I'm sure many of you have read about the Dr. Susan Lim case which is now before the SMC. She is trying to prevent the SMC from convening an investigation into her billing [Link]. I'm not here to discuss Dr. Lim's case or her morals but how the desire for Singapore to be a medical hub for the rich has raised the cost of healthcare for ordinary Singaporeans who are now made to shoulder the increasing financial burden of our govt's aspiration to maximise the profits made in this sector while keeping its own expediture on healthcare down by passing the increased costs to ordinary Singaporeans.
While Dr. Lim's case was brought up, the newspapers went around to interview doctors on what they think of it. Some say she should bill no more than $5000 a day others say it is okay for her to bill the $450k a day if the patient is willing to pay this amount for her services. There is no concensus on what amount she should bill a patient. Some suggested it should be based on patient's ability and willingness to pay. If this is true, Singaporeans with a median household income of $4-5K have to compete with the richest in the region. Healthcare is starting to get treated like housing -the good size bungalows for the rich and rental flats for the poor, you get what you pay for and the more you pay the higher the availability and quality. Pure capitalism.
Sometime back, I needed an minor operation on my back. I went to the GP who suggested that I pay a few thousand for day surgey at a private hospital called Eastshore. He told me the doctor there was very experienced, highly available and I can get my surgery the next day after an initial inspection. I asked him if there is any risk if it is done by a doctor with no experience. He told me the risk was minimal (nearly zero but doctors cannot say zero). I decided to have it done at the public hospital. The waiting time was months but I was not in need of any immediate treatment so I was opted to wait. To cut a long story short during my surgery I was put on LA (local anesthesia) - they killed the pain on my back but I was fully awake during the surgery. While they operated on my I could hear all the interesting small talk between a specialist and two surgeons who were "cutting" me. The surgeons sounded like rookies taking instructions from the specialist. I was quite okay with that given my condition was not complex and the surgery was a simple one. Half way through, the head of department came around to check on the surgery team. When he left, one of the surgeons said he was very nervous when his "boss" came to look at what he was doing. I told him, "hey doctor, you forget I'm still awake, now your patient also very nervous".
The surgery did go well and I have recovered fully. I was lucky to have a small problem and the public hospital took good care of it. However, my experience that highlights what is going in our public hospitals. Many highly experienced senior doctors, surgeons and specialists have been drawn out of our public hospitals into the private sector where they can earn much more money doing less work. That leaves those who remain in the public hospitals to handle a bigger loads - we enter a vicious cycle because those remain have to be retained with higher pay. The govt has shown no desire to fix this as they simply pass on the increased cost to Singaporeans (means testing, higher insurance premiums etc). They continue to advertise Singapore as a medical hub for the rich in the region[Linkj] and the expansion of capacity in private hospital will further strain our limited resources.
There is only one other developed country that allowed free markets to dominate healthcare - USA. We are going along the same trajectory and will reach a stage when it becomes very difficult to fix just like in the US. You cannot ask surgeons that make $15M a year to trottle down to $5M. We have already seen insurance premiums moving up - old schemes such as basic medishield becoming inadequate and more and more people with inadequate coverage. The medical care financial strain is moved up from low income now to middle income families. We continue to be told that "healthcare is affordable" and we are on the right track. This is not true. There are many other ways to run a healthcare system and many of my readers who are Singaporeans or ex-Singaporeans now living in Australia, New Zealand, Canada, France and UK attest the workability of other systems that give the sick the better care and lower financial burdens. The PAP likes to scare us by saying that such system can only lead to higher tax - ideologically the PAP likes to keep income taxes low but that comes at a price of burdening those in need. In the 2011 budget the PAP govt cut taxes for the middle income, in essence, giving money to all those in this bracket including those who don't need the money. But why do this? The govt hurt the sick people in the same income category by implementing means testing....why take from those who need it most to give to everyone? This philosophy can only exacerbate the effects of the already large income gap among the populace and thin out what ever remains of any safety net for those who need it most.