Angry Doctor

Monday, November 28, 2005

Money for Nothing?

Came across this blog entry on Technorati, which discusses this study on the differences between public and private sector doctors in India.

I’m not sure how seriously to take a study titled “Money for Nothing - The Dire Straits of Medical Practice in Delhi, India”, but it seems like a topic worth looking at.

From the abstract:

First, what doctors do is less than what they know they should do - doctors operate well inside their knowledge frontier.

Second, competence and effort are complementary so that doctors who know more also do more.

Third, the gap between what doctors do and what they know responds to incentives: Doctors in the fee-for-service private sector are closer in practice to their knowledge frontier than those in the fixed-salary public sector. Under-qualified private sector doctors, even though they know less, provide better care on average than their better-qualified counterparts in the public sector.

These results indicate that to improve medical services, at least for poor people, there should be greater emphasis on changing the incentives of public providers rather than increasing provider competence through training.

Interesting. The scientific circle often goes to elaborate lengths to conclude something that seems self-evident.

The study seems to suggest that care (note that I say care, not service) in the private sector is better than that in the public sector. I wonder if the same can be said of the local healthcare system.

Firstly, do all doctors practise inside their knowledge frontier? Certainly in the public sector the doctors are under closer watch, although I have heard of a doctor being reprimanded for introducing unproven therapy in a major restructured hospital. But what about the private sector?

Secondly, while doctors in the private sector will try harder to please the patient, but that is not to say that the quality of care given is necessarily higher. Again, without any audit, the doctors may simply end up just trying to please patients rather than to provide them the best care. This state of affairs is possible because patients cannot and sometimes do not want to know the difference between good service and good care.

Conversely, doctors in hospitals and polyclinics are audited and their performance indices monitored. Being on fixed pay plus performance bonus, the incentive here seems to be pleasing the paymasters rather than the patients.

I don’t think one can say that fees correlate well with quality of care in the local healthcare system, or that it doesn’t, but I would certainly be interested to see a study done.


  • Hi, I'm back.

    This topic vely dry leh, better go to bed. I really don't give a rat's ass as to what is happening in India.

    Also catch no balls.

    Something more interesting leh, like the famous local docs with infamous idiosyncracies.

    thank you.

    By Blogger uglybaldie, At November 28, 2005 6:51 pm  

  • Dear Angry Doctor

    If only you were introduced to the medical scene just 5 years ago or before then you will know how the polyclinics were. Audit? Sure kenna.

    Recently, audit is introduced because polyclinics have improved a lot. In fact I am not surprised that you get that impression because this is the result of what's done by the previous health minister.

    Is that the right direction to go? I think we have to hear from the current health minister.

    By Anonymous Anonymous, At November 28, 2005 9:04 pm  

  • I think sometimes certain decision made in the private practice is more profit based than patient oriented. Sometimes doctors working for groups or government, I think would take the profit driven decision out of the equation. Unless one is audited/evaluated using the bottom line as the criteria.

    By Anonymous Anonymous, At November 29, 2005 12:23 am  

  • Ask yourself:

    Do you want your medical bill to be low or do you want the total National health expenditure to be low?

    DO you want to live long with bearable morbid conditions (lets say 75 years) or do you want to die
    young but good quality of life (lets say 45 years)?

    DO you want to save a patient from heart attack and result in a patient in coma or do you want to let him die of a heart attack?

    DO you know who to treat and who not to?

    Its more than just immediate dollars and cents...and by audit, you are suppose to know if you are doing the right thing.

    By Anonymous Anonymous, At November 29, 2005 11:47 am  

  • "Do you want your medical bill to be low or do you want the total National health expenditure to be low?"

    Typical Singaporean : BOTH.

    Politician : If all the individual medical bills are low, then the total national health expenditure would also be low.

    Me : I think I better change jobs.

    "DO you want to live long with bearable morbid conditions (lets say 75 years) or do you want to die
    young but good quality of life (lets say 45 years)?"

    Typical Singaporean : I want to be rich. You give me money I have unbearable morbid conditions also can. You give my family a few million dollars I die young for you also can

    Politician : We will make sure that all live long with no morbid conditions and no one dies
    young but has good quality of life. That is the goal of our health care system (but we won't pay for it hee hee)

    Me : Err I think you hired all the wrong people. That's a job for God.

    "DO you want to save a patient from heart attack and result in a patient in coma or do you want to let him die of a heart attack?"

    Typical Singaporean : Which one can earn more money ah?

    Politician : Err which patient has more political-social-economic importance to the country ar?

    Me : I save the patient first. Later then talk whether he prefer to die or not.

    "DO you know who to treat and who not to?"

    Typical Singaporean : Of course I know lah

    Politician : You have my assurance, the doctors will know.

    Me : I really dunno leh? I treat those who want me to treat and dun treat those who dun want me to treat. Correct answer or not har?

    By Anonymous Anonymous, At November 29, 2005 12:18 pm  

  • The way I see it, so long as a doctor in the public sector has things to worry about other than care of patients, then a conflict of interest will sometimes arise.

    What will happen to my PB this year?

    My CO doesn't want me to give out so many MCs

    Sian, 3 a.m oredi, page for consultant sure kena screw. Will wing it til the morning.

    By Blogger andrew, At November 29, 2005 3:19 pm  

  • But in private sector also got other things to worry about.

    "can I pay my workers salary this month?"

    But I suppose everyoen accepts that private sector all have other things to worry about right?

    Well for public, should be patients first isn't it? It depends on a case by case basis as with all things and people in Singapore. Remember the Melvyn Tan case?

    By Anonymous Anonymous, At November 29, 2005 3:25 pm  

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