Sunday Times 8th April 2012
By Salma Khalik , HEALTH CORRESPONDENT
They have met privately, written to their professional bodies, blogged, and gathered to tell the Health Sciences Authority (HSA) what they think of the tightened regulation of medical devices in force here since the beginning of the year.
The bottom line is that private specialist doctors think it takes too long, costs too much and requires far too much paperwork to get medical devices cleared for use.
Despite meetings with HSA officials, including one with about 50 at Gleneagles Hospital last month, the doctors say their difficulties have not yet been resolved.
Their work has been affected, because some doctors have run out of supplies of some items their patients need.
Read digital version here ( must pay- I think) or buy the Sunday Times.
Dear Friends,
I have blogged about this issue here
Straits Times/Sunday Times health correspondent,Salma Khalik, interviewed me for the above story.
Despite advice to the contrary, I feel that many reporters working in Singapore’s “controlled” environment try to do the “right thing” and airing the doctors’ point of view over the Mainstream media (MSM) will ultimately help our patients. Of course, we know Singapore’s SPH and Mediacorps is a duopoly of mega-proportions and this decision is made on political grounds (as the PAP believes a fully independent media is not conducive to their type of rule -to put it mildly).
If you read the whole article ( sorry- I only have the free and hence incomplete version), the HSA says it is trying to engage the doctors. I am wary of engaging them now as I do not want a “half-measure” solution that only postpones the problem while our SME vendors are dying day by day ( like a death of a thousand cuts).
With my hand on heart, I sincerely feel that wrong policies should be rescinded or at least severely altered. That means in the least,medial devices that have been cleared by USA’s FDA need not need registration and the doctors or vendors bear responsibility when we use them. Period.
Let us get the entrepreneurship amongst the vendors going again… for the sakes of all our patients.
Cheers,
Dr Huang Shoou Chyuan
Showing posts with label Healthcare. Show all posts
Showing posts with label Healthcare. Show all posts
Sunday, April 08, 2012
Tuesday, February 16, 2010
Singaporeans' Medisave Money for Malaysian hospitals
Hi Friends,
Gong Xi Fa Cai!
May we not just have material blessings but also good health so that we can live meaningful lives amongst our kinfolks, friends and community.
My largely unedited letter has been published in the Straits Times Forum today.
I am disturbed that MOH –which had backed down earlier about setting up Old Folks’ Homes in Malaysia after an uproar, has now introduced it again, albeit in a different skin.
Healthcare initiatives- Old Folks’ Homes and now this
The Old Folks’ Home initiative and now the Medisave for Malaysia move is an admission that certain Singaporeans have been priced out of their own homeland.
To some,it seems a logical solution,” If Singaporeans cannot afford to live their remaining days in Singapore- why not just let them do it in Malaysia”. Now it is –“ If Singaporeans cannot afford to have quality healthcare on our own shores- maybe Malaysia boleh (can) ( with a little help from Medisave)”
But others will ask questions like "Why is it that the MOH feels that in our multi-strata healthcare system, which range from C class beds in public hospitals to the super-duper suites in our private hospitals (that even regional royalties feel comfortable in), cannot meet the needs of Singaporeans? Shouldn’t we try to meet the demands and aspirations of Singaporeans within our system instead of sending them up north? Did we not pay tax so that our system can help us when we are sick and old?
MOH should try harder to improve the system so that Singaporeans feel they get more “bang for their dollars" . I do not recall all major stakeholders being consulted about this.
Impact for tourism industry
What about our national plan to make Singapore a regional centre of excellence for Medical Tourism? Each medical tourist comes typically with at least 2-3 family members. This is a huge spin-off with a multiplying effect for hotels, F&B and shopping centres. In one stroke, the MOH has just leaked out a family secret ( and I am not agreeing to this) that Malaysian hospitals are cheap and just as good!
Malaysia has just got a very un-expected Lunar Near Year Hong Bao from MOH! No amount of publicity nor advertisements by Malaysia’s tourism board can compare with such an ringing endorsement from none other than Malaysia’s erstwhile competitor.
Read this space- there will soon be insurance policies which are priced below our present premiums, but with a catch- “Co-payment if treated in Singapore hospitals, but, full reimbursements if treated in Malaysia”
I guess this populist move will win the minister many votes for the coming elections. Why worry about our healthcare system?
Cheers
Dr Huang Shoou Chyuan
Will it come back to haunt us later? (16 Feb 2010 ST Forum)
I REFER to last Thursday's report, 'Medisave can be used in 12 Malaysian hospitals'. The move by the Ministry of Health (MOH) to allow Medisave deduction for hospitalisation in Malaysian hospitals is, in my view, like scoring an own goal in a soccer match.
To say the least, it sends a confusing signal. It is as though MOH is admitting that it has failed in its mission to cater to all Singaporeans in our own often-lauded health-care system.
Is the claim that even the poorest Singaporean will be looked after in our health-care facilities - with its subsidies and special funding such as Medifund - just an empty boast now?
MOH is in fact using national resources - Medisave infrastructure - to build up a competitor's capabilities. Is MOH still serious about helping Singapore become a medical tourism centre of excellence?
This populist measure may seem to placate short-term demands - only to come back to haunt us later when our own health-care and tourism industries are hollowed out in the medium to long term.
By then, any new measure will be futile and like shutting the stable door after the horse has bolted.
Dr Huang Shoou Chyuan
Gong Xi Fa Cai!
May we not just have material blessings but also good health so that we can live meaningful lives amongst our kinfolks, friends and community.
My largely unedited letter has been published in the Straits Times Forum today.
I am disturbed that MOH –which had backed down earlier about setting up Old Folks’ Homes in Malaysia after an uproar, has now introduced it again, albeit in a different skin.
Healthcare initiatives- Old Folks’ Homes and now this
The Old Folks’ Home initiative and now the Medisave for Malaysia move is an admission that certain Singaporeans have been priced out of their own homeland.
To some,it seems a logical solution,” If Singaporeans cannot afford to live their remaining days in Singapore- why not just let them do it in Malaysia”. Now it is –“ If Singaporeans cannot afford to have quality healthcare on our own shores- maybe Malaysia boleh (can) ( with a little help from Medisave)”
But others will ask questions like "Why is it that the MOH feels that in our multi-strata healthcare system, which range from C class beds in public hospitals to the super-duper suites in our private hospitals (that even regional royalties feel comfortable in), cannot meet the needs of Singaporeans? Shouldn’t we try to meet the demands and aspirations of Singaporeans within our system instead of sending them up north? Did we not pay tax so that our system can help us when we are sick and old?
