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With my hand on heart, I sincerely feel that wrong policies should be rescinded or at least severely altered.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 medicine. Show all posts
Showing posts with label medicine. 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
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
Monday, December 29, 2008
Tribute to Emeritus Professor Wong Hock Boon
Hi Friends,
I sent the following letter to the forum page and ST has confirmed that it will be published:
Tribute to Emeritus Professor Wong Hock Boon
The passing on of Emeritus Professor Wong Hock Boon has saddened Singapore’s closely-knit medical community.
Professor Wong Hock Boon was without a doubt the father of Paediatric Medicine in Singapore and had almost single-handedly influenced the lives of thousands of undergraduate and postgraduate students and doctors who had the fortune of being taught by him during his famous didactic lectures and the grand ward rounds. The latter were held 365 days a year!
Prof Wong’s academic credential is world renown but he is also remembered by patients and friends for his humility and humanity. As Prof. Wong’s wife Lily commented recently, he shunned media attention and would rather focus his energy on his research and patients.
Even though his daughter Julia, also a paediatrician (what else?), had to “wrestle” with scores of doctors for a share of her father’s love and affection, she must be immensely proud that her father is one of Singapore’s greatest sons and that he will be greatly missed by all of us.
Young doctors in Singapore, have lost a role model- one that I can safely vouch, will not be seen again in my lifetime.
The authorities should honor Professor Wong in a way befitting his immeasurable contributions to our nation.
Dr.Huang Shoou Chyuan
The passing on of Emeritus Professor Wong Hock Boon has saddened Singapore’s closely-knit medical community.
Professor Wong Hock Boon was without a doubt the father of Paediatric Medicine in Singapore and had almost single-handedly influenced the lives of thousands of undergraduate and postgraduate students and doctors who had the fortune of being taught by him during his famous didactic lectures and the grand ward rounds. The latter were held 365 days a year!
Prof Wong’s academic credential is world renown but he is also remembered by patients and friends for his humility and humanity. As Prof. Wong’s wife Lily commented recently, he shunned media attention and would rather focus his energy on his research and patients.
Even though his daughter Julia, also a paediatrician (what else?), had to “wrestle” with scores of doctors for a share of her father’s love and affection, she must be immensely proud that her father is one of Singapore’s greatest sons and that he will be greatly missed by all of us.
Young doctors in Singapore, have lost a role model- one that I can safely vouch, will not be seen again in my lifetime.
The authorities should honor Professor Wong in a way befitting his immeasurable contributions to our nation.
Dr.Huang Shoou Chyuan
PS:I was Julia's classmate in Medical school and schoolmate in JC
Monday, June 30, 2008
Organ trading: Peril of Slippery Slope and Ethics Committee's Impossible Tasks
Hi Friends,
I wrote the following letter to the forum pages of our MSM (Mainstream Media).
Addendum (1.7.08): The letter has been printed in all the 3 papers that I sent to. But in one of them, the letter is almost unrecognizable ( but better than nothing).It is mostly unedited in the other two (Actually totally unedited in Today's version).
Let me state that I am active in my hospital's committees- including the Medical Advisory Board ( elected) but I am not on the Ethics Committee of my hospital.
I have written some posts on Organ Trading and HOTA (Human Organ Trading Act) :
1. Organ trading- What next? Is there nothing sacrosanct?
2. Brain death case at SGH (HOTA)
3. Mystery of crooked undertakers and Alistair Cooke
Cheers
Dr.Huang
June 29, 2008
Dear editor,
I wish to make two points about Organ Trading.
1.Organ trading is dehumanising and problem of the “slippery slope”
I am opposed in principle to Organ Trading as to legalize the sale of human organs will inevitably put Singapore’s healthcare system on the slippery slope down to a level where we become less human. There are already some who argue that so long as there is a willing seller and willing buyer, the market should be left to sort itself out.
Although narcotics and other illegal drugs also have such a scenario, we do not seek to decriminalise them nor campaign to allow narcotics trading do we?
