerate the numbers - in a population of 4.5 Million - how many are truly internet savvy ?

Even with the numbers who can afford Class B2 and Class C beds, how many will actually confront the Doctors with information and data downloaded from the internet ?

Of those who are able to download the information from the Internet, how many will actually have found the right methods that the Singapore Doctors have missed out, or willing to try, or available in Singapore ?

Place your feet on the ground, and consider the basic treatment without
extending the debate into exotic medicines.

On the second part of your reply -
Are we discussing one medical system for locals and one for foreigners ?

Even at SGH and NUH, the charges are definitely different for those who are Singaporeans and those who are Foreigners.

Is it not a fact that new technologies are introduced by the Medical Community to raise efficiency and supposedly to help in reducing costs ?

That's a major misconception here. Doctoring is not the same as manufacturing die casts. IT and automation of some lab processes can raise efficiency but that constitutes a small part of healthcare costs. You cannot automate surgery or looking down a microscope. The new technologies that have transformed medicine are mainly in newer surgical techniques/treatment regimes and more accurate diagnostics. All of these are more expensive as there are few skilled professionals who have the skill and the techniques are covered by expensive patents.

Most new technologies are introduced to improve diagnosis and treatment, not to reduce costs.

We seem to interprete technologies and medical efficiency in two separate bell jars of understanding.

While surgery cannot be automated - although robotics is currently being investigated to allow for micro surgery and non-invasive surgery - can you deny that technologies will help to introduce new techniques that increases the efficiency of a surgeon or a doctor in their respective specialized areas that can also help the patient to be diagnosed more accurately to allow for ealier and faster recovery ?

With Economy of Scale from a World Wide demand of a proven medicine or material or medical technique - one would expect costs to be made lower, except for the greed of the Medical Community to take advantage of a niche specialty and to accelerate the time duration to recover the cost of Research and Development. [/b]

Laughing Economy of scale? Can you perform surgery on a conveyor belt as if every appendicetomy is the same? If you do, yes, you get economy of scale. Are you suggesting that instead of performing a rarely ordered lab test, we wait for a month to batch enough requests before running it? That will give us economy of scale but WHAT ABOUT THE PATIENT??

As for pharmaceuticals, surgical equipment and diagnostic reagents/kits, yes, it is the partly the greed of the pharmaceutical industry that has kept the prices so high. But that is not the fault of the government. These are private companies, not charities...and the business does carry high risks. Merck has been sued millions of dollars in a single court case over Viox, with thousands of cases pending. One drug failure can mean billions of dollars lost.

Perhaps you are suggesting that the government should ignore patents and copyright? [/b]

ECONOMIES OF SCALE - Conveyor belt syndrome ? Surely you must have witnessed the present rate of surgery that is being conducted, with a Q of patients sedated in their beds waiting in the corridors and waiting rooms at SGH and NUH ?

Are we too far off the mark ?

Economies of Scale is not necessarily fixxated in industry and manufacturing, it is applicable in commerce and medicine as well as medical practices - if you are willing to be generous in re-looking at the subject ?

GREED AND LOSSES - Have you not heard of government pressures ?

There are many ways in which the Government can influence the outcome of the price of goods and services, and our Singapore Government aka the Ruling Political Party has vast experience in weilding their wicked lightning sharp knife in this area of their specialty.

Trust me, leave it to them and they will buy themselves into any profitable enterprise in one form or another.

When all things fail, the Government or Governments will be able to press on price controls, and at the last resort - some Governments have gone into their own production with "near similar products".

Should the patients bear the high costs for the risks that the Pharmaceutical Companies undertake in their rush to market poorly tested products that fail during usage ?

oxford mushroom SG

Is the Bumrungrad Hospital (Bangkok, Thailand) not comparable to the best private hospitals in Singapore - when you compare them to SGH and NUH, who are claiming themselves to be as good as the Best Private Hospitals in Singapore - if not, even better ?

They are good but I do not agree that our SGH/NUH are in any way inferior. In fact, if you want to compare the accreditation awards, our public hospitals are superior.

As I said, you have to compare like with like. Let the Bumrungrad Hospital treat subsidized cancer patients with the same drugs and diagnostics, yet with a cap for the government subsidy like public hospitals in Singapore, then look at their charges for private patients. Money must come from somewhere...if you cannot increase government subsidy, if you cannot get rid of subsidized patients, then you have to charge private patients more.

And as I said, I concede the Bumrungrad Hospital has one major advantage over Singapore hospitals: the lower infrastructure costs (land, utilities and labour costs) there.

Given these constraints, you must be a fool if you cannot run a hospital cheaper in Bangkok or JB.

oxford mushroom SG

Place your feet on the ground, and consider the basic treatment without
extending the debate into exotic medicines.

A responsible government must take care of the medical needs of ALL its citizens. You are suggesting that Singapore should only treat patients with simple medical problems and ignore more complex ones that require expensive treatment? Patients with diabetes will be treated and those with cancer should just die??

It is easy for you to say...but if you are the one with cancer, you will clutch at any straw to improve your survival by a year, regardless of what it costs. Should doctors refrain from telling patients that there is treatment available to prolong their lives?

Once again, you seem to be saying...give the modern, expensive medical care to the wealthy, and a lower quality of healthcare to Singaporeans. I cannot agree with that..

Atobe SG

Originally posted by oxford mushroom:

Why do you compare cost of procedures that are not available in countries such as Malaysia and Thailand ?

Limit your comparison of costs on general medicine and medical procedures in all countries, based on a similar standard of best professional practices, and the entire comparison chart will take a different perspective

---------------------------------------------------------------------------------------------------

Because you have to compare like with like...You cannot compare the cost structure of a company that makes cheap watches with one that manufactures high-end Rolex watches.