MOH should try harder to improve the system so that Singaporeans feel they get more “bang for their dollars" . I do not recall all major stakeholders being consulted about this.
Impact for tourism industry
What about our national plan to make Singapore a regional centre of excellence for Medical Tourism? Each medical tourist comes typically with at least 2-3 family members. This is a huge spin-off with a multiplying effect for hotels, F&B and shopping centres. In one stroke, the MOH has just leaked out a family secret ( and I am not agreeing to this) that Malaysian hospitals are cheap and just as good!
Malaysia has just got a very un-expected Lunar Near Year Hong Bao from MOH! No amount of publicity nor advertisements by Malaysia’s tourism board can compare with such an ringing endorsement from none other than Malaysia’s erstwhile competitor.
Read this space- there will soon be insurance policies which are priced below our present premiums, but with a catch- “Co-payment if treated in Singapore hospitals, but, full reimbursements if treated in Malaysia”
I guess this populist move will win the minister many votes for the coming elections. Why worry about our healthcare system?
Cheers
Dr Huang Shoou Chyuan
Will it come back to haunt us later? (16 Feb 2010 ST Forum)
I REFER to last Thursday's report, 'Medisave can be used in 12 Malaysian hospitals'. The move by the Ministry of Health (MOH) to allow Medisave deduction for hospitalisation in Malaysian hospitals is, in my view, like scoring an own goal in a soccer match.
To say the least, it sends a confusing signal. It is as though MOH is admitting that it has failed in its mission to cater to all Singaporeans in our own often-lauded health-care system.
Is the claim that even the poorest Singaporean will be looked after in our health-care facilities - with its subsidies and special funding such as Medifund - just an empty boast now?
MOH is in fact using national resources - Medisave infrastructure - to build up a competitor's capabilities. Is MOH still serious about helping Singapore become a medical tourism centre of excellence?
This populist measure may seem to placate short-term demands - only to come back to haunt us later when our own health-care and tourism industries are hollowed out in the medium to long term.
By then, any new measure will be futile and like shutting the stable door after the horse has bolted.
Dr Huang Shoou Chyuan
Sunday, December 20, 2009
Singapore Healthcare- A Personal Perspective
Hi Friends,
I know our healthcare system is not perfect.
And our doctors are definitely not “angels”.
But there are still Singapore doctors out there who are ethical and abide by the spirit of the Hippocratic Oath (even in the private sector) that I feel a defence of our system is warranted here.
Is our healthcare more expensive than our neighbours’ ? Are there times when we wished that the results from surgery or treatment were better? Are there black sheep in our system who are “outliers” as far as indications for treatment or treatment fees are concerned? The answers are of course “Yes”!
But would I still recommend my loved ones to be treated here in Singapore? Of course (except for the most trivial conditions).
In all hospitals (public and private), volunteer doctors and other personnel sit in committees to look into how healthcare can be better delivered to our patients.In my hospital, Gleneagles Hospital, amongst other things, committees ensure that there is Quality assurance; that all deaths are independently reviewed and surgical specimens from patients confirm that operations were really needed etc.
When near-misses or actual mishaps happen, we help the hospital to diligently look for the root causes and design correct processes to plug gaps in the system. We are often pleasantly surprised to know that in many near-misses, these mistakes are identified further down the line by another vigilant colleague who actually helped to avert potential disasters.
An “honour” system where healthcare workers including nurses and doctors, voluntarily submit “Hospital Occurrence Reports” (HOR) whenever such incidences occur. These range from serious ones such as prescribing patients with drugs that they are known to be allergic to, to trivial incidences such as patients having broken skin when plasters are removed.
In fact, reporting near misses is not unique to the healthcare industry. The aviation industry also reports near misses and the familiar safety rule of turning off electronic devices that can interfere with navigation equipment, is a result of this.
However, when staff (including doctors) are recalcitrant and disregard established safety norms, they are investigated and disciplinary actions are taken when appropriate. Some doctors have had their working privileges suspended or get reported for further action by the Singapore Medical Council and the Ministry of Health.
Cheers
Dr Huang Shoou Chyuan
The unabridged letter (20.12.09) ( I will append Salma Khalik's letter the moment I find a digital copy) Click here for the "edited" published letter.
Dear Editor,
I refer to Salma Khalik’s article “Make hospitals and docs more accountable”.
Khalik refers to the unfortunate case where the tissue biopsy diagnosis from a “quick analysis” frozen section (FS) (usually obtained within minutes while the patient is already in the operating theatre) differed from the final permanent section (usually reported at least one day later). It is internationally accepted practice for a surgeon to rely on FS for guidance as to whether a major operation should proceed.
In this case, the final permanent section showed “no cancer” – by which time major surgery had already been done as the FS reported a diagnosis of “cancer”.
FS is an invaluable tool used by surgeons. However, as with any diagnostic tool, there are limitations that allow errors to occur, including the initial selection of tissue by the surgeon, the tissue sampling by the pathologist, the technical expertise required to prepare the slides, errors in interpretation, and delivery of the result back to the surgeon.
Some diseases are so complex that even the most renowned pathologist would make errors in the FS or even in the permanent section!
To complicate the issue, a converse situation could also happen. The FS could report “benign” and surgery aborted, only to be proven wrong much later- by which time cancer might be too advanced for curative treatment.
Let me cite an actual example. My patient had thyroid surgery in another country. FS was not done and only partial resection was done. On re-evaluation of the tissue slides by our pathologist, “cancer”was confirmed and a second operation was needed for total resection of the cancer-bearing organ. If initial surgery was planned with FS, he would only have needed one operation.
Despite what Khalik has written in recent times, I sincerely feel that Singapore’s healthcare in both public and private hospitals has proven, time and again, to meet the needs of Singapore’s residents. The “complaints” published in the media pale in comparison to compliments we hear about our system from our patients and families.
Doctors, especially in the public hospitals, frequently miss meals as the 5-10 minutes slots allotted for outpatients are not sufficient for complex cases and those needing procedures.
Yes, mishaps do regrettably happen and on a daily basis too, but these are mainly minor with no “adverse outcomes”. This is unsurprising as Alexander Pope had said that “To err is human”.