The “slippery slope” arguments also forces us to consider a scenario where we may start with trading of kidneys and livers now but will then slide down to include hearts and brains in the future. Although the sale of a human heart will entail the death of the donor, public consensus may by then be that as different people have different usefulness for society, it is then not immoral that the less economically productive should make the ultimate sacrifice ( with or even without payment).
It may seem unthinkable now but once we accept that the human being and his organs are mere commodities to be traded like meat in the market, it becomes less difficult to imagine Singapore in the future as a version of Aldous Huxley’s Brave New World where “Alpha humans” are treasured and “Epsilon humans” are expendable.
2. Ethics committees’ impossible job- MOH should take over policing of organ trading
In my opinion, any organ donation other than by a close family member (spouse/parent/children) should always be suspect. Why should any distant relative be so altruistic as to donate his kidney at great surgical risk to himself if there is no financial gain? I have even heard of a military general claiming that his humble private soldier is willing to voluntarily donate his kidney out of respect for the general!
The committee members are volunteers and are not professional sleuths. The two doctors and one layman can only trust their instincts whether to accept the accounts told to them by the donor and organ recipient. If these latter two are well coached and well-armed with affidavits and diagrams of family trees, short of going to remote towns and villages in South Asia or Indonesia, the ethics committee would just have to clear the transplant!
I suggest that the responsibility of detecting organ trading is too onerous for the hospital’s ethics committee. MOH itself should take over this function as it has more resources at its disposal and only after organ trading has been excluded by MOH’s committee should the hospital’s ethics committee convene and then only to do what these doctors have been trained to do- to vet the medical indications for transplant and other such medical-related issues.
Dr.Huang Shoou Chyuan
cc: Ministry of Health
PS: Published in Straits Times; Today; My Paper. No reply from MOH
I wrote the following letter to the forum pages of our MSM (Mainstream Media).
Addendum (1.7.08): The letter has been printed in all the 3 papers that I sent to. But in one of them, the letter is almost unrecognizable ( but better than nothing).It is mostly unedited in the other two (Actually totally unedited in Today's version).
Let me state that I am active in my hospital's committees- including the Medical Advisory Board ( elected) but I am not on the Ethics Committee of my hospital.
I have written some posts on Organ Trading and HOTA (Human Organ Trading Act) :
1. Organ trading- What next? Is there nothing sacrosanct?
2. Brain death case at SGH (HOTA)
3. Mystery of crooked undertakers and Alistair Cooke
Cheers
Dr.Huang
June 29, 2008
Dear editor,
I wish to make two points about Organ Trading.
1.Organ trading is dehumanising and problem of the “slippery slope”
I am opposed in principle to Organ Trading as to legalize the sale of human organs will inevitably put Singapore’s healthcare system on the slippery slope down to a level where we become less human. There are already some who argue that so long as there is a willing seller and willing buyer, the market should be left to sort itself out.
Although narcotics and other illegal drugs also have such a scenario, we do not seek to decriminalise them nor campaign to allow narcotics trading do we?
The “slippery slope” arguments also forces us to consider a scenario where we may start with trading of kidneys and livers now but will then slide down to include hearts and brains in the future. Although the sale of a human heart will entail the death of the donor, public consensus may by then be that as different people have different usefulness for society, it is then not immoral that the less economically productive should make the ultimate sacrifice ( with or even without payment).
It may seem unthinkable now but once we accept that the human being and his organs are mere commodities to be traded like meat in the market, it becomes less difficult to imagine Singapore in the future as a version of Aldous Huxley’s Brave New World where “Alpha humans” are treasured and “Epsilon humans” are expendable.
2. Ethics committees’ impossible job- MOH should take over policing of organ trading
In my opinion, any organ donation other than by a close family member (spouse/parent/children) should always be suspect. Why should any distant relative be so altruistic as to donate his kidney at great surgical risk to himself if there is no financial gain? I have even heard of a military general claiming that his humble private soldier is willing to voluntarily donate his kidney out of respect for the general!
The committee members are volunteers and are not professional sleuths. The two doctors and one layman can only trust their instincts whether to accept the accounts told to them by the donor and organ recipient. If these latter two are well coached and well-armed with affidavits and diagrams of family trees, short of going to remote towns and villages in South Asia or Indonesia, the ethics committee would just have to clear the transplant!
