Surgical Fee guidelines a good job half done

Hi all,

The letter below was published in the Forum page of the Straits Times (23.11.2018)

Dear Editor, 

The recently published fee guidelines for more than 200 common surgical procedures by private surgeons in Singapore could not have come a day sooner (Opting for private surgeon? See fee guidelines; Nov 14).

Many, even specialists in the private sector, have felt that recent price trends have not been sustainable and that Singapore is beginning to lose its competitive edge in this area to neighbouring countries.

Whether regional patients return to our shores in substantial numbers remains to be seen, but the latest move can only be good if we are serious about Singapore being a centre of medical excellence - a mantra seldom mentioned nowadays.

However, the surgeon's fee is but only a portion of the patient's total hospital bill. How does knowing only this portion allow for realistic financial planning for any patient coming into our private hospitals?

Why leave this task half done? Surely private hospitals have a critical role to play in this journey towards an excellent yet sustainable Singapore healthcare.

To this end, I propose the following:

For the most common surgical procedures - for example, the top 10 procedures of each speciality - the Health Ministry should require all major private hospitals to have all-encompassing fixed-fee packages.

This will introduce real competition and offer real choices for patients and payers (employers and insurers).

With the surgeon's fee kept at reasonable levels by the recent fee benchmarks and the hospitals' fixed-fee packages, patients and their families can be confident of avoiding shocks on the day of discharge, barring unexpected complications or transfers to intensive care units.

Other components of the total fee - for instance, an anaesthetist's fee - are usually predictable as a percentage of the surgical fees.

Only if this is achieved and uncertainty alleviated will Singapore's private healthcare truly be able to enlarge the pie and be ready to compete with our fast-improving regional competitors.

We may just be able to make it, but time is of the essence.

Huang Shoou Chyuan (Dr)

Silly hope that ST will not be like China Daily, Pravda or KCNA.

Yesterday was the last time I will be reading from a subscribed Singapore newspaper.

No right thinking person will read the China Daily expecting anything other than partial news that support the official line of the Chinese government. Ditto for Pravda ( Russian Federation) or KCNA ( North Korea).

The only reason we will feel angry when our only English newspaper appears biased and partisan towards the government ( which incidentally owns it in a not too complex shareholding structure) is that deep down somewhere in our hearts ( or brains) is that we thought that somehow the Journalists could be allowed to act and write as professional fair-minded Singaporeans (or maybe PRs).

I ( now I am getting personal) thought, naively now its clear, that the senior people that run the Straits Times ( now I have named the paper) have a conscience to do what is right for us. That they cannot be so blatantly biased or else I and others will get disgusted and not read their paper anymore. Well I was wrong and they were right.

They could and were and will be blatant and yet people like me , till yesterday, would buy and read with a glimmer of hope that is totally unwarranted. Hope that they will do the right thing. It wont happen anytime soon.

I have unsubscribed to the Straits Times. In investment terms we call this “cutting loss”.

Writing to the Forum Page ( and why I write) is also a rather unusual thought process. That is the subject of another post.

We live in difficult but exciting times.

Best wishes

Dr Huang Shoou Chyuan

Referendum for 377A repeal

Dear Friends,

We are told that repeal of Section 377A of the Penal code has the potential to divide Singapore and split us into 2 irreconcilable camps.

However keeping it unchanged is deemed a violation of the rights of a not insignificant percentage of Singaporeans. Repealing it, unfortunately, would offend conservative citizens who claim guidance from their ancient scriptures.

It was not too long ago when women could not vote and humans of colour had to make themselves invisible and use separate toilets, buses and their children attend inferior schools all in the name of these same conservative values.

These societal crossroads are now in the distant past.

And yet we are told and many believe that Singaporeans are mainly conservative and demand that the 377A remains on the legal statutes.

Is this even true? Has there been any real poll to confirm this?

Or is this potentially fake news?

There is one simple way to know if Singaporeans want to retain 377A as it is.

I suggest that the Singapore government carries out a referendum or plebiscite to  decide what Singaporeans want to do about 377A. This should be a non-binding vote carried out according to similar rules familiar to the Department of Elections ( eg compulsory etc) .

If the vote for pro-repeal wins or is close eg less than 10% difference then Parliament would be deemed to have the moral duty to do more than sit on its hands ( and tweedle its thumbs) and should start work on amending or repealing 377A.

However, it the vote is decisively  for retention, then the repeal camp must agree not to have any referendum till at least 10 years later. This allows the government of the day to carry out its mandate for the majority without upsetting the status quo..