Time does not permit me to elucidate measures taken by hospitals to minimize mishaps.
I am particularly heartened to learn that despite suffering from the KKH chemotherapy mix-up, the patients were willing to forgive. They remind me that Pope’s quotation ended with ..” to forgive is divine”.
Dr Huang Shoou Chyuan
I know our healthcare system is not perfect.
And our doctors are definitely not “angels”.
But there are still Singapore doctors out there who are ethical and abide by the spirit of the Hippocratic Oath (even in the private sector) that I feel a defence of our system is warranted here.
Is our healthcare more expensive than our neighbours’ ? Are there times when we wished that the results from surgery or treatment were better? Are there black sheep in our system who are “outliers” as far as indications for treatment or treatment fees are concerned? The answers are of course “Yes”!
But would I still recommend my loved ones to be treated here in Singapore? Of course (except for the most trivial conditions).
In all hospitals (public and private), volunteer doctors and other personnel sit in committees to look into how healthcare can be better delivered to our patients.In my hospital, Gleneagles Hospital, amongst other things, committees ensure that there is Quality assurance; that all deaths are independently reviewed and surgical specimens from patients confirm that operations were really needed etc.
When near-misses or actual mishaps happen, we help the hospital to diligently look for the root causes and design correct processes to plug gaps in the system. We are often pleasantly surprised to know that in many near-misses, these mistakes are identified further down the line by another vigilant colleague who actually helped to avert potential disasters.
An “honour” system where healthcare workers including nurses and doctors, voluntarily submit “Hospital Occurrence Reports” (HOR) whenever such incidences occur. These range from serious ones such as prescribing patients with drugs that they are known to be allergic to, to trivial incidences such as patients having broken skin when plasters are removed.
In fact, reporting near misses is not unique to the healthcare industry. The aviation industry also reports near misses and the familiar safety rule of turning off electronic devices that can interfere with navigation equipment, is a result of this.
However, when staff (including doctors) are recalcitrant and disregard established safety norms, they are investigated and disciplinary actions are taken when appropriate. Some doctors have had their working privileges suspended or get reported for further action by the Singapore Medical Council and the Ministry of Health.
Cheers
Dr Huang Shoou Chyuan
The unabridged letter (20.12.09) ( I will append Salma Khalik's letter the moment I find a digital copy) Click here for the "edited" published letter.
Dear Editor,
I refer to Salma Khalik’s article “Make hospitals and docs more accountable”.
Khalik refers to the unfortunate case where the tissue biopsy diagnosis from a “quick analysis” frozen section (FS) (usually obtained within minutes while the patient is already in the operating theatre) differed from the final permanent section (usually reported at least one day later). It is internationally accepted practice for a surgeon to rely on FS for guidance as to whether a major operation should proceed.
In this case, the final permanent section showed “no cancer” – by which time major surgery had already been done as the FS reported a diagnosis of “cancer”.
FS is an invaluable tool used by surgeons. However, as with any diagnostic tool, there are limitations that allow errors to occur, including the initial selection of tissue by the surgeon, the tissue sampling by the pathologist, the technical expertise required to prepare the slides, errors in interpretation, and delivery of the result back to the surgeon.
Some diseases are so complex that even the most renowned pathologist would make errors in the FS or even in the permanent section!
To complicate the issue, a converse situation could also happen. The FS could report “benign” and surgery aborted, only to be proven wrong much later- by which time cancer might be too advanced for curative treatment.
Let me cite an actual example. My patient had thyroid surgery in another country. FS was not done and only partial resection was done. On re-evaluation of the tissue slides by our pathologist, “cancer”was confirmed and a second operation was needed for total resection of the cancer-bearing organ. If initial surgery was planned with FS, he would only have needed one operation.
Despite what Khalik has written in recent times, I sincerely feel that Singapore’s healthcare in both public and private hospitals has proven, time and again, to meet the needs of Singapore’s residents. The “complaints” published in the media pale in comparison to compliments we hear about our system from our patients and families.
Doctors, especially in the public hospitals, frequently miss meals as the 5-10 minutes slots allotted for outpatients are not sufficient for complex cases and those needing procedures.
Yes, mishaps do regrettably happen and on a daily basis too, but these are mainly minor with no “adverse outcomes”. This is unsurprising as Alexander Pope had said that “To err is human”.
Time does not permit me to elucidate measures taken by hospitals to minimize mishaps.
I am particularly heartened to learn that despite suffering from the KKH chemotherapy mix-up, the patients were willing to forgive. They remind me that Pope’s quotation ended with ..” to forgive is divine”.
Dr Huang Shoou Chyuan
Wednesday, April 08, 2009
Thanks Minister, I also do not want Singapore to be a rogue regime!
Hi Friends,
It appears that Health Minister Khaw Boon Wan has changed his mind about including foreigners in the organ donation scheme.
The Straits times mentioned that “Only Singaporeans will be reimbursed for donating a kidney.” And that “Payments will be extended to foreigners only when there is enough confidence in the scheme, said Health Minister Khaw Bonn Wan yesterday.”
Mr. Khaw even said “We don’t want Singapore to be a rogue regime.”
This was one of the major sticking points for me as this potentially allows for legalized organ trading. ( read my post on this here) As mentioned elsewhere, I am not against reimbursing donors for expenses incurred as a result of this truly altruistic act.
If we include foreign donors into the scheme, we are unable to monitor the donor back in their homeland and we do not know where the money goes to and we are never sure that the money from the recipient really went to help defray expenses only.
This money could have been attractive enough to act as an inducement for the donor.
I know from conversations online and offline, that some people think that this is just demand and supply economics and I should not have made a big deal of it.
However for me and I think for much of the medical community, medical ethics is just as important as economics in this issue.
Anyway, I don’t expect everyone reading this to get it. Never mind.
Nevertheless, I am glad that Minister Khaw has come to his senses about this.
I might have supported him for the HOTA amendment if this was the case in the first place.
BTW, other positive aspects which he mentioned at the 40th anniversary celebrations of the NKF yesterday included:
Safeguards such as:
1.Thorough screening including psychological assessment to exclude exploitation.
2. Cooling-off period which is good as we do not want “pressure-selling” ala "time share" scams.
3. Kidney donors to be reimbursed through third party and payment partly into Medisave Top-ups (read here)
Also, Kidney patients will get travel subsidy. They should get all the help they need.