I suggest that the responsibility of detecting organ trading is too onerous for the hospital’s ethics committee. MOH itself should take over this function as it has more resources at its disposal and only after organ trading has been excluded by MOH’s committee should the hospital’s ethics committee convene and then only to do what these doctors have been trained to do- to vet the medical indications for transplant and other such medical-related issues.
Dr.Huang Shoou Chyuan
cc: Ministry of Health
PS: Published in Straits Times; Today; My Paper. No reply from MOH
Thursday, March 27, 2008
Aesthetic Medicine and Snake-oil-My unabridged letter to the Straits Times
Hi Friends,
The below is the complete letter sent to the ST Forum page.
The editor chose to print only this sentence:
"As not all aesthetic treatment is “snake-oil” we should not throw the baby out with the bath-water by banning aesthetic medicine. "
That's his prerogative.
Mine is to publish it on this blog.
Now I know why Jeff Ooi and the gang up north had become cult figures! Maybe I can be famous too.
Cheers
Dr.Huang Shoou Chyuan
Dear editor,
I like to make some comments about the “aesthetic medicine” issue and the apparent U-turn by MOH.
Public trust doctors- we should not abuse that trust
Despite protests from certain quarters of the medical community, I feel that it is right that doctors should be judged by higher standards than laymen. To say that if beauticians and Traditional Chinese Medicine (TCM) practitioners are allowed to carry out unproven treatment, doctors should be too is to ignore the good reputation that doctors in Singapore had taken decades to earn.
I do not agree that dubious treatments without any shreds of evidence should be allowed.As members of an honourable and ancient profession, patients inherently trust that any treatment recommended by us is not snake-oil. They assume the treatment is good for them and that it is evidence-based. They do not hold beauticians to such lofty standards.
This higher standard applies to all professions. Hence when a doctor, lawyer or accountant has “fraud” convictions, he will be deemed unfit to practice and be struck off the membership rolls.
Place of Aesthetic Medicine in Singapore healthcare
Recent action by the Ministry of Health (MOH) to ban unproven treatment ( and subsequent U-turn) has brought sharp focus on the place of Aesthetic Medicine in Singapore Healthcare.
Even amongst doctors, the views vary widely with one end of the spectrum feeling that treating normal face and skin is not “medicine” and should be best left to beauty salons. The other extreme is that the supply and demand for “beauty” in the marketplace should be left to play itself out without restraint and that economics would always find its own equilibrium. Willing buyer willing seller scenario.
My view is that Aesthetics is here to stay and will not be wished away. As not all aesthetic treatment is “snake-oil” we should not throw the baby out with the bath-water by banning aesthetic medicine.
Working towards win-win
The medical community, led by the Singapore Medical Council and the MOH, has to decide what treatment is proven and safe. It has then to decide who is competent to perform these. There would necessarily be several tiers where simple procedures such as Botox can be safely administered by trained GP’s and higher tier surgeries such as Liposuction, should be the preserve of doctors who had extensive training and who understand advanced anatomy and surgical pathology as these are potentially lethal in the wrong hands.
The authorities must provide ample opportunities for interested doctors to undergo structured instructions and the necessary certifications. Doctors should not need to learn Botox over a weekend in Bali.
Plastic surgeons should volunteer to impart their skills to fellow doctors who have passions for this field. This would help dispel notions that this is a “turf war” being played out. Although competition has lowered prices of procedures like Botox, the enlarged pie also benefit all doctors, even specialists. It is a win-win scenario.
Best of all, Singapore Medicine gets to keep its good reputation intact,
Dr.Huang Shoou Chyuan
The below is the complete letter sent to the ST Forum page.
The editor chose to print only this sentence:
"As not all aesthetic treatment is “snake-oil” we should not throw the baby out with the bath-water by banning aesthetic medicine. "
That's his prerogative.
Mine is to publish it on this blog.
Now I know why Jeff Ooi and the gang up north had become cult figures! Maybe I can be famous too.
Cheers
Dr.Huang Shoou Chyuan
PS: I remember I posted something about PAP and Economic Imperative.
The choice for them was $200 mil/year or a matter of principle. You guess which they picked?
