Comparative Advantage

angry doc is angry today. Angrier than usual, that is.

I count five letters on the issue of teleradiology on the ST Forum today. One in particular asks a very relevant question: if the purported reason is to save moeny, where is the savings to the patients?

But the letter I want to rant about today is this one.

I will interspace my comments within the text.


Comparative advantage at work in teleradiology service

I REFER to the letter 'Isn't it cheaper and better to have in-house radiologists?' (ST Forum, March 3) by Dr Shoen Low Choon Seng.

Teleradiology is not something new. Many advanced countries are practising it and this signals the fact that this trade is profitable and sustainable. Medical industries are often highly regulated and it is unthinkable that the governments of these advanced countries would invest in a form of trade that is as unprofitable as described.

Addressing Dr Low's first concern, I would like to point out that the overhead costs of any new business or trade dealings will always be high. To reject this path because of the $2.3 million initial cost resembles a minority who rejected the initial stages of the Industrial Revolution because of the cost of buying and maintaining machines. Thanks to the majority who believed in moving forward, today we stand as grateful beneficiaries of the revolution.


The cost of the Industrial Revolution was more than the costs of buying and maintaining machines. There was also exploitation of the workers in the forms of child labour, hazardous work conditions, and poor or absent benefits. Even today many workers in factories in Developing Countires work under such conditions. We may be beneficiaries, but let's not forget there are also victims when we 'move forward'.

The sum of $2.3 million might not seem so high if medical practitioners in Singapore are willing to utilise and support this system, for in so doing the cost per X-ray reported will be decreased. Spending this amount of money might also be justified if we understand 18th-century economist David Ricardo's theory which states that 'each country should specialise in producing the good for which its comparative cost is lower'. Comparative advantage is the main basis for most economists' belief in free trade today. The idea is this: A country that trades for products that it can get at lower cost from another country is better off than if it had made the products at home.

Clearly, the comparative advantage (cheaper labour costs in India, the allocation of local radiologists to more promising industries) will outweigh the $2.3 million cost.

I'm not sure the practice of medicine should be viewed merely as a tradable commodity. In fact, I suspect a better strategy would be for each nation to be at least self-sufficient in its own basic healthcare needs, inasmuch as that is possible in this day and age of globalisation.

It may be nice to see that we are saving money when we employ cheaper radiologists, or import nurses from the Philippines, but perhaps we should also stop and think of all the patients in India who now have to wait longer for their X-rays to be read, and all the patients in the Philippines who can't get healthcare, because their nurses (and even doctors) have gone overseas to work as nurses there.

Should a nation sell its bread to its richer neighbours when its own people do not have enough to eat?

Or to put it in another way: If a poor man who has only 20 cents wants to buy the last loaf of bread from a baker to feed his family, would you offer the baker 50 cents for that loaf of bread just because you don't want to spend a dollar getting it from your usual baker?

Dr Low's second concern of whether the radiologists in India are legally liable to our laws or medically well-trained is a relevant one.

As a medical industry, the overriding principle that the welfare of patients is maximised must be enforced and cannot be compromised for the sake of profit. From this perspective, many might see a dead end to the path of globalisation for this industry. However, I see an endless spectrum of opportunities.

For isn't this the best time to export our legal and medical professions, and in so doing make Singapore both a medical and legal hub in this region?

Koo Zhi Xuan

I wonder how happy Mr Koo will be when the day comes that Singapore becomes a successful medical industry exporter and when all our best and brightest doctors have been exported to work in Developed Countires, and Singaporeans themselves cannot get adequate or timely healthcare. Import cheaper doctors from overseas? Well, why would them want to work for you when there are obviously higher bidders who have already bought your doctors?

We live in an interesting and exciting time when technology allows us to have better things faster, often at a cheaper price. I have nothing against teleradiology or importing of doctors to work locally per se, but I am uncomfortable with the idea that this is the solution to all our healthcare problems and that it is 'good' just because we can save some money. Let's not forget to count all the costs behind this convenience and economy, and wonder what it will be like if the shoes were on our own feet.