Cheers
Dr.Huang Shoou Chyuan
Link: 1.Gigamole: Human Organ Trade- a nuanced approach
2.Gigamole: Human Organ Trade-Agree or disagree?
It appears that Health Minister Khaw Boon Wan has changed his mind about including foreigners in the organ donation scheme.
The Straits times mentioned that “Only Singaporeans will be reimbursed for donating a kidney.” And that “Payments will be extended to foreigners only when there is enough confidence in the scheme, said Health Minister Khaw Bonn Wan yesterday.”
Mr. Khaw even said “We don’t want Singapore to be a rogue regime.”
This was one of the major sticking points for me as this potentially allows for legalized organ trading. ( read my post on this here) As mentioned elsewhere, I am not against reimbursing donors for expenses incurred as a result of this truly altruistic act.
If we include foreign donors into the scheme, we are unable to monitor the donor back in their homeland and we do not know where the money goes to and we are never sure that the money from the recipient really went to help defray expenses only.
This money could have been attractive enough to act as an inducement for the donor.
I know from conversations online and offline, that some people think that this is just demand and supply economics and I should not have made a big deal of it.
However for me and I think for much of the medical community, medical ethics is just as important as economics in this issue.
Anyway, I don’t expect everyone reading this to get it. Never mind.
Nevertheless, I am glad that Minister Khaw has come to his senses about this.
I might have supported him for the HOTA amendment if this was the case in the first place.
BTW, other positive aspects which he mentioned at the 40th anniversary celebrations of the NKF yesterday included:
Safeguards such as:
1.Thorough screening including psychological assessment to exclude exploitation.
2. Cooling-off period which is good as we do not want “pressure-selling” ala "time share" scams.
3. Kidney donors to be reimbursed through third party and payment partly into Medisave Top-ups (read here)
Also, Kidney patients will get travel subsidy. They should get all the help they need.
Cheers
Dr.Huang Shoou Chyuan
Link: 1.Gigamole: Human Organ Trade- a nuanced approach
2.Gigamole: Human Organ Trade-Agree or disagree?
Saturday, February 07, 2009
Medical Guideline on Fees should be reinstated now
Hi,
The Straits Times Forum printed my letter on the issue of the Singapore Medical Association (SMA) Guideline On Fees (GOF).
I have blogged on this matter in 2007 (here).
Recently the topic is on the radar screen again - I think because it was resurrected by Prof. Lee Wei Ling. If you do not already know, she is the daughter of MM Lee Kuan Yew.
Dr. Huang Shoou Chyuan
The CCS mentioned that SMA paid $5000 as an application fees in Feb 5 (2009) and is insinuating that my figures are inflated. It is a matter of public record that the President, SMA quoted in a national newspaper the figure of $200,000 in 2007! So who is right? Anyway, bureaucrats will always get their last word in!
The forum letter:
FEES FOR MEDICAL PROCEDURES
Reinstate guidelines for docs
Feb 7, 2009
I REFER to the report 'Fee guidelines for docs: Yes or no?'.
I feel that the Competition Commission of Singapore (CCS) has itself been poorly advised as its stand had led the Singapore Medical Association (SMA) to scrap its Guidelines On Fees (GOF) for fear of being branded anti-competitive.
The 47th SMA Council dropped the bombshell announcement at its annual general meeting on April 1, 2007, and it became clear later that it had no choice as it would cost the SMA at least $200,000 - that is, $20,000 for guidance from CCS to file paperwork; $30,000 for a decision; $150,000 for legal fees - to get a formal decision from the commission on the guidelines.
All most of us wanted was to ensure that Singapore's reputation as a centre of medical excellence - which was painstakingly built by previous generations of doctors - would not be ruined by the black sheep in our profession, who think nothing of charging many times what another doctor would for the exact same procedure.
For example, how would any patient know that procedure X is charged $2,000 by most doctors rather than the $20,000 quoted?
The GOF was mooted in the early 1980s when the Ministry of Health, the SMA and the Association of Private Medical Practitioners of Singapore felt a need to publish a fee schedule to provide greater transparency for patients. Much work was put in collaboratively by general practitioners as well as by doctors of different sub-specialities, and by the time it was scrapped, there were already four editions.
Contrary to the commission's fears, the medical community is not a cartel and the GOF was never a tool for price-fixing.
In fact, the editor of the fourth edition wrote: 'Practitioners who wish to charge outside this guideline should inform their patients accordingly...' and 'practitioners are encouraged to continue their practice of reducing or waiving fees for patients who cannot afford to pay the usual fees'.
The doctor-patient relationship is a very unequal one. The doctor holds all the cards as he has knowledge that the patient requires. The patient often does not have the time and resource to seek many medical opinions before deciding on treatment. This is especially true for foreign patients.
If we leave the patients without any guidance, patients may be 'fleeced' and Singapore's reputation in the medical field would be short-lived.
The Competition Commission should admit its mistake and advise the SMA to reinstate the guidelines immediately. It should not take six months to 'look at how the medical sector is structured and its practices here and in other countries'.
Dr Huang Shoou Chyuan
CCS's reply in the ST Forum (11.2.09)
I REFER to last Saturday's letter, 'Reinstate guidelines for docs'. Competition issues are often complex and have significant economic impact on many segments of the public. It is, therefore, necessary that the Competition Commission of Singapore (CCS) undertakes a thorough analysis before it concludes whether any practice is anti-competitive. It is not appropriate for CCS to provide specific advice on any competition case without doing so.
Price transparency to consumers should be encouraged. In this regard, CCS supports the practice of service providers clearly publishing and explaining their respective pricing information to consumers. A price recommendation by an association of service providers, on the other hand, entails the association recommending what the industry as a whole should charge. CCS notes that price recommendations are generally held by many competition authorities worldwide not to be in the public interest.
CCS has initiated a detailed study of the issue of fee guidelines in the medical services sector, in view of recent public interest in this subject. The study will examine the local market for medical services to see if there are special circumstances that justify any form of fee guidelines. We will also consider any alternative measures that may improve price information to the consumer. In conducting the study, CCS welcomes all input and views from the medical community and the public.