My letter to the ST Forum pageDear editor,
I like to make some comments about the “aesthetic medicine” issue and the apparent U-turn by MOH.
Public trust doctors- we should not abuse that trust
Despite protests from certain quarters of the medical community, I feel that it is right that doctors should be judged by higher standards than laymen. To say that if beauticians and Traditional Chinese Medicine (TCM) practitioners are allowed to carry out unproven treatment, doctors should be too is to ignore the good reputation that doctors in Singapore had taken decades to earn.
I do not agree that dubious treatments without any shreds of evidence should be allowed.As members of an honourable and ancient profession, patients inherently trust that any treatment recommended by us is not snake-oil. They assume the treatment is good for them and that it is evidence-based. They do not hold beauticians to such lofty standards.
This higher standard applies to all professions. Hence when a doctor, lawyer or accountant has “fraud” convictions, he will be deemed unfit to practice and be struck off the membership rolls.
Place of Aesthetic Medicine in Singapore healthcare
Recent action by the Ministry of Health (MOH) to ban unproven treatment ( and subsequent U-turn) has brought sharp focus on the place of Aesthetic Medicine in Singapore Healthcare.
Even amongst doctors, the views vary widely with one end of the spectrum feeling that treating normal face and skin is not “medicine” and should be best left to beauty salons. The other extreme is that the supply and demand for “beauty” in the marketplace should be left to play itself out without restraint and that economics would always find its own equilibrium. Willing buyer willing seller scenario.
My view is that Aesthetics is here to stay and will not be wished away. As not all aesthetic treatment is “snake-oil” we should not throw the baby out with the bath-water by banning aesthetic medicine.
Working towards win-win
The medical community, led by the Singapore Medical Council and the MOH, has to decide what treatment is proven and safe. It has then to decide who is competent to perform these. There would necessarily be several tiers where simple procedures such as Botox can be safely administered by trained GP’s and higher tier surgeries such as Liposuction, should be the preserve of doctors who had extensive training and who understand advanced anatomy and surgical pathology as these are potentially lethal in the wrong hands.
The authorities must provide ample opportunities for interested doctors to undergo structured instructions and the necessary certifications. Doctors should not need to learn Botox over a weekend in Bali.
Plastic surgeons should volunteer to impart their skills to fellow doctors who have passions for this field. This would help dispel notions that this is a “turf war” being played out. Although competition has lowered prices of procedures like Botox, the enlarged pie also benefit all doctors, even specialists. It is a win-win scenario.
Best of all, Singapore Medicine gets to keep its good reputation intact,
Dr.Huang Shoou Chyuan
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
Tuesday, April 03, 2007
Singapore Medical Association’s Guideline of Fees (GOF) Withdrawal: Patients now have less protection!
Withdrawal of SMA Guidelines of Fees (GOF)
Singapore, April 2, 2007 – The Singapore Medical Association (SMA) announced at its Annual General Meeting on April 1, 2007 that the Association is withdrawing its Guideline of Fees (GOF) with immediate effect. This decision by the 47th SMA Council was made after it received indications that the SMA GOF might run the risk of contravening Section 34 (2)(a) of the Competition Act and also after the Council had sought advice from five of its seven Honorary Legal Advisers.
The GOF was first introduced in 1987 with the aim to protect patients from being overcharged and to equip them with knowledge on medical procedures in hope that with improved knowledge there would be lesser cases of misunderstandings. It helped doctors with an indication of the current rates and how much to charge their patients. The guideline was the result of the collaboration of the Singapore Medical Association and the Association of Private Medical Practitioners of Singapore (APMPS) in response to the Health Ministry’s call for a guide on medical charges.
To date there have been four editions of the GOF (1987, 1992, 2001 and 2006).
My comments:
Dear Friends,
This is not a sick April Fool’s joke.
I found out about this from an email sent to SMA’s members only last night and it is all in the papers today.
The marketplace
There are various known relationships with respect to suppliers and consumers in the marketplace.
Those familiar with Economics 101 will know of Perfect Competition; Monopolies; Monopolistic competition; Oligopolies and others.