If the government is not ready to take this risk, then a respectable NGO, or even the Workers’ Party ( which has been neutral on this) can take up the mettle on Singapore’s behalf.

I know there will some who argue against this as an example of “Ruling by Referendum” but don’t Singaporeans want to know how middle Singapore feels about this? I sure do!

Best wishes

Dr Huang Shoou Chyuan

Amended letter published in Straits Times Forum

Is this what Mediocrity looks like?

Dear friends,

The recent debate about Minister’s pay and mediocrity ( ref GCT speech https://www.theonlinecitizen.com/2018/08/05/goh-chok-tongs-speech-defending-high-ministerial-pay-and-defence-budget-at-grassroots-event/)  has made me realise that our present social political system, if not tweaked, could have drastic consequences.

1.About National Day songs
We have not had any new songs for our National Day celebrations for the longest time. The songs of old like Dick Lee’s “Home” or Hugh Harrison's  “Stand up for Singapore" were memorable and iconic but why are new songs from new songwriters deemed not deserving of an airing on the national stage on our National Days? Is there a defeatist attitude by the organising committee who is  afraid that any new songs will not stand up to public scrutiny. When will this change?

2.About Microsoft and competition
Does anyone remember when Microsoft was a near monopoly and regulators were trying to make the playing field fairer? I was amongst many who were saying that  “Microsoft Office Suite” was already so good and affordable, why should we not it monopoly power? But after the regulators had done their jobs we were pleasantly surprised with a plethora of applications and software  eg Linux Open Office / Google etc, which were more innovative providing better communications for all.

3.About Grab and free market
If our regulators eg LTA was short sighted and disallowed “Grab” from entering the market, we would still be complaining about misbehaving taxi drivers instead of enjoying benefits of private rental cars . Of course, not everything is easy to control eg bicycle rental schemes. Frequent tweakings are often needed.

4. About Salaries and motivation
Has high salaries of public officials ( including politicians) ring fenced and allowed them to innovate, avoiding short term criticisms or has it ironically make such remuneration. an “iron rice bowl” so coveted that these talented officials will ( perhaps subconsciously) do what is safe to avoid perceptions of failure ?

Is this what Mediocrity looks like?

Cheers,

Dr Huang Shoou Chyuan

Urgent solutions needed to rental bike problems

Dear Friends,

Straits Times Forum printed an edited version of this letter. Click here.

Dear Editor,

In urban planning “last mile” refers to the difficult problem of getting commuters from a transportation hub eg MRT station to their final destination eg home. “First mile” would be from starting location to the hub.

The Last Mile Connectivity is the “Holy Grail” that town planners, including  ours, aspire towards.

Bike sharing schemes fronted by 5 companies  namely GBikes, Mobike, oBike, ofo and  SG Bike,  - which have more than 30,000 bikes between them, could be a positive disruptive influence  by improving public transport accessibility leading to a more “car-lite” Singapore.

However, complaints are heard more than accolades.Why?

These complaints include how our  reputation of our “city within a garden”  has been tarnished by these haphazardly parked bikes found in even odd places eg road dividers or in flower beds.

Bikes also pose dangers by blocking walkways and emergency exits .

Andrew Delios from NUS Business School had alluded to  economic concepts of “negative externalities”  and “free-riding”. ( Bike-sharing: Time to crack down on free-riding? Straits Times 18 Oct 2017)

“Negative externalities” are hidden costs not borne by company owners but passed to others, namely Singapore tax payers, who not only bears with the eyesore where previously was pristine environment, he  now has to skirt around or move aside fallen bikes. It could be said that our red passport is diminishing in value.

“Free riding” concept is when rich owners ( eg Ofo‘s young billionaire CEO Dai Wei ) are taking advantage of a public good (eg parking space) without paying for it. Some countries insist docking stations be built at costs of millions.

I propose the following:

1. Users who do not park at geo-fenced areas lose their deposits. Losing credits ( Mobike) is not deterrent enough.“No deposit” (Ofo) promotion not be allowed.

     2.“ Free first 15 minute” promotions (Mobike) not be allowed.  Bikes marooned on road dividers could be by riders who had run out of “free” time.

      3. Total number of bikes from each company be limited in each region and rebalancing of bikes assiduously done when they “bunch” in places.

4. Enough  geo-fenced lots  eg HDB void decks , outside condos and around private estates apart from transport hubs. Bike companies bear full cost of works.

Singapore is already very accessible and to walk few hundred metres is actually healthy.

To expect full door to hub connectivity is a tad too much.

Dr Huang Shoou Chyuan