Saturday, January 19, 2013

How to shorten long A & E queues? - Patients referred from GP/Polyclinic should get 50% discount

 Dear Friends,
This is a suggestion to shorten the never-ending queues at the public hospital’s Accident and Emergency Departments that may be worth considering. Sometimes the queues can be longer than 4-5 hours ( not exactly a first world standard?).

I want to emphasise that obvious serious emergencies such as symptoms of heart attacks and major trauma ( eg broken bones)- of course should go straight to the A & E and I trust that the staff who do the triaging ( filtering) at the reception will get the doctors to treat these immediately. It is the rest ie not obvious emergencies- eg giddiness, fevers, pain here or there etc that I think may consider seeing the GP or Polyclinic. If the doctors at the GP/Polyclinic then direct them to A&E as they are deemed emergencies needing urgent and early intervention, then these should get a 50% ( or whatever sum) discount. Hence the total sum of someone who sees a GP + A&E ( referred) should be less than the flat fee of A & E ( direct self-referral). Eg Flat fee of A & E now ( approx $95), new amended sum ( if accepted) should be ( $43 + $25-30 ( GP’s fees)).

I did not add, that referred patients should join a fast-track queue also…

Addendum (19.1.13- same day)
Another non-emergency source of A & E attendance are the patients who go there to get referral to specialist clinics at the public hospitals.  Referrals to specialist clinics from A & E and polyclinics are considered subsidised and enjoy discounts whereas patients referred by GP's are automatically considered as non-subsidised and pay ( often substantial) full rates even if the patients are obviously poor. Those who are referred by GP's , and who then try to appeal to be downgraded to subsidised rates have to go through a sometimes demeaning process where they are interviewed by Medical Social Workers who pry into household incomes etc to see if there are any rich members in the family etc and hence do not deserve subsidies ie the Means test. This is the subject of another letter to the press...
Click here for the published letter ( which was edited slightly). Here

Below is my original letter.


Dr Huang Shoou Chyuan

Unabridged Letter
Dear Editor,
I wish to lend my support to 2 recent letters writers (Lower A&E fees for referred patients: Ms Soh Ah Yuen ) and (Why non-emergency cases throng A&E departments:Ms Wong Jee Kiat ) who suggested that patients referred to the Accident and Emergency Departments ( A&E) of public hospitals ( by GP’s and polyclinics respectively) should get a discount from the flat fee charged to patients who “referred” themselves there directly.

This is a sound proposition as one of the major reasons why patients (even emergency cases) need to wait for several hours before being seen by attending doctors is that despite best efforts at triaging patients at the reception area to identify patients who have life or organ-threatening conditions (eg heart attacks; airway obstruction) , many others with less dire emergencies but still require timely intervention nonetheless ( eg semi-acute bleeding from internal organs) are left to wait in the queue together with many who obviously do not have urgent conditions (eg patients whose companies do not recognize GP’s Medical Certificates (MC); mild diarrhoeas).

To incentivize patients to see GP’s and Polyclinics first , patients who have been screened by doctors at family clinics and polyclinics and deemed as emergencies that require urgent intervention at public hospitals through admissions at A & E, should get substantial discount from the said flat fee. This sum must be significant enough or else the thought of paying at the GP’s followed by paying almost the same A & E flat fee again if referred to A&E will not be any incentive. I suggest 50% discount so that together with fee from the GP or polyclinic ( if referred back) – will still be lower than the original flat fee.


The advantage in this system is that :

1.     Many who would have otherwise joined the throng at the A & E , would have been treated and followed up at the GP’s / polyclinics with no untoward effects to themselves

2.     Less non-urgent cases in the A & E queue would allow more accurate triaging ( which is still needed) and more expeditious treatment of whole range of dire to semi-urgent emergencies.

3.     This also has added advantage of increasing the work load at the GP’s ( which is good and may dissuade some from embarking on non-conventional branches of medicines e.g. Aesthetics)

 Other measures that MOH/MOM can consider include not allowing companies to only recognize MC's from A & E and not those from GP’s as the latter are bona fide SMC-qualified doctors.

A further disincentive ( but may not be politically-palatable) may be to surcharge those who ( even by any stretch of imagination) can consider themselves as having an emergency ( eg mild rashes with no associated organ symptoms etc) .

Unfortunately, there will be an increase in attendence at polyclinics who may need to beef up their staff numbers but their consolation would be that they have contributed to emergency cases being better treated at the A & E’s!

Dr Huang Shoou Chyuan


Anonymous said...

Please read updated online forum dd 16 Jan by Ms Wong Jee Kiat "Deduct X-Ray fees from A&E charges" Patients with referral letters and X-Rays from polyclinic should have the X-Ray fees deducted from A&E charges.

Winking Doll said...

Hi Dr Huang,

There is also the problem of transportation cost. If a pt is significantly unwell, he/she may need a taxi to get to the GP. And then if referred to the hospital, another taxi/ambulance ride, registration and queuing for consultation is involved.

I suspect it may help to have some medical knowledge to determine the probability of theirs being a GP (i.e. non-emergent) or hospital case. After all, chances are people would like to avoid doing everything twice -- to travel to GP/hospital, registration, and joining a consultation queue. Thus, it may help if there is a free health information helpline to advise them on what to do.

E.g. Health Link B.C.

Cheers, WD.

Winking Doll said...

Hi Dr Huang,

There is a simpler way to encourage patients to go to GP/Polyclinic instead of hogging the A&Es -- allow CPF Medisave to be used for approved-GP and Polyclinic consultancy, and maybe part of the prescription drug costs too.

Singaporeans are pragmatic, ERP can change road traffic patterns, a fine can hem-in undesirable habits, baby bonus can encourage fertility rates, so why not use of Medisave funds? But I am sure the PAP dominated government will not approve, not within the next few years at least.

Cheers, WD.

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Anonymous said...

Looks like they should seriously consider your suggestions. The hospitals should reduce the A&E fees for those who took the initiative/trouble to visit a GP first. The army should also be more willing to accept MCs of private GPs to reduce boys in green hogging A&E.

In addition, can't the A&E depts. not refuse to treat non-emergency cases but refer them to be seen by GPs/polyclinics in the evenings or next day? Of course, this also means that polyclinics should consider staying open in the evenings to cater to those who cannot afford private GPs but are not sick enough to be treated at A&E. I notice that some specialist clinics in govt hospitals already have evening hours (eg. eye centre at TTSH) so why can't polyclinics do the same?

Anonymous said...
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