The writer may wish to note that on Feb 5, the Singapore Medical Association (SMA) submitted a formal application to CCS for a decision on whether its Guidelines on Fees are excluded from the Competition Act's prohibition against anti-competitive agreements. This is the first time that SMA has applied to CCS for a decision. To correct any misperception that the writer may have about the fees to be paid, SMA paid $5,000 to CCS for this application. CCS will respond to the application after completing its evaluation.
Chin Yen Yen (Ms)
Deputy Director,
Corporate Communications Competition Commission of Singapore
The Straits Times Forum printed my letter on the issue of the Singapore Medical Association (SMA) Guideline On Fees (GOF).
I have blogged on this matter in 2007 (here).
Recently the topic is on the radar screen again - I think because it was resurrected by Prof. Lee Wei Ling. If you do not already know, she is the daughter of MM Lee Kuan Yew.
Dr. Huang Shoou Chyuan
NB: (11.2.09) The CCS has replied and I attach it below.
The CCS mentioned that SMA paid $5000 as an application fees in Feb 5 (2009) and is insinuating that my figures are inflated. It is a matter of public record that the President, SMA quoted in a national newspaper the figure of $200,000 in 2007! So who is right? Anyway, bureaucrats will always get their last word in!
The forum letter:
FEES FOR MEDICAL PROCEDURES
Reinstate guidelines for docs
Feb 7, 2009
I REFER to the report 'Fee guidelines for docs: Yes or no?'.
I feel that the Competition Commission of Singapore (CCS) has itself been poorly advised as its stand had led the Singapore Medical Association (SMA) to scrap its Guidelines On Fees (GOF) for fear of being branded anti-competitive.
The 47th SMA Council dropped the bombshell announcement at its annual general meeting on April 1, 2007, and it became clear later that it had no choice as it would cost the SMA at least $200,000 - that is, $20,000 for guidance from CCS to file paperwork; $30,000 for a decision; $150,000 for legal fees - to get a formal decision from the commission on the guidelines.
All most of us wanted was to ensure that Singapore's reputation as a centre of medical excellence - which was painstakingly built by previous generations of doctors - would not be ruined by the black sheep in our profession, who think nothing of charging many times what another doctor would for the exact same procedure.
For example, how would any patient know that procedure X is charged $2,000 by most doctors rather than the $20,000 quoted?
The GOF was mooted in the early 1980s when the Ministry of Health, the SMA and the Association of Private Medical Practitioners of Singapore felt a need to publish a fee schedule to provide greater transparency for patients. Much work was put in collaboratively by general practitioners as well as by doctors of different sub-specialities, and by the time it was scrapped, there were already four editions.
Contrary to the commission's fears, the medical community is not a cartel and the GOF was never a tool for price-fixing.
In fact, the editor of the fourth edition wrote: 'Practitioners who wish to charge outside this guideline should inform their patients accordingly...' and 'practitioners are encouraged to continue their practice of reducing or waiving fees for patients who cannot afford to pay the usual fees'.
The doctor-patient relationship is a very unequal one. The doctor holds all the cards as he has knowledge that the patient requires. The patient often does not have the time and resource to seek many medical opinions before deciding on treatment. This is especially true for foreign patients.
If we leave the patients without any guidance, patients may be 'fleeced' and Singapore's reputation in the medical field would be short-lived.
The Competition Commission should admit its mistake and advise the SMA to reinstate the guidelines immediately. It should not take six months to 'look at how the medical sector is structured and its practices here and in other countries'.
Dr Huang Shoou Chyuan
CCS's reply in the ST Forum (11.2.09)
I REFER to last Saturday's letter, 'Reinstate guidelines for docs'. Competition issues are often complex and have significant economic impact on many segments of the public. It is, therefore, necessary that the Competition Commission of Singapore (CCS) undertakes a thorough analysis before it concludes whether any practice is anti-competitive. It is not appropriate for CCS to provide specific advice on any competition case without doing so.
Price transparency to consumers should be encouraged. In this regard, CCS supports the practice of service providers clearly publishing and explaining their respective pricing information to consumers. A price recommendation by an association of service providers, on the other hand, entails the association recommending what the industry as a whole should charge. CCS notes that price recommendations are generally held by many competition authorities worldwide not to be in the public interest.
CCS has initiated a detailed study of the issue of fee guidelines in the medical services sector, in view of recent public interest in this subject. The study will examine the local market for medical services to see if there are special circumstances that justify any form of fee guidelines. We will also consider any alternative measures that may improve price information to the consumer. In conducting the study, CCS welcomes all input and views from the medical community and the public.
The writer may wish to note that on Feb 5, the Singapore Medical Association (SMA) submitted a formal application to CCS for a decision on whether its Guidelines on Fees are excluded from the Competition Act's prohibition against anti-competitive agreements. This is the first time that SMA has applied to CCS for a decision. To correct any misperception that the writer may have about the fees to be paid, SMA paid $5,000 to CCS for this application. CCS will respond to the application after completing its evaluation.
Chin Yen Yen (Ms)
Deputy Director,
Corporate Communications Competition Commission of Singapore
Tuesday, January 13, 2009
Suggestions to improve specialist healthcare to subsidised patients
Hi friends,
I have written to the forum page with copy to Ministry of Health on how delivery of specialist healthcare for subsidised patients can be improved.
(It has been printed in one paper and MOH has also replied- see below)
Being from the private specialist sector, this letter is from that perspective. Some parts of the letter gets a bit "deep" and involved. I apologise for that.
Private specialists have taken flak ( and deservedly so) for being aloof and being far removed from the masses who are suffering and have difficulty in making ends meet.
Despite this, I feel that the Public (govt) and Private healthcare sectors can work together to better serve all Singaporeans.
Yes, there are many doctors ( not just in private sector) who may have forgotten their Hippocratic oath.
However, I do know many private specialists who have big hearts ( and I am proud to call them "friend" )and who treat poorer patients at reduced rates ( or even waive charges). Sometimes we put on leotards and become Robin Hoods.
We in private practice, often try to find ways to beat the Private hospital system in order to reduce patients' charges. The more obvious means include pleading with the hospital for discounts ( for patients) or even going to cheaper hospitals. Other ways cannot be divulged publicly.
Private specialists are human too- Most of us chose private practice for Work-Life Balance or just could not take the "office politics"anymore. Of course the money (usually) was not too bad also.
Dr. Lee Wei Ling has already mentioned some of the shameful acts of the Black Sheep of the profession. As a fellow doctor, I fully agree with what she has said ( on most things).