Perfect competition (PC): Eg Salt/sugar. There are many suppliers/ low entry and exit barriers/suppliers are price takers/homogenous products. Ie consumers have much choice and if supplier tries to be funny and raise the price even by 2 %, the consumer will buy from the next guy.
Monopoly: eg Singapore power / PAP govt ( serious!) : Only 1 supplier/price maker/ unique product/high entry and exit barrier. Take it or leave it. I say this product cost $1 million dollars- if you want you got to rob and steal and then buy it from me only.
Monopolistic competition/ Oligopolies: I do not have time to elaborate but these are variations of PC and monopoly.
Others: The doctor and patient relation is under this category.
Asymmetric Information: The doctor (supplier) in the relationship holds all the cards, as he has the knowledge that the patient ( consumer) requires . The patient depends on the advice of the doctor. If the doctor says that he requires a tonsillectomy, the patient usually has to accept it unless he makes an effort to get a second opinion ( or surfs the net).
Hence in a situation where there is unequal power relationship (eg with asymmetric info), self-regulation is crucial or else the consumer will get fleeced.
Self-regulators are usually appointed by or encouraged by the authorities to keep its members in line so that there is no profiteering nor exploitation of the public who do not know better.
The SMA’s Guideline of Fees was formulated for this very purpose. ( see above)
Beside consultation charges, surgical fees are also included in the GOF. The surgery fees are more of less grouped similarly to the Ministry of Health’s Table of Surgical Procedures (TOSP) (Groups A-G vs Tables 1-7) which determines how much of the patient’s Medisave can be claimed for the said procedures and hospital admissions.
Types of surgeries are grouped according to degree of complexity. A range of fee is then suggested for each of these groups. It is not a price-fixing attempt and only serves as a guide. Doctors are allowed to go above or below it.
Implications for patients with withdrawal of GOF
From now on, when asked about charges, doctors can tell their patients with a straight face (and with hand on heart) that there is no guideline.Period. The fee is such and such and that he does not know whether his charges are high or low with respect to other similar specialists.
The patient would then have to decide either to seek a second opinion and then go through the whole process of consultation again or else accept the doctor’s offer for treatment and hope that he has not been overcharged.
In the event that a patient does complain to the Singapore Medical Council (SMC) that he feels that he has been overcharged, SMC is in no position whatsoever to decide whether the charge is reasonable or not, short of surveying all the specialists doing that particular surgery and then get the mean/median or any other statistical method that it feels will help determine the fairness of the charge.
In the past, SMC just picks up the latest GOF and if everything else in the complaint have been dealt with, will usually reply to the patient that yes or no, the fee was unreasonable or reasonable as the case may be.
PTC and other regulatory bodies
Public Transport Council is an example of a regulatory body set out to protect the consumer who is at the mercy of companies who run our public transport system. I know some skeptics who think the PTC behaves like a cartel with official sanction.
Even oligopolies in the communication industry (Singtel/M1/Starhub) are regulated in some ways by their respective regulatory bodies.
Although SMA ( as contrasted to SMC) is a voluntary association of doctors, which de-facto had taken on some self-regulating functions of the medical profession.
With SMA surrendering this role, SMC will be hard-pressed to come up with some measure to assess the fairness of the doctors’ pricing of services.
At the end of the day, I can only say that there is less protection for patients as there is now worse asymmetry of information. Some doctors may be wringing their handsin anticipation, thinking that there is now no longer any need to follow any guidelines and they can charge as high as they think the patients are willing to pay. Maximise the consumer surplus ( as economists will say)
My honest opinion is that the SMA's decision is ill-advised and hasty. And wrong!
( Author's note (7.30 am 4th April)- SMA President Dr. Wong Chiang Yin has clarified in the Today Newspaper: "It was, in effect, a choice of scrap the guideline now — or cough up $200,000 for a decision from the Competition Commission of Singapore that might simply lead to the same result.
Getting guidance alone from the Competition Commission to file paperwork would have cost $20,000, while getting a decision would have cost the non-profit organisation $30,000. In addition, the SMA would have had to cough up some $150,000 in legal fees."
In view of the new fact, I agree that the SMA was between the rock and a hard place and has no choice but to act as it had. The conspiracy theorists are having a field day! More exciting than Kieffer Sutherland's "24"!)
