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

Friday, February 07, 2014

National Service- Major review of this "Sacred Cow" is needed

National Service ( NS): Time to Review this national sacred cow?

National Service (NS) came into being after the National Service (Amendment) act was passed in Parliament on 14 March 1967.  NS has often been touted as a “rites of passage” when boys become real men.

However, many feel that amongst national “sacred cows”, this is one that deserves a serious look.

NS a bug-bear for many

For many Singaporean men, NS is a major bugbear as they feel that in the scheme of things, this “patriotic” duty has become too onerous and has even become a disadvantage. The Singaporean man’s life is put on hold for 2 years in the prime of his life ( not to mention the decade of reservist obligations after that). All this time while they are serving their nation, their fairer sex counterparts ( women) and non-Singaporeans are overtaking them in terms of seniority in the universities and at their work-place. Second generation male Permanent Residents (PRs) are in a different predicament but for the sake of simplicity will be treated here together with Singaporean men.

Whether we like to recognise it or not, there are employers who, all things being equal, would prefer an employee who does not have annual reservist obligations.

There is also a special breed of Singaporeans whose chosen careers value youth most eg sportsmen/ arts and culture, and for them, spending 2 years away and not being in touch regularly with their sports or artistic environment is as good as ( or as bad) sounding a death knell for them. Imagine Ian Thorpe or Nadal in uniform for 2 years and you know what I mean.  It is more than just allowing one Joseph Schooling postponement of NS as  there are many Schooling “wannabees” out there in our schools and perhaps out of 100 talented sportsmen, only a handful will eventually emerge to have the potential to be a champion.

It is (in a way) a numbers game.

Pertinent questions that need answers

Before I discuss my proposals, a few questions need to be answered:

1. What is the optimum size and composition of the SAF, taking into consideration Singapore’s geo-political situation and its demographics? Can either or both of SAF’s active and reservist components be smaller than its present configuration?

2.Is each National Service personnel (active and reservist) utilised optimally? Can we say (hand to heart) that the training schedule (barring unforeseen contingencies eg weather ) has been refined to such an extent that any reasonable person  who was to go through the same program would find that the time and effort spent on it as worth the sacrifice  

My proposals:

I postulate that with increased productivity and better planning, a smaller but just as effective SAF can exist without compromising national security:

1.  NS be shortened to 1 year with BMT of 3 months. For the majority of NS conscripts, the remainder of the year will be to equip him with the skills to be an integral part of a effective unit. Better pre-enlistment planning by Mindef will reduce time wastage before and after NS so that he can go to university with the maximum hiatus of one year.

2. NS allowance should be pegged to market rate, perhaps this should commensurate with what a polytechnic graduate can expect to get ie $1500-1800. This puts his economic status at near-parity with his cohort.
The  increase of the allowance to market rate may encourage PR’s who are sitting on the fence to volunteer (first gen PR) or at least deter others from renouncing their PR prior to NS.

3. Those who have been selected ( or volunteered) for Officer Cadet School /senior Non-Commissioned Officer school will need a longer NS liability of 1.5-2 years ( as responsibility is greater)  but will be compensated with market rate allowances of $2300-2800 to better reflect society’s meritocratic values.

4. Courses conducted in the NS should be validated by international accreditation bodies (eg ISO) so that any certification is portable for the servicemen’s future be it in the university or the workfloor. This may even shorten university courses or help in career advancements.

5. Reservist training should be short but efficiently administered (Short and Sharp) so that each year’s training is like a continuation of the previous year’s so that a “Band of brothers” camaraderie can be forged over time. This is possible with good commanders and planning.

Implications for smaller SAF ( ie less bodies in each unit)

Are there implications of having less bodies in the SAF units? Of course there are but these are not necessarily negative.

1. Less bodies will make SAF commanders cognizant of the real world and remind them that every soldier is a valued asset that has a definite cost and that these men should never be viewed as just a digit or just a photo in an ORBAT (Order of Battle ) chart. Each serviceman should thus be trained to be a productive member of a closely knit unit or else the unit will be dysfunctional.

2. Less bodies will mean that servicemen should only concentrate on being a part of an effective SAF to fulfil its primary mission of defending our nation. They should no longer be used as cheap labour for sports events or other national celebrations. If there is only 12 months to train a soldier- he is unlikely to spend 6 months preparing for the next NDP- even if his commander is the officer in charge. 

I am a Singaporean and proud of it. But SAF can be better.

I have done a 2.5 year NS followed by 13 HK and 4 LK reservist in-camps!

But it need not be a case of equal misery.

Dr Huang Shoou Chyuan

Tuesday, January 28, 2014

Changi General Hospital thinks out of box to solve overcrowding ( but I said it first)

Dear Friends

Changi General takes a small step ( but significant one) to try to solve severe overcrowding at the Accident & Emergency Dept ( A&E). ( click here)

It incentivises patient to try to seek treatment at their neighbourhood General Practitioners (GP) first.

If after that the GP still deems them serious enough to seek re-attendance at the A&E, they are accorded a $50 discount.

This is good as:
1. Non-emergency cases will be seen ( more quickly) by their GP's at a lower total cause. ie $30-50 GP fees compared to $100 A & E fees.
Even if re-attended at A & E : total fees will be $80-100 .

2. Non-emergency cases will not clog up the A&E- leaving the remaining ( ie less) emergency cases to be seen by the already over-burdened doctors/nurses.

Most stakeholders will be happier:
1. Non-emergency patient : happy! 2. Emergency patient: happy! 3. GP lagi happy! 4. A&E docs/nurses lagi lagi happy!

Slightly unhappy: if emergency case goes to EXPENSIVE GP who charges $150... then gets referred back to A&E to only get $50 discount... TOTAL BILL: $200 but he will be fast-tracked and does not have to wait with the rest of the crowd... so Not so unhappy!

BTW: CGH copied my idea! Really!

I wrote on this exact topic ( click here)  and this was published in the newspaper's forum pages and I thought it was forgotten... BUT.. no... nothing is ever wasted. I always thought it was feasible!

In life- there are always negative people who will pour cold water on anything new others want to introduce... why rock the boat ( they say)... society is not ready ( they say)... this is Singapore and we do things differently from the rest of the whole wide world ( they say)...

But I say- Huat Ah! Just say and do what you think is right! What is good for your fellow men... and women...

Gong Xi Fa Cai! Huat Ah!

Dr Huang Shoou Chyuan