Angry Doctor

Thursday, November 10, 2005

Clues for the Clueless – Chapter 8

Chapter 8 – Other people’s money

You would imagine that healthcare is a simple relationship between two parties – the patient and the doctor.

This is still the case if you see a general practitioner or a private specialist: you agree on a care plan that is mutually satisfactory, at a price that is acceptable to both parties.

A simple transaction. You pay, you get.

But when it comes to seeing a doctor at a government polyclinic or a specialist at a subsidised clinic or in a subsidised ward, you actually take more than you give.

Subsidy means you don’t pay the full cost, which in turn means someone else, in this case the taxpayers, pay.

That means with every visit or admission, the institution makes a loss.

Other people are paying for you.

Yes, I know you pay taxes too, but if the amount you pay exceeds the cost of your triple bypass, you wouldn’t be staying in a subsidised ward now, would you?

So to demand the most expensive drugs or short waiting time or more personalised care at a subsidised clinic or ward is like going to a soup kitchen and demanding a steak and a table for two with candles and a violinist.

Subsidy is the same reason why the government spends money on health promotion; if you are willing to pay your own medical bills in full no one would care if you ate unhealthy food, smoked, or didn’t exercise. Your body, your money, your choice.

Problem is many people mess their own bodies up and expect the rest of us to pick up the tab, and unfortunately that’s a state of affairs we have to tolerate until someone with enough moral courage puts a stop to it.

Until then, the next time you step into a subsidised clinic or ward, try to remember that you are a recipient of tax dollars, and not 'a paying customer'.

Thank you.


  • Which Countries' healthcare services are not subsidised??

    By Anonymous Anonymous, At November 10, 2005 9:23 am  

  • anon> From what I hear, it's not easy to see a doc (public hospital) in the US or the UK. So I suppose the system here is already pretty good, even if you're a subsidised patient.

    By Anonymous Anonymous, At November 10, 2005 10:28 am  

  • I just got back from Australia. There is a HUGE demand for doctors in many suburbs.

    Many patients are turned away and asked to drive 40km+ to other clinics to see a doctor. Why?

    Because the clinics are no longer accepting new patients into their books. Doctors there see about 5 patients an hour. It is usually an appointment based system. Hence if the doctor's appointments are full for the day, you can't see him. Priority also goes to patients that are already registered with him.

    Of course the practice is subsidized. But the govt checks to make sure GPs don't see like 10-15 patients an hour like in Singapore.

    There are pros and cons. But overall I think the public/patients in Singapore should be grateful that there is no problem if they wanted to see a doctor. Just walk to any clinic and you will be seen.

    On the other hand, MOH has not looked after doctors well in Singapore. We are seeing far too many patients an hour to give quality service by Australia's standards but risk being labelled unproductive instead. Also the amount that doctors are paid in Singapore per patient consult is pittance compared to Australia. Which means doctors either see as many patients they can per hour or make up by selling more drugs. These two are hardly things that are good for the patient.

    By Anonymous Anonymous, At November 10, 2005 11:18 am  

  • I am glad that 'better late than never', the Minister is doing his utmost to reduce healthcare cost. I think people will do so too if they realise the significance of what's happening rather than wait for the wake-up pinch. Or maybe they need to reach the stage whereby their backsides are getting burnt?

    Too many people have developed this don't bother attitude despite health education and public education messages in the media. It is definitely cheaper to treat chronic patients early if not prevent them, rather than having this attitude of 'responding only when (they perceive) the need arises'.
    How many are willing to adopt disciplined healthy lifestyles instead of paying for slimming treatment and other seemingly miraculous programmes?
    How many are willing to accept treatment and medications when they are at the early stages of chronic medical conditions rather than panic and grumble about hefty medications cost when there are established damages to end-organs?

    How to get these people to change, rather than labelling them as no hope and leaving them to rot and die?

    By Anonymous Anonymous, At November 10, 2005 11:47 am  

  • Dr Oz Block
    I also looking to go Australia and work. Probably Melbourne.

    By Anonymous Anonymous, At November 10, 2005 11:58 am  

  • when they pay peanuts(not in the Mrs Goh sense) they complain about long waiting, poor quality of consultation. When they pay premium to see the private GP they complain it is a rip off and that the GP are overcharging compared to the poly! What can you do?

    By Anonymous Anonymous, At November 10, 2005 12:17 pm  

  • Interesting point about people not bothering about health education and getting chronic illnesses because of that. From what I can see, quite a number of my fellow medical students lead pretty unhealthy lives themselves. Maybe we should consider leading by example?

    By Anonymous Anonymous, At November 11, 2005 10:57 am  

  • interesting question which was posed to me quite a number of years back: do you subsidise patients who engage in high-risk & illness-contributing behavior?

    imagine a scenario where an elderly ah pek, living alone and subsisting on charity, gets turned down for subsidised cancer therapy because he declared in his medical history that he smoked a pack a day before coming down with CA lung.

    By Blogger andrew, At November 13, 2005 5:29 pm  

  • As far as I know they are currently NOT denied subsidy despite the high-risk behaviour.

    Not sure about the Medishield bit though (I never did understand Medisave and Medishield ...), but there was a letter to the forum recently on the Housing Protection Scheme recently where a guy was denied insurance?

    What makes me laugh is actually the way they waste manpower having a medical team on-site for all those high-risk sports. It's like saying: we know it's dangerous but we still think doctors and ambulance-teams should spend their time watching over us instead of helping sick people while we get our thrills.

    By Blogger angry doc, At November 13, 2005 5:46 pm  

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