Saturday, January 31, 2015

Sengkang Columbarium Model (SCM): Is this PAP’s Theory of Everything (ToE)?

Dear Friends,

Theory of Everything
In theoretical physics, the Holy Grail has always been the Theory of everything ( ToE), the single all-encompassing theory that purports to link together all aspects of the universe.
One of the theories is the aptly named “string theory” that strings together (duh) everything that (until some future “Eureka  moment”) had eluded everyone about God, the origin of Life or even the Meaning of Life. Click here.
I had such a moment of epiphany or “A-Ha moment “ this evening when I was reading something from social media while killing time when the wife was testing various varnishes for her toe nails at Sephora at Great World City.
Khaw's Assumptions and Butterfly Lovers
I was, of course reading, about Minister Khaw’s Assumptions (here ) and how he is into seeking religious wisdom and meditation and how Butterfly lovers (click here) had fooled or lulled even one as intelligent as his team at MND into awarding  “Eternal Pure Land Pte Limited” (EPL)  as the winner of the tender to build a “Chinese temple”- not withstanding the fact that EPL’s forte was funeral homes and Columbariums . It’s probably just coincidental that EPL is domiciled in Australia and … oh yes, it’s bid was irresistibly the highest. Click here  

My epiphany occurred in the mall corridor outside Sephora ( I do not have any commercial interests here nor do I varnish my toe nails) when I read about how the new HK “Gleneagles “ hospital that IHH - the successor of Parkway Holdings ,had won in a HK tender, had to fulfil certain conditions including ensuring the hospital remains affordable to Hongkongers by certain price control mechanisms. Click here.

Here comes the String which ties Singapore to HK and PAP to Raffles Hotel…
HK is not like Singapore
How is it that when the ultimate capitalist land on earth ( HK) can stipulate how a winner of a land tender must control its pricing but when Singapore sold it’s last major piece of land for a private hospital at Novena ( now called Mount Elizabeth Novena Hospital-) not to be confused with Mount Elizabeth Hospital ( not Novena)) that Parkway  has a free hand in deciding to have only single-room suites ( including one $17000 per night suite) and is allowed to charge whatever it deems fit. I do not presume it is high but I “assume” it is ( pun unintended) ? Why? Click here. A very senior Parkway official even hosted me for a meal ( over cheap lunch) after my letter was published by the Straits Times, and explained why Parkway had some assumptions ( my lips are sealed) which led them to pay the government Sg $1.25 billion (for the land) and why they have only single rooms ( to earn money duh!) and dispensed with any tokenistic multi-bed suites.

Sale of our Crown Jewel
The string gets longer when those of my vintage remember that Raffles Hotel ( together with the doorman) was once one of Singapore’s most recognizable icon. It was sold to a foreign private equity group aptly named “Colony Capital” and was then kicked around like the football we so loved to watch and this ex-icon is now owned by Qatar.  Click here.

Then of course there are the power stations sold to China.

Someone said ( or perhaps it is a song) that Money makes the world go round…
SCM: What makes the PAP all wound up
Since now we know what the string is made of that ties up what is important to this PAP government (and what irks me) and since it is epitomized by the Sengkang Columbarium saga, I shall henceforth call the PAP’s Theory of Everything, the Sengkang Columbarium Model (SCM).

When you have the time, think of what irks most Singaporeans about the PAP eg ministers’ not inconsiderable ( ok high) salaries , then SCM will help you explain why the universe at one degree north of the equator is so warped. Click here - you won't regret)
Cheer up! It's not definitely the end of the world ( it could be but not definitely).
Dr Huang Shoou Chyuan

Thursday, January 22, 2015

Short-term stay industry eg AirBnB can be positive for Singapore.

Dear Friends,

URA is getting feedback on short-term rentals in private homes. ( click here).

Before we say NO and dismiss this nascent industry as unworkable, let us consider if with some regulating, this industry may in fact be a boon rather than a bane.

Update: Straits Times Forum page printed my letter on this topic: Click Here


The world is changing and none more than in the“sharing economy”. There is a global paradigm shift in this aspect and in Singapore, we should not dismiss this without considering its merits.
Short-term stay industry most obviously spearheaded by companies like AirBnB and PandaBed has a role to play in many modern cities and many tourists all around the world do stay in homes hosted by these websites and have found them a real alternative to hotels. Why not Singapore?

Singapore's situation
In Singapore, accommodation for tourists and visitors is extremely expensive or often unavailable during peak seasons eg school holidays/ F-1 events etc. This is the same refrain we ( private hospitals) hear from our patients from time to time. Even though budget airlines have done wonders in bringing in more tourists, lack of economical niche homes present a stumbling block for them.
If this short-term stay industry can be properly regulated, beneficiaries are many and include home owners and tourism industry ie retail /airline/ medical tourism sans (excluding) hotels. The hotel industry , for obvious reasons, will try to prevent competition and will try to lobby and influence government leaders why we should not allow this into Singapore.