Cheers,
Dr.Huang Shoou Chyuan
The Letter to the Forum page ( cc MOH)
Dear editor,
Re:Enhancement of Public Private Partnership (PPP) in Singapore’s healthcare
I would like the Ministry of Health to consider expanding the partnership between the public and private healthcare to include specialist care in addition to primary healthcare (family medicine).
1.The present situation
From 1st January 2009, General Practitioners (GP) were roped in to see mainly needy elderly patients who were Community Medical Benefit (CMB) cardholders or Public Assistance (PA) scheme cardholders. This highly innovative scheme (called Primary Care Partnership Scheme- PCPS) is popular as it allows patients to be seen by their neighbourhood GP’s who receive similar or equivalent subvention from the government as when these patients go to the polyclinic. The patients co-pay either by cash or from the Medisave accounts (subject to caps).
Acute conditions (eg coughs and colds) and 3 chronic medical conditions viz.Diabetes Mellitus, Hypertension and Lipid disorders, are included in the PCPS.
Although Singapore’s healthcare has a well-deserved reputation for being of a high standard, there are gaps in the delivery of specialist care for subsidised patients. These are the patients referred by the polyclinics and (from Jan 2009) the PCPS-GP’s.
The main bugbear is the long waiting time to get an appointment at the government specialist clinics (eg SGH/NUH etc) which in turn translates to overworked specialist doctors who may not be able to provide optimal patient care.
2.My suggestion to plug the gaps in specialist care delivery
I advocate an expansion of the system to include private specialists and to expand the patient pool to include not just CMB and PA cardholders seen by PCPS-GP’s but also all polyclinic-referred patients.
These patients, when they have complicated conditions requiring specialised care, would have been referred to government hospitals where they will be seen by specialists.
However, when the specialist clinics have filled up all appointment slots and these patients cannot be seen by the recommended waiting time, my suggestion is that these patients be channelled to those private specialists who are willing to see them at subsidised rates.
For this to work, the government should ( as in PCPS) continue to pay similar or equivalent subvention ( with reasonable addition for different cost structure in private practice). This could even be made to work in private hospitals when these patients need surgery or other institutional care. Co-payment is as per the PCPS.
3.Benefits of PPP for specialist care
There are many benefits for considering this Public-Private-Partnership (PPP) for the whole chain of healthcare delivery in Singapore.
i.All patients (be they subsidised and non-subsidised) will get timely and optimal care from both primary care doctors or specialists.
ii.Specialists in government hospitals will have more time for teaching medical students and trainee specialists and for treating more sophisticated “tertiary-care” cases.
iii.There is no increased government spending as subvention remains almost similar. In fact less government hospitals may need to be built in the future.
iv.Allows private specialists to better participate in the treatment of all classes of Singaporeans. Believe it or not, most doctors (even private specialists) perceive Medicine as a calling and not as a way of “getting rich” .
For sure, all stakeholders in Singapore healthcare will need a paradigm shift in mindsets so that all ( esply needy Singaporeans) can benefit from this mini healthcare revolution.
Getting a pool of willing private doctors in each specialty and getting private hospitals to participate in the scheme should not be too difficult in view of the dire economic climate and the impending glut of private hospital beds in the near future.
Perhaps the government hospitals should remain gatekeepers and the system can be implemented in stages with close monitoring to prevent abuses.
Needless to say, private specialists who only want to cater to select class of patients need not apply.
Yours Sincerely,
Dr.Huang Shoou Chyuan
Addendum (14.1.09) 4.50pm: Reply from MOH
Dr. Huang:In essence, MOH ( or Alxxx who represents it ) said, " Ya, sure" but in 98 words!
So here goes ( for those who enjoy standard bureaucratic "cut and paste" answers).
I wonder if this letter even got past the first guy who read it? Am I just wasting my time and energy trying to write a succint and cogent piece about how the system can be improved?
Sigh!
Oh- BTW, one paper has printed the letter, one rejected it and one has not said anything (yet).
Reply from MOH (Reply - PQ-09-000116):
Dear Dr Huang,
We refer to your suggestion to include interested private specialists under the PCPS.
As you are aware, GPs are able to refer patients who require specialist care to the restructured hospitals' specialist outpatient clinics (SOCs) under the current PCPS.
Although there are no plans to involve the private specialists at this point in time, we are definitely open to explore such collaborations in the future when the need arises and we would hope to garner your support then.
Thank you for your suggestion.
Yours sincerely,
Alxxx Hx
for Quality Service Manager
Ministry of Health,
Singapore
I have written to the forum page with copy to Ministry of Health on how delivery of specialist healthcare for subsidised patients can be improved.
(It has been printed in one paper and MOH has also replied- see below)
Being from the private specialist sector, this letter is from that perspective. Some parts of the letter gets a bit "deep" and involved. I apologise for that.
Private specialists have taken flak ( and deservedly so) for being aloof and being far removed from the masses who are suffering and have difficulty in making ends meet.
Despite this, I feel that the Public (govt) and Private healthcare sectors can work together to better serve all Singaporeans.
Yes, there are many doctors ( not just in private sector) who may have forgotten their Hippocratic oath.
However, I do know many private specialists who have big hearts ( and I am proud to call them "friend" )and who treat poorer patients at reduced rates ( or even waive charges). Sometimes we put on leotards and become Robin Hoods.
We in private practice, often try to find ways to beat the Private hospital system in order to reduce patients' charges. The more obvious means include pleading with the hospital for discounts ( for patients) or even going to cheaper hospitals. Other ways cannot be divulged publicly.
Private specialists are human too- Most of us chose private practice for Work-Life Balance or just could not take the "office politics"anymore. Of course the money (usually) was not too bad also.
Dr. Lee Wei Ling has already mentioned some of the shameful acts of the Black Sheep of the profession. As a fellow doctor, I fully agree with what she has said ( on most things).
Cheers,
Dr.Huang Shoou Chyuan
The Letter to the Forum page ( cc MOH)
Dear editor,
Re:Enhancement of Public Private Partnership (PPP) in Singapore’s healthcare
I would like the Ministry of Health to consider expanding the partnership between the public and private healthcare to include specialist care in addition to primary healthcare (family medicine).
