Angry Doctor

Friday, November 11, 2005

Better, Faster, Cheaper

All the comments on the healthcare costs and subsidies reminded me of this documentary I saw a while ago on how the (then) new NASA chief promised 'Better, Faster, Cheaper' space missions. But then they found out that you can't have all three.

To a very large extent this is also true of a healthcare system, which when it comes to the subsidised healthcare system consists of three parties: the patients, the doctors, and the Health Ministry.

Patients expect the best healthcare delivered timely and with good service, but baulk at the cost, or else at the waiting times if they go the subsidised route.

Doctors want less work, more pay (yes, admit it!), and higher standards for themselves (in terms of the job satisfaction, quality of delivered care, upgrading of skills and knowledge, and living up to the ethical code), but find it hard to achieve all three when in the system.

The Ministry must strike a balance between three components: patient/voter satisfaction, health of the nation (as it affects productivity), and budget.

At least the Ministry seems to have decided what it wants its
priorities to be.
(If you look at the priority list, you realise that the Ministry is concerned with costs and wants to 'spend within our means'. Patient expectations are expected to be 'moderated'. There is nothing there that says they should be seen fast or about service with a smile. :) )

At the end of the day, you have three parties, each with its own priorities and agenda, competing for limited resources. It seems that one party's gain must come at another's loss.

Is that a bad thing?

It may surprise you that angry doc doesn't think so. All three parties are stake-holders and are accountable to each other. All three parties should argue for their position and negotiate for the best terms. A system dominated by only one of the parties will mean the others lose their voice.

My hope is that we as a society can argue and argue with the understanding that it's about us sharing limited resources within the same system, and hopefully we all come to a status that is sustainable and satisfactory to all three parties involve.

My rantings on this blog is sometimes just me arguing for what I think doctors' position should be. I am not advocating that my view should be the only one. In fact, I think it will be a dark day for mankind if it was...

So do continue to post your comments when you feel like; hopefully together we will make a difference.

Added: Dr Oz Bloke's comment reminded me that there is another arm in the subsidised healthcare system: the Primary Care Partnership Scheme.


  • My father was telling me that he went to the Polyclinic yesterday and saw a doctor who couldn't speak english properly.

    It seems that the polyclinics are being staffed with foreign doctors who can't speak english properly.

    So it would seem that we have a shortage of doctors in the public sector. And then we have a surplus of GPs in the private sector to an extent that they are going into Aesthetic medicine! In addition to that some are beginning to consider moving to other countries which have a shortage of doctors to practice for eg Australia.

    What this all means is that at the primary health care level, there is a gross mismanagement of resources on a national scale. Having foreign doctors who would never be accepted by first world countries like Australia or Canada working in our polyclinics to solve the shortfall of doctors is in my opinion hardly a wise decision. It does not bear well for the people. I would like to see our MOH/NHG/Singhealth health administrators see some of these foreign doctors at the polyclinics themselves and ask them for their opinions.

    Their is room for MOH to co-operate with private GPs to provide a better more balanced primary healthcare system. I just cannot understand why they choose not to. Perhaps it is all part of the inherent lack of feedback or feedback just for show culture in Singapore.

    By Anonymous Anonymous, At November 11, 2005 9:20 am  

  • Wah, why you never see your own father?
    (I know lah, you were still in Australia then, right?)

    There is a scheme that allows patients to see GPs and still get subsidised - I'll try to find the info later.

    By Blogger angry doc, At November 11, 2005 9:43 am  

  • Re: dr oz bloke's Qn on why MOH not doing anythg...

    Could it also be that on of the stakeholders, i.e. the Drs themselves (as a fratenity) not willing to be actively involved in changing the current ways of doing things?

    By Anonymous Anonymous, At November 11, 2005 11:33 am  

  • The doc go where the money is. You will never get the pay you want if you don't gamble and take a chance to set up your own clinc. Some move to aesthetic medicine because that is where the money is. Women are willing to spend to preserve their beauty. Probably only 10%-20% are the altruistic type staying in the restructured hospital having a vision for a better healtcare system. Money prospects and autonomy I think is the reason for the exodus. After all you spend 6 years in hell you would of course expect to reap the benefits in whatever way you see fit :)

    By Anonymous Anonymous, At November 11, 2005 12:17 pm  

  • The scheme- limited to select age group (elderly I think) and in areas without polyclinic.. anyway..apparently for this scheme, some are gaining and taking advantage of this scheme to earn more $$..

    By Anonymous Anonymous, At November 12, 2005 4:44 pm  

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