If you can say to Singaporeans, we will only treat diabetes and hypertension, but not cancer which requires high tech diagnostics and treatment, then you can save a lot of money. You will not need to hire expensive, highly skilled oncologists, tumour surgeons, pathologists, radiologists, molecular biologists, histologists and chematherapeutic pharmacists etc..

It would be easy to cut healthcare costs massively if we do not offer treatment to cancer patients, especially for the rare cancers. Let's stick with the simple stuff, shall we? Is that what you are suggesting?

In fact, the Minister might well take your suggestion. Let our patients with simple medical problems all go to JB for treatment...the government will have to subsidize less. Singapore hospitals will treat private patients and those with cancer and more complex medical problems, if they can afford it....

It's better on the balance sheet for the government, but I dare say NOT for the patient.

CHEAP WATCHES AND ROLEX
Why are you suggesting a comparison of cheap watches with Rolex Watches ?

Is it not arrogance in your derogatory remark comparing the best hospital in Thailand and Malaysia as manufacturers of cheap watches and that our SGH-NUH are making Rolex Watches ?

I would not go so far as that - if I were you, especially if your familiarity of Singapore's medical practices is NOT as a Professional but as a Lay Person; and even if you are a Professional, it is sheer unprofessional conduct to state what you have stated.

A watch is needed to tell time, what is the difference between a Rolex and a digital watch from Swatch or Casio ?

Does one need a Mercedes S600 when an A160 can fixed our medical problems ?

Do we need a Mercedes A160, when a Toyota Altis can get the job done as safely ?

EXAGERATED COMPARISONS - General Medicine and Special Diseases
Not so clever in twisting your argument to move at a tangent to the issue at hand.

You may as well tell all Cancer Patients to go to a hospice and wait their days as no known treatment can save any patients with malignant cancer.

Do we need to do that, or can we provide the best POSSIBLE HELP with the LATEST KNOWN MEDICINES AND MEDICAL TECHNOLOGIES that are affordable and PROVEN ?

You may wish to know that patients suffering from general maladies are not charged at a price that will subsidised the costs of patients suffering more serious diseases such as AIDS or Cancer.

Keeping things simple is exactly to lower costs is exactly what the Minister is guiding the Health Service, by even outsourcing the work of the Radiologist, and who knows what more is to come to lower costs ?

Perhaps, the Ministry of Health should contact the esteem Hospital in Bangkok, Thailand - which you say is comparable to our SGH and NUH - and come to some agreement that allow us to outsource our surgical and medicinal procedures, and the Ministry will still see a healthy bottom line.

oxford mushroom SG

While surgery cannot be automated - although robotics is currently being investigated to allow for micro surgery and non-invasive surgery - can you deny that technologies will help to introduce new techniques that increases the efficiency of a surgeon or a doctor in their respective specialized areas that can also help the patient to be diagnosed more accurately to allow for ealier and faster recovery ?

Haha...you have absolutely no idea as to the cost of robotics and the manpower requirement...these techniques you talked about increases, not decrease healthcare costs. The treatment is better for the patient, but at a high costs...do your research and find out how much they actually cost Very Happy

Surely you must have witnessed the present rate of surgery that is being conducted, with a Q of patients sedated in their beds waiting in the corridors and waiting rooms at SGH and NUH ?

I have conducted surgery and i have been in operating theatres more often thean you have been to a hospital. And I can assure you that will not work. There is a queue precisely because each patient has to be handled one at a time...each with his own unique problems. Alas! Humans are not machines with the same specifications.

When all things fail, the Government or Governments will be able to press on price controls, and at the last resort - some Governments have gone into their own production with "near similar products".

Yes, ignore patents and kill off our biomedical industry which is supposed to be the mainstay of our economy? Look at what has been holding up our economy when IT companies and manufacturers like Maxtor leave? Not only will Singapore be subject to expensive lawsuits and sanctions by the World trade bodies, our pharmaceutical industry will collapse. Shooting ourselves in both feet?

oxford mushroom SG

A watch is needed to tell time, what is the difference between a Rolex and a digital watch from Swatch or Casio ?

Does one need a Mercedes S600 when an A160 can fixed our medical problems ?

Before the arrival of new drugs and treatment, we used to prescribe morphine to patients with cancer, tell them to go home and write a will. That is still done in many third world countries. Nowadays we can cure some and give them more time.

No, the analogy is not perfect. It is more like a watch that tells time accurately to the second, compared to the one accurate to the hour.

Do we need to do that, or can we provide the best POSSIBLE HELP with the LATEST KNOWN MEDICINES AND MEDICAL TECHNOLOGIES that are affordable and PROVEN ?

You still do not get the point. The fact is that the best possible treatment are also expensive and not everyone can affiord it. That is the dilemma facing governments all over the world. How do you fund it?

Or perhaps your statement is really a covert intention to LIMIT the best and proven treatment to those who can afford it.

oxford mushroom SG

Perhaps, the Ministry of Health should contact the esteem Hospital in Bangkok, Thailand - which you say is comparable to our SGH and NUH - and come to some agreement that allow us to outsource our surgical and medicinal procedures, and the Ministry will still see a healthy bottom line.

Finally I can agree with you on this and I do think the government will agree as well. If the bangkok hospital can provide medical care for less complex conditions, especially routine orthopaedic operations, for subsidized patients at the same subsidized rate as our public hospitals, the Minister will agree.

The hospital in Bangkok will really have to charge a very low price, because you will have to factor in the cost of transporting patients to Bangkok and a certain period of postop care before they can return.

But if it is still economical, the Minister for Health will jump up and clap hands and the CEOs of our public hospitals will shout for joy. Not sure if our patients want that though...but yes, I fully agree if that can be done.