1.The present situation
From 1st January 2009, General Practitioners (GP) were roped in to see mainly needy elderly patients who were Community Medical Benefit (CMB) cardholders or Public Assistance (PA) scheme cardholders. This highly innovative scheme (called Primary Care Partnership Scheme- PCPS) is popular as it allows patients to be seen by their neighbourhood GP’s who receive similar or equivalent subvention from the government as when these patients go to the polyclinic. The patients co-pay either by cash or from the Medisave accounts (subject to caps).
Acute conditions (eg coughs and colds) and 3 chronic medical conditions viz.Diabetes Mellitus, Hypertension and Lipid disorders, are included in the PCPS.
Although Singapore’s healthcare has a well-deserved reputation for being of a high standard, there are gaps in the delivery of specialist care for subsidised patients. These are the patients referred by the polyclinics and (from Jan 2009) the PCPS-GP’s.
The main bugbear is the long waiting time to get an appointment at the government specialist clinics (eg SGH/NUH etc) which in turn translates to overworked specialist doctors who may not be able to provide optimal patient care.
2.My suggestion to plug the gaps in specialist care delivery
I advocate an expansion of the system to include private specialists and to expand the patient pool to include not just CMB and PA cardholders seen by PCPS-GP’s but also all polyclinic-referred patients.
These patients, when they have complicated conditions requiring specialised care, would have been referred to government hospitals where they will be seen by specialists.
However, when the specialist clinics have filled up all appointment slots and these patients cannot be seen by the recommended waiting time, my suggestion is that these patients be channelled to those private specialists who are willing to see them at subsidised rates.
For this to work, the government should ( as in PCPS) continue to pay similar or equivalent subvention ( with reasonable addition for different cost structure in private practice). This could even be made to work in private hospitals when these patients need surgery or other institutional care. Co-payment is as per the PCPS.
3.Benefits of PPP for specialist care
There are many benefits for considering this Public-Private-Partnership (PPP) for the whole chain of healthcare delivery in Singapore.
i.All patients (be they subsidised and non-subsidised) will get timely and optimal care from both primary care doctors or specialists.
ii.Specialists in government hospitals will have more time for teaching medical students and trainee specialists and for treating more sophisticated “tertiary-care” cases.
iii.There is no increased government spending as subvention remains almost similar. In fact less government hospitals may need to be built in the future.
iv.Allows private specialists to better participate in the treatment of all classes of Singaporeans. Believe it or not, most doctors (even private specialists) perceive Medicine as a calling and not as a way of “getting rich” .
For sure, all stakeholders in Singapore healthcare will need a paradigm shift in mindsets so that all ( esply needy Singaporeans) can benefit from this mini healthcare revolution.
Getting a pool of willing private doctors in each specialty and getting private hospitals to participate in the scheme should not be too difficult in view of the dire economic climate and the impending glut of private hospital beds in the near future.
Perhaps the government hospitals should remain gatekeepers and the system can be implemented in stages with close monitoring to prevent abuses.
Needless to say, private specialists who only want to cater to select class of patients need not apply.
Yours Sincerely,
Dr.Huang Shoou Chyuan
Addendum (14.1.09) 4.50pm: Reply from MOH
Dr. Huang:In essence, MOH ( or Alxxx who represents it ) said, " Ya, sure" but in 98 words!
So here goes ( for those who enjoy standard bureaucratic "cut and paste" answers).
I wonder if this letter even got past the first guy who read it? Am I just wasting my time and energy trying to write a succint and cogent piece about how the system can be improved?
Sigh!
Oh- BTW, one paper has printed the letter, one rejected it and one has not said anything (yet).
Reply from MOH (Reply - PQ-09-000116):
Dear Dr Huang,
We refer to your suggestion to include interested private specialists under the PCPS.
As you are aware, GPs are able to refer patients who require specialist care to the restructured hospitals' specialist outpatient clinics (SOCs) under the current PCPS.
Although there are no plans to involve the private specialists at this point in time, we are definitely open to explore such collaborations in the future when the need arises and we would hope to garner your support then.
Thank you for your suggestion.
Yours sincerely,
Alxxx Hx
for Quality Service Manager
Ministry of Health,
Singapore
Thursday, February 28, 2008
Letter about Parkway Novena Hospital
Hi Friends,
I owe The Straits Times' editor a treat. I have given him so much extra work!
Recently,whenever I write a letter to the ST forum, he/she has to:
1. take out French words
2. take out financial concepts like "triple bottomline" and "corporate social responsibility"
3. rewrite most parts leaving only some ideas behind
4. take out the fizz so as to avoid too much controversy ( such as putting the government on the spot)
Well done editor! You have succeeded on all counts!
I wonder if I leave French words out in the future, I can be spared more of the editor's scissors?
Anyway, Letter A is the letter printed in ST Forum today (28 Feb 08) and the actual letter is specimen B.
Reconsider 'single-room only' plan for hospital
THE news of Parkway Holdings' plan to build a new private hospital on its freshly acquired site in Novena raises a few questions.
True, Parkway Holdings, like all businesses, must try and maximise profit. But we are also living in a new, enlightened economy where the bottom line is not only financial responsibility, but environmental and social as well.
The implications of the company's winning bid of $1.25 billion - more than double that of the second- highest bid - and its plan to offer only A-class single- room beds and better are obvious: It intends to cater only to the super-rich and its patients can expect to be charged supra-normal rates.
Yet, the payback for the company will be derived not only from the patients found by its new hospital, but from patients of its present stable of hospitals at Gleneagles, Mount Elizabeth and Eastshore.
Not all private hospital patients are super-rich. Not all patients admitted to the company's hospitals are wealthy. Many are ordinary Singaporeans who patronise these hospitals because the specialists with whom they have built a relationship over a period of time now practise there.
These patients are mostly middle-income earners who scrimp and save to afford treatment at Parkway's hospitals.
Parkway Holdings should reconsider its 'single-room only' policy for the Novena hospital. Having double- and four-bedder rooms, like other hospitals, will make health care more affordable and increase choices for our patients.
There should also be such provisions in the tender process to allow more Singaporeans the chance to afford private patient care and help relieve the pressure on public and restructured hospitals.
Dr Huang Shoou Chyuan
B: The letter I actually wrote
Dear editor,
We follow the news about Parkways’ new Novena hospital with interest and concern.
Profit maximization the raison d’etre?
We understand that Parkway is a publicly listed company and up till the recent past, it is accepted that the raison d’etre of all business corporations was profit maximization. “Make hay while the sun shines” so to say.
