Angry Doctor

Thursday, August 24, 2006


angry doc hasn't been sleeping well this week. He’s been having dreams. Too many dreams. Some he cannot recall, some which he can, like this one below...

MOH: What's wrong, angry doc? You look preoccupied.

angry doc: It's the latest press release from the ministry…

MOH: The Data on Affordability of Healthcare?

angry doc: Ya.

MOH: What's the matter? You don't think healthcare is affordable?

angry doc: Well, it's not that – but I don't think the data tell you that.

MOH: It's pretty straightforward, isn't it? The average Singaporean has more than $13,000 in his Medisave account, and the average hospital bill for B2 or C class is below $1,100. An average Singaporean can afford to stay in a hospital once a month for a year, or once a year for twelve years.

angry doc: But an average Singaporean does not stay in a hospital once a month, or even once a year. In fact, the
Health Facts tell us that fewer than 10% of all Singaporeans are admitted to the hospitals each year; and we know that some Singaporeans are admitted more than once a year. If the average Singaporean chalked up the 95th percentile bill of $2,747, he would deplete his Medisave in four admissions. The averages look good, but the outliers are the ones who need the most help.

MOH: If. He might not chalk up the 95th percentile bill, he might not be admitted four times, and you forget that he might still be contributing to his Medisave in the meantime. To be fair, we need to work on averages here when presenting the data to the public. And even if he was a 'non-average' patient who had depleted his Medisave, we have Medifund. We have been giving out more money from the Medifund, you know?

angry doc: Then again, even if he did have money in his Medisave account, he might still have to pay out of his own pocket because of the withdrawal limits.

MOH: Yes. We realise that and we've increased the withdrawal limit this year as part of the reform. At $400 a day, the average Singaporean can pay for a three or four day stay and pay for almost all of it with his Medisave. You still don't think the figures tell you that healthcare is affordable?

angry doc: No. They tell you that hospitalisation is probably affordable for the 'average' Singaporean. But hospitalisation is only a fraction of the nation’s total healthcare costs. In fact, if the 315,149 admissions to public sector hospitals in 2005 were all under B2 or C class (which I am sure they are not, but for argument's sake…), and the mean bill size is close to the median bill size of $1,100, we are looking at about $350 million. And if the nearly 100,000 admissions to private sector hospitals were close to the median bill size of $2,400, that will give a sum of $240 million. Adding the two gives us 590 million, or about 13% of the total annual health expenditure of about $4.3 billion?

MOH: It does. But we're talking about 13% of the total cost, for what you've noted earlier to be probably fewer than 10% of the population. Hospitalisation cost is a disproportionately high part of the total cost, and what most Singaporeans worry about too.

angry doc: It is, but then almost 100% of Singaporeans will need outpatient care, including those who need hospitalisation care. And 87% is a higher percentage than 13%.

MOH: I agree. Which is why we are also going to allow Medisave to be used for outpatient bills. We'll provide the figures when we have them. You need to be patient.

angry doc: OK.

MOH: Tell me - do you think I am really trying to make healthcare affordable here?

angry doc: Honestly? I do. I just don't think the data published make a very convincing argument that healthcare as a whole is affordable.

MOH: They are only the first set of data. Do *you* think healthcare is affordable?

angry doc: For the vast majority, I think it is, even when you take into account the fact that 'affordability' is largely a subjective term. I think for most people healthcare is something they would rather not have to pay for rather than something they really cannot afford to pay for.

MOH: There will always be those who believe healthcare should be free.

angry doc: So why did you bother to publish the data then? These people are not going to be convinced by the numbers anyway.

MOH: Well, I know you like numbers - they fire your imagination.



  • Excellent analysis! Well done!

    Is healthcare affordable in Singapore? Personally I would say the healthcare costs in Singapore are lower than places like USA. However the question will always be "How low can you go"

    And that would be FREE.

    Personally I have told my wife that if I get cancer or a stroke or heart attack....and the bill will be high....just let me die. Don't waste money.

    I believe more in prevention rather than cure for the BIG diseases. And if they happen, then I let nature takes its course, after all at the end of the day, we do have to die eventually.

    The end point is the same. But that's my personal opinion for my personal health matters. If my wife got cancer I'd want to do everything to save her. And I'm sure she'd do the same for me.

    So we're stuck lah. Still gotta pay and get treated. haha!

    By Blogger Dr Oz bloke, At August 24, 2006 10:48 am  

  • Thanks, Oz Bloke. I was really just thinking aloud there, and I'm sure I have missed many aspects of the problem. I didn't even discuss Medishield.

    I think the ministry must have a hard time trying to shape people's opinion and change the perception that healthcare is not affordable for most Singaporeans. Healthcare cost can be very high for some and I suspect it is the stories of these who give the impression that healthcare is universally expensive. The problem with this general perception is that some people are actually turned off from seeking healthcare at an earlier stage in their illness when they would benefit from it.

    I think we doctors realise that there is no such thing as 'death from old age' - it's either going to be cardio- or cerebrovascular, or malignancy. Everyone should expect to suffer and die from one of those conditions, and have an idea of how they can delay the onset, and how to pay for their treatment (or not) when they do strike.

    By Blogger angry doc, At August 24, 2006 4:53 pm  

  • Healthcare in Singapore is very good. On the NHS, everything is free, but you might be dead before you get anything done.

    By Blogger tscd, At August 24, 2006 10:07 pm  

  • "Healthcare in Singapore is very good. On the NHS, everything is free, but you might be dead before you get anything done."

    The beauty of that system is that nobody would ever complain that the govt are trying to squeeze money out of them or that the fees are too high etc.

    The bad thing is, well you might wait so long in the queuse that you do not get what you are "entitled" to before it is too late. But it's applicable to EVERYBODY so it seems fair regardless if you are rich or poor.

    It's like food is free. But the queue is so long that somewhere in the long queue people start to die of starvation before they get their food. The only way to get food is to queue regardless if you are rich or poor!

    But if the queue is visible, people may find it hard to complain. After all it is free and everyone has to queue even if they are rich or poor. (Of course the rich make more noise than the poor in this system)

    Personally I think there should be an almost free system like NHS and then for those who have money, go to the swanky Morton's to get your big juicy steak without having to queue at all.

    Funny thing is that what we have is a NTUC-Steak House where you can also get your steak, but in the very same restaurant there are people queuing for free food and dying along the way all in full view of each other. People SEE the differences. And the ones in the queue are angry that there are double standards in FULL VIEW.

    AND then you have Morton's that is for tourists mainly.

    By Blogger Dr Oz bloke, At August 25, 2006 10:07 am  

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