As it is now, many of patients/family coming for prolonged medical treatments already stay in apartments in Lucky Plaza/ China town. These are probably illegal. If legitimised there will be extra income tax collection for Singapore’s treasury. But more importantly, a new industry will grow to the benefit of many ordinary home owners.
Problems are not insurmountable
Potential problems eg overuse of common amenities/ loss of privacy are manageable by having proper regulations. For instance, HDB flats should not be allowed to participate in this scheme as HDB is supposed to be subsidised housing for the masses.  
Condominium participation depends on each condo’s (MCST) Bylaws. The strata title members decide for themselves if short term tenants are desirable. Their property prices may increase/ decrease depending on which way the  coin falls. The market decides. One may be surprised, if in Condos who say YES,  buyers may turn up to drive up demand for apartments there as then there will be another new income stream for them later.
There is little reason why landed private housing, eg  bungalows /semiD / terraces cannot rent out their properties so long as the tenants/landlords abide by existing laws of traffic/ environment) etc. If tenants are noisy or traffic jams ensue, existing provisions should suffice.
If this industry is allowed, landlords/owners must be held accountable and keep proper documentation/registers of tenants to ensure proper tax submission and for national security ( esply important for post-911 world).

Properly regulated short-term accommodation industry will make our hotel industry more competitive and this industry has potential for bringing our tourism industry to the next level.

Don’t just say NO!
Dr Huang Shoou Chyuan

Sunday, July 13, 2014

Medishield Life- Singapore's Obamacare... what's there not to like?

Medishield Life- Singapore’s Obamacare… What’s there not to like? 

Dear friends,

A long-time reader of my blog asked me to comment on Medishield Life (MSL) (MOH link here, here and here) from a doctor’s view-point.

LOL- the assumption was that doctors understand Medishield more than the lay-person.

Truth be told- many of us, docs, do not fully comprehend the soon to be defunct Medishield as it was irrelevant to us (esply in the private healthcare system). When asked by many patients how this 2nd of the 3M   ie (Medisave/Medishield/Medifund) was relevant to their impending surgery/hospitalization… I just truthfully say- “it is irrelevant to you ( in private hospital with elective ENT condition) as it does not affect you”.

The high “deductibles” plus the “co-insurance” portions means that when the final invoice is issued- little (if any) Medishield funds will be disbursed in most private hospital scenarios. Please do not be confused with the Private Integrated Plan ( enhanced private scheme that supplements Medishield).

Private hospital healthcare is very expensive and as Medishield is designed for the public hospitals’ B2/C wards in mind, the payout portion is miniscule compared to the total private hospital bill and even if disbursed, it will be such a negligible portion of the total bill as to be meaningless.

Friends- I hope that you do not think me as condescending … but if you think public healthcare is expensive, you have not seen anything yet.  That is why we must do something to ensure healthcare remains  affordable to Singaporeans … in both public and private healthcare sectors. Did you know that public hospitals often act as pricing signal for the private sector? Many procedures/investigations cost more in the public hospitals. Hard to believe?

Also- don’t confuse MSL with CPF Life or with the debate about CPF payouts or even with the court case about the PM and Roy.

Medishield Life (MSL): Universal coverage that will be affordable to most in B2/C Ward setting.

1.MSL is not free healthcare. Anything that is free attracts morale hazard ( also known as buffet syndrome). Co-payment ( even a little) makes one less generous with other people’s money. Hence I am a strong believer in need for deductible and co-insurance.

I have seen people who feel that since they paid insurance premiums- then their hospital stay should be like a holiday stay with consultations with multiple different specialists (even when not needed) and with many expensive tests thrown in for good measure.

2.Advantages of  MSL in a nutshell (click here). 
All -even those with pre-existing conditions and previously uninsurable ,are covered. No one is rejected ( although there is higher premiums for pre-existing conditions). IMHO- it is good that no opting out means that no one sacrifices his health due to pressure from domestic situations etc. All of us chipping in to ensure no one gets left behind is a good thing. 

Lower co-insurance: That means for each hospitalization- out of pocket cash portion is less.
Increase in limits  for annual claim/daily claim limit/each surgical procedure/ outpatient cancer treatment ( Chemo/radiotherapy).

Contrary to what I expected- the deductibles appear unchanged.

Rightly- higher wards such as B1/private wards and private hospitals, does not come under ambit of MSL. Government should take care of basic no-frills healthcare. If one wants the bells and whistles- then pay for it.

3. Cost of future healthcare should be consciously contained
Even in public hospitals- the cost should be contained or else the payouts from the MSL would soon be made redundant in a few years time. Eg the surgery cost for Table 7 ( most complex surgery) will easily be more than $2000 (MSL surgery claim limit now) if not controlled.

4. Perceptions of B2/C wards should be addressed
The general public perception that doctors/medications for B2/C class are inferior to higher class wards should be addressed and corrected. Does MOH keep track of every hospital department to ensure that doctors with appropriate competence treat each patient regardless of ward class? I am sure the majority of departments do- but are there black sheep department? If one needs robotic or minimally invasive surgery- one must get it (and not have to upgrade to higher class ward).  If Generic (unbranded) drugs are just as good they should be used for all class patients. Proprietary (branded) drugs still under patent- should be used in patients of all class- if needed. No discrimination!

Every public hospital is a teaching hospital- regardless of class ward- trainees (medical students/ post-graduate doctors) should have access to all patients – but they should of course be closely supervised. Doctors have been trained via apprenticeship from time in memorial!

I fully support the thinking behind MSL. No one should be left behind. We should tweak the top-ups to help those who have problems paying for the premiums and keep an eagle eye to ensure every public hospital department does not neglect B2/C ward patients.

Don’t anyhow protest.. or we risk throwing out the baby with the bath water.


Dr Huang Shoou Chyuan