The GOF is not a cartel's attempt at price-fixing. We do not monitor members' pricing policies ala OPEC. There is no collusion and the doctors do not meet in dark alleys and smoky corridors conspiring to fix the consumers. Far from it. The GOF actually serves as a psychological barrier to doctors who want to charge fees far in excess of the guidelines as when they are put under the microscope ( eg SMC/ Insurance companies), they would have to justify why they are an outlier!
Sigh! Try to be good doctor, also difficult. Maybe should just mind my own business and make the big bucks whilst the sun still shines.
Addendum 3rd April 07 9pm:
Ways of resolving assymetric information includes:
1.Mandatory disclosure- useful only if information can be objectively verified
( also not useful if I tell the patient my price for Procedure A is $1000. So what? There is no way to compare unless he goes and call up another 10 doctors to find out their prices)
2.Regulation of conduct- eg "cooling off" period. But we don't force patients to decide on the spot anyway. At least I don't. We are not selling "timeshare" !
3.Regulation by self ( doctors association) or by higher authority- but that is the exact thing that SMA has decided against.
The question is : Can we ask SMC ( being a govt-appointed body) to take over the function of a price watchdog?
Another question: Does the Law Society still have a recommended scale of fees for legal services? So bodies like PTC is ok but SMA's GOF not?
Singapore, April 2, 2007 – The Singapore Medical Association (SMA) announced at its Annual General Meeting on April 1, 2007 that the Association is withdrawing its Guideline of Fees (GOF) with immediate effect. This decision by the 47th SMA Council was made after it received indications that the SMA GOF might run the risk of contravening Section 34 (2)(a) of the Competition Act and also after the Council had sought advice from five of its seven Honorary Legal Advisers.
The GOF was first introduced in 1987 with the aim to protect patients from being overcharged and to equip them with knowledge on medical procedures in hope that with improved knowledge there would be lesser cases of misunderstandings. It helped doctors with an indication of the current rates and how much to charge their patients. The guideline was the result of the collaboration of the Singapore Medical Association and the Association of Private Medical Practitioners of Singapore (APMPS) in response to the Health Ministry’s call for a guide on medical charges.
To date there have been four editions of the GOF (1987, 1992, 2001 and 2006).
My comments:
Dear Friends,
This is not a sick April Fool’s joke.
I found out about this from an email sent to SMA’s members only last night and it is all in the papers today.
The marketplace
There are various known relationships with respect to suppliers and consumers in the marketplace.
Those familiar with Economics 101 will know of Perfect Competition; Monopolies; Monopolistic competition; Oligopolies and others.
Perfect competition (PC): Eg Salt/sugar. There are many suppliers/ low entry and exit barriers/suppliers are price takers/homogenous products. Ie consumers have much choice and if supplier tries to be funny and raise the price even by 2 %, the consumer will buy from the next guy.
Monopoly: eg Singapore power / PAP govt ( serious!) : Only 1 supplier/price maker/ unique product/high entry and exit barrier. Take it or leave it. I say this product cost $1 million dollars- if you want you got to rob and steal and then buy it from me only.
Monopolistic competition/ Oligopolies: I do not have time to elaborate but these are variations of PC and monopoly.
Others: The doctor and patient relation is under this category.
Asymmetric Information: The doctor (supplier) in the relationship holds all the cards, as he has the knowledge that the patient ( consumer) requires . The patient depends on the advice of the doctor. If the doctor says that he requires a tonsillectomy, the patient usually has to accept it unless he makes an effort to get a second opinion ( or surfs the net).
Hence in a situation where there is unequal power relationship (eg with asymmetric info), self-regulation is crucial or else the consumer will get fleeced.
Self-regulators are usually appointed by or encouraged by the authorities to keep its members in line so that there is no profiteering nor exploitation of the public who do not know better.
The SMA’s Guideline of Fees was formulated for this very purpose. ( see above)
Beside consultation charges, surgical fees are also included in the GOF. The surgery fees are more of less grouped similarly to the Ministry of Health’s Table of Surgical Procedures (TOSP) (Groups A-G vs Tables 1-7) which determines how much of the patient’s Medisave can be claimed for the said procedures and hospital admissions.
