Angry Doctor

Tuesday, August 29, 2006

Big Doctor is watching you 2

The details on the use of Medisave for outpatient medical bills are released today. I leave the readers to decide if the deductible sum and cap are fair or sufficient, because I am more bothered by something else that was announced.

Specifically, what was reported in this part of the Channel Newsasia report:

"To ensure doctors do not over-service patients, the ministry will audit larger clinics, and publish the data online.

Said Health Minister Khaw Boon Wan, "We will definitely be capturing information like how much the patients pay, what are their initial diabetes blood sugar levels, so that we can track over time. Then we can easily compile (the data) with computers and publish it - so and so cost so much; the average, median, whatever percentile. And then over a one-year, three-year, five-year period, do their patients actually improve."

and this part of the Today report:

"The online system for Medisave submissions could have unexpected benefits, pointed out Mr Khaw. When the doctor filled out the form to certify he was treating a patient for diabetes, for example, he would also need to record the patient's blood sugar levels.

Mused Mr Khaw: "Over a 12--month or six-month period, I can compile, doctor by doctor, the number of patients they handle and the percentage of patients who improve on blood sugar, who stay put or get worse, as well as the cost to the programme. And I can publish it in a simple paper."

This could improve the quality of healthcare as others could learn from doctors or clinics that were doing particularly well. "We need to be able to share their experience with the medical community so everybody learns and everybody improves," said Mr Khaw.

The data will be made available through the Ministry of Health's website."

Numbers, numbers, numbers.

Percentages, percentiles, performace indicators.

Mean, median, mode.

angry doc likes numbers, because they can tell him a lot. But one also has to be very careful in interpreting what the numbers are saying. For one thing, when you grade doctors or clinics by their performance, half of them automatically become 'below-average'.

Diabetes is a complex medical problem. There are patients who do well simply because their disease is mild, and there are patients who don't do well despite their efforts because their disease is severe, and then there are patients who don't do well because they can't be bothered.

In the ideal world each doctor or clinic has the same proportion of each type of patient. The reality may be different.

When you grade doctors by the numbers they return with no regard for their patient profile, the temptation for them to cherry-pick or 'play the system' is always there.

Unless you deny them the right to turn patients away.

But if you do that, the unlucky doctors who happen to have more non-compliant patients or patients with more severe disease will be penalised.

The truth is control of chronic medical conditions requires effort from both parties - the doctor, and the patient. The proposed system does not seem to have taken that into account.



  • The way the Singapore govt approaches everything is with money.

    Too few babies born? Throw money at couples.

    Too many cars on the road? Make it expensive so that less people can afford it.

    Too few votes...err....

    Too many people with ESRD (number 3 in the world), it's because they got not enough money to pay for the healthcare. So open up Medisave.

    It's really just THAT SIMPLE!! REALLY?

    Anyway the way I look at this Medisave program......think about it, will $300 from Medisave buy you more at the Polyclinics or the Private GP clinics? Probably the Polyclinic.

    This scheme is meant to slow down the exodus of patients from private GP clinics to the Polyclinics. But eventually the Private Clinics will have to put the patients on the right dosages of drugs. They have to do the HBA1c. The Lipid profiles. The DRP!!! So overall cost will go up. Patients will realise that instead of spending LESS, they are spending MORE! And patients would hardly see anything with regard to the point that they are now actualy being taken care of PROPERLY. All they see is "Basket now I paying more overall!!!!"

    In the end I foresee that this scheme will cause EVEN MORE patients with chronic diseases to go to the Polyclinic.

    It's all about money anyway right? Who cares whether the right thing is done or not? That's Singaporeans for you.

    I think I will join the Polyclinics next year. Make things easy lah. Just see patients and take care of them. Let the politicians talk money.

    By Blogger Dr Oz bloke, At August 29, 2006 8:48 pm  

  • Qn:
    may i know if there's a team of real drs working in the committees/workgroups that help develop such programs rolled out by the MOH?

    By Blogger pretzel, At August 29, 2006 8:54 pm  

  • I am not against the idea of using Medisave for outpatient bills per se - it makes sense if you believe the reason why people are not taking care of their diseases is financial constraints.

    But the fact is for most people, money is not a real constraint.

    They don't want to be on long-term medication because they believe it's bad for their health. Maybe. But then so is a high blood pressure.

    Or they don't want to be on insulin even though it is cheaper than the 3 or 4 oral medications they are already on. Fine. Your body, your choice.

    Still, opening up Medisave will still help those people who *are* constrained by money, so maybe this programme will help a number of people.

    I'm just a bit wary about publishing the data on performance of each doctor or clinic, but I suppose we will have to wait for the data to be published before we know what exact form it will be presented in.

    By Blogger angry doc, At August 29, 2006 9:29 pm  

  • pretzel,

    I have worked with a few senior doctors who tell me they have attended meetings with the health ministers on policies, but that's the limit of my knowledge.

    By Blogger angry doc, At August 29, 2006 9:33 pm  

  • There ARE real doctors in the committees/divisions within MOH. However, having a medical degree may not neccesarily mean that you have the frontline experience of dealing with the day to day quirks of treating real patients! 'Nuff said...


    By Blogger aliendoc, At August 29, 2006 11:35 pm  

  • Aliendoc is right. Those who play a significant part in making the final decisions w e committees are more than often qualified doctors.. who err.. hold a medical degree running the administrative matters in healthcare much more than treating patients in the frontline.

    By Anonymous Anonymous, At August 30, 2006 11:44 pm  

  • oh man..
    even i also know abt confounders

    By Anonymous Anonymous, At August 31, 2006 5:07 pm  

  • i guess it's easy to dissect each individual initiative by itself, and you see many loopholes, and possible implications.

    I've read some of the white papers, masterplans, etc on how the govt intends to position the healthcare sector, etc. Most of it make logical sense, to resolve/alleviate current problems...

    ... erm, so i'll put my faith and hope that the relevant folkz/teams are moving all the different pieces of the puzzles together, so that the Big Picture will be clearer soon. :)

    By Blogger pretzel, At August 31, 2006 8:31 pm  

  • it's sad that drs and patients keep up this illusion of dr's being concerned about patients above all else and patients respecting dr's for it..
    when the fact is money does matter..
    Dr's want more of it..or rather feel they deserve more of it..

    and patient's want good medical care...where dr's take the time and effort to listen and "care".. but don't want to pay for it!

    when in fact dr's are treated with distrust..hence the need for monitoring/performance indicators/managed healthcare to prevent overservicing..

    By Anonymous Anonymous, At September 05, 2006 10:49 am  

  • Well, I do not actually imagine it is likely to have success.
    2 | - | 2 . | glance | 1 . | ...

    By Anonymous Anonymous, At February 16, 2013 9:13 pm  

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