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.