Types of surgeries are grouped according to degree of complexity. A range of fee is then suggested for each of these groups. It is not a price-fixing attempt and only serves as a guide. Doctors are allowed to go above or below it.
Implications for patients with withdrawal of GOF
From now on, when asked about charges, doctors can tell their patients with a straight face (and with hand on heart) that there is no guideline.Period. The fee is such and such and that he does not know whether his charges are high or low with respect to other similar specialists.
The patient would then have to decide either to seek a second opinion and then go through the whole process of consultation again or else accept the doctor’s offer for treatment and hope that he has not been overcharged.
In the event that a patient does complain to the Singapore Medical Council (SMC) that he feels that he has been overcharged, SMC is in no position whatsoever to decide whether the charge is reasonable or not, short of surveying all the specialists doing that particular surgery and then get the mean/median or any other statistical method that it feels will help determine the fairness of the charge.
In the past, SMC just picks up the latest GOF and if everything else in the complaint have been dealt with, will usually reply to the patient that yes or no, the fee was unreasonable or reasonable as the case may be.
PTC and other regulatory bodies
Public Transport Council is an example of a regulatory body set out to protect the consumer who is at the mercy of companies who run our public transport system. I know some skeptics who think the PTC behaves like a cartel with official sanction.
Even oligopolies in the communication industry (Singtel/M1/Starhub) are regulated in some ways by their respective regulatory bodies.
Although SMA ( as contrasted to SMC) is a voluntary association of doctors, which de-facto had taken on some self-regulating functions of the medical profession.
With SMA surrendering this role, SMC will be hard-pressed to come up with some measure to assess the fairness of the doctors’ pricing of services.
At the end of the day, I can only say that there is less protection for patients as there is now worse asymmetry of information. Some doctors may be wringing their handsin anticipation, thinking that there is now no longer any need to follow any guidelines and they can charge as high as they think the patients are willing to pay. Maximise the consumer surplus ( as economists will say)
My honest opinion is that the SMA's decision is ill-advised and hasty. And wrong!
( Author's note (7.30 am 4th April)- SMA President Dr. Wong Chiang Yin has clarified in the Today Newspaper: "It was, in effect, a choice of scrap the guideline now — or cough up $200,000 for a decision from the Competition Commission of Singapore that might simply lead to the same result.
Getting guidance alone from the Competition Commission to file paperwork would have cost $20,000, while getting a decision would have cost the non-profit organisation $30,000. In addition, the SMA would have had to cough up some $150,000 in legal fees."
In view of the new fact, I agree that the SMA was between the rock and a hard place and has no choice but to act as it had. The conspiracy theorists are having a field day! More exciting than Kieffer Sutherland's "24"!)
The GOF is not a cartel's attempt at price-fixing. We do not monitor members' pricing policies ala OPEC. There is no collusion and the doctors do not meet in dark alleys and smoky corridors conspiring to fix the consumers. Far from it. The GOF actually serves as a psychological barrier to doctors who want to charge fees far in excess of the guidelines as when they are put under the microscope ( eg SMC/ Insurance companies), they would have to justify why they are an outlier!
Sigh! Try to be good doctor, also difficult. Maybe should just mind my own business and make the big bucks whilst the sun still shines.
Addendum 3rd April 07 9pm:
Ways of resolving assymetric information includes:
1.Mandatory disclosure- useful only if information can be objectively verified
( also not useful if I tell the patient my price for Procedure A is $1000. So what? There is no way to compare unless he goes and call up another 10 doctors to find out their prices)
2.Regulation of conduct- eg "cooling off" period. But we don't force patients to decide on the spot anyway. At least I don't. We are not selling "timeshare" !
3.Regulation by self ( doctors association) or by higher authority- but that is the exact thing that SMA has decided against.
The question is : Can we ask SMC ( being a govt-appointed body) to take over the function of a price watchdog?
Another question: Does the Law Society still have a recommended scale of fees for legal services? So bodies like PTC is ok but SMA's GOF not?
Dr.Huang Shoou Chyuan
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