However the buzzword for the “enlightened” new economy are concepts like “corporate social responsibility” and the “triple bottom-line” where emphasis is not just on financial results but also on environmental and social responsibilities.
With Parkway winning the Novena tender with a “must-win” bid of $1.25 billion for the plot of land and its subsequent proposed strategy of catering to the super-rich ( it will have the single A-class room as its lowest room option), the implications are obvious.
Implications for Singapore’s healthcare- More Inflation
This above-market price (a miscalculation to some analysts) would be earned back by charging patients supra-normal rates. The payback would come not just the new hospital’s patients but also from patients of its present stable of Gleneagles, Mount Elizabeth and Eastshore hospitals. Parkway has already implied that the existing hospitals’ charges will be raised when Novena hospital is completed.
Where does this new development lead Singapore’s healthcare to? Further inflation- what else?
Not all private hospital patients are super-rich
Not all patients that are admitted to Parkway’s hospitals are rich. Many are ordinary folks who come to these hospitals as their trusted specialists practise there. These mostly middle class patients “scrim and save” when they need hospitalization treatment. Another pull factor for these patients is the shorter waiting time compared to the government hospitals which are simply overcrowded.
Parkway’s win may encourage monopolistic behavior as they now control almost all the premier private hospitals.
No other tender condition but “highest bid wins”?
We are also surprised that “highest bidder wins” seemed to be the only winning criteria. Does not it make sense that as the land sold belongs to the state, the tendering authorities should have stipulated some basic conditions such has having rooms that are affordable for the majority of Singaporeans? Why should Parkway be the only beneficiary? How about the people?
Some questions that require answers
1. Will Parkway reconsider its “only single room” policy for the Novena hospital. Having double and 4-bedder rooms like everywhere else will make healthcare more affordable and increase choices for our patients.
2.What has the government done to prevent anti-competitive monopolistic practices?
3. Should not more land be released for hospital development?
Would the relevant authorities and entities please comment?
Dr.Huang Shoou Chyuan
I owe The Straits Times' editor a treat. I have given him so much extra work!
Recently,whenever I write a letter to the ST forum, he/she has to:
1. take out French words
2. take out financial concepts like "triple bottomline" and "corporate social responsibility"
3. rewrite most parts leaving only some ideas behind
4. take out the fizz so as to avoid too much controversy ( such as putting the government on the spot)
Well done editor! You have succeeded on all counts!
I wonder if I leave French words out in the future, I can be spared more of the editor's scissors?
Anyway, Letter A is the letter printed in ST Forum today (28 Feb 08) and the actual letter is specimen B.
Cheers
Dr.Huang Shoou Chyuan
A: Printed on ST Forum (28th Feb 2008)
Reconsider 'single-room only' plan for hospital
THE news of Parkway Holdings' plan to build a new private hospital on its freshly acquired site in Novena raises a few questions.
True, Parkway Holdings, like all businesses, must try and maximise profit. But we are also living in a new, enlightened economy where the bottom line is not only financial responsibility, but environmental and social as well.
The implications of the company's winning bid of $1.25 billion - more than double that of the second- highest bid - and its plan to offer only A-class single- room beds and better are obvious: It intends to cater only to the super-rich and its patients can expect to be charged supra-normal rates.
Yet, the payback for the company will be derived not only from the patients found by its new hospital, but from patients of its present stable of hospitals at Gleneagles, Mount Elizabeth and Eastshore.
Not all private hospital patients are super-rich. Not all patients admitted to the company's hospitals are wealthy. Many are ordinary Singaporeans who patronise these hospitals because the specialists with whom they have built a relationship over a period of time now practise there.
These patients are mostly middle-income earners who scrimp and save to afford treatment at Parkway's hospitals.
Parkway Holdings should reconsider its 'single-room only' policy for the Novena hospital. Having double- and four-bedder rooms, like other hospitals, will make health care more affordable and increase choices for our patients.
There should also be such provisions in the tender process to allow more Singaporeans the chance to afford private patient care and help relieve the pressure on public and restructured hospitals.
Dr Huang Shoou Chyuan
B: The letter I actually wrote
Dear editor,
We follow the news about Parkways’ new Novena hospital with interest and concern.
Profit maximization the raison d’etre?
We understand that Parkway is a publicly listed company and up till the recent past, it is accepted that the raison d’etre of all business corporations was profit maximization. “Make hay while the sun shines” so to say.
However the buzzword for the “enlightened” new economy are concepts like “corporate social responsibility” and the “triple bottom-line” where emphasis is not just on financial results but also on environmental and social responsibilities.
With Parkway winning the Novena tender with a “must-win” bid of $1.25 billion for the plot of land and its subsequent proposed strategy of catering to the super-rich ( it will have the single A-class room as its lowest room option), the implications are obvious.
Implications for Singapore’s healthcare- More Inflation
This above-market price (a miscalculation to some analysts) would be earned back by charging patients supra-normal rates. The payback would come not just the new hospital’s patients but also from patients of its present stable of Gleneagles, Mount Elizabeth and Eastshore hospitals. Parkway has already implied that the existing hospitals’ charges will be raised when Novena hospital is completed.
Where does this new development lead Singapore’s healthcare to? Further inflation- what else?
Not all private hospital patients are super-rich
Not all patients that are admitted to Parkway’s hospitals are rich. Many are ordinary folks who come to these hospitals as their trusted specialists practise there. These mostly middle class patients “scrim and save” when they need hospitalization treatment. Another pull factor for these patients is the shorter waiting time compared to the government hospitals which are simply overcrowded.
Parkway’s win may encourage monopolistic behavior as they now control almost all the premier private hospitals.
No other tender condition but “highest bid wins”?
We are also surprised that “highest bidder wins” seemed to be the only winning criteria. Does not it make sense that as the land sold belongs to the state, the tendering authorities should have stipulated some basic conditions such has having rooms that are affordable for the majority of Singaporeans? Why should Parkway be the only beneficiary? How about the people?
Some questions that require answers
1. Will Parkway reconsider its “only single room” policy for the Novena hospital. Having double and 4-bedder rooms like everywhere else will make healthcare more affordable and increase choices for our patients.
2.What has the government done to prevent anti-competitive monopolistic practices?
3. Should not more land be released for hospital development?
Would the relevant authorities and entities please comment?
Dr.Huang Shoou Chyuan
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