Angry Doctor

Wednesday, October 18, 2006

Dollars and Sense

The cost of outpatient consultation and investigations for urinary tract symptoms: S$200

The average inpatient bill (after subsidy for C class) for investigation and treatment of urinary tract infection: S$300

The chance to see a Singaporean point of view on healthcare costs: priceless

angry doc feels sorry for the person who has to reply to this letter:

Bills pile up with too many visits to hospital

ON SATURDAY, Oct 7, I took my son, who was experiencing excruciating pain near the kidney, to the A&E Department of Changi General Hospital where a urine test was conducted and blood was detected.

The doctor prescribed some antibiotics as he suspected either an infection or stone in the kidney and referred him to a specialist the following Wednesday. The bill: $65.50.

On Wednesday, when my son told the specialist he was no longer experiencing pain, he was told to go for another urine test and to return on Saturday for an X-ray to confirm his condition. The bill: $37.50.

On Saturday, the X-ray was taken (cost: $55.50) and I was told that my son would have to return on Oct 27 for the specialist to tell us the results, for which I would have to pay another $37.50.

I was told by the hospital that if my son had been admitted for, say, removal of kidney stones on his first visit, I would have been able to pay for the expenses with my Medisave funds.

It is my opinion that all expenses incurred in the exploratory stages, though done during different visits to the hospital, should be payable with Medisave funds when the tests finally result in a patient having to be admitted to hospital.

Also, why penalise the patient, when the scheduling for appointments and admission is done by the hospital?

The appointment on Oct 27 with the specialist is for the results of the X-ray to be made known to us. Why is there a need for the fourth visit and to wait 13 days when the results could be relayed to us via phone, e-mail or fax two to three days after the X-ray was done?

Why does one need to make so many visits?

If the urine test and X-ray could be done at the A&E, couldn't the final results be made known during the visit to the specialist?

Carol Lim Siew Imm (Ms)

angry doc is often amused by how the Medisave system shapes people's decisions on healthcare matters.

It seems that Ms Lim feels it's a better idea for her son to be admitted for investigation and treatment of his condition even though that will possibly double the size of the medical bill (95th percentile), since that money will come out of her Medisave funds rather than her own pocket.

Never mind the trouble that it would actually cause her family to have her son admitted, the cost of transport for the family to and from the hospital to visit him, or the bed and manpower her son would take up while he is being investigated (for what seems to be a condition which can be investigated and managed on an outpatient basis), possibly denying or delaying someone else who needed that bed more.

Ironically, while she wanted admission for management of the problem, she is happy to receive the results of the investigations for that problem 'via phone, e-mail or fax'.

No need to see a doctor to discuss the implications of the findings or further management options and plan.

Anything to avoid having to pay out of pocket, it seems.

Perhaps there really *are* some things money can't buy...

Added: The reply to Ms Lim's letter is reproduced below.

Why patients have to return for review of special X-ray

I REFER to the letter by Ms Carol Lim Siew Imm, 'Bills pile up with too many visits to hospital' (ST, Oct 18).

It is necessary for patients to come back for a review of their specialised X-ray examination results. This is to ensure confidentiality as well as to provide professional consultation on the medical condition.

A normal result does not exclude other causes of the problem. Hence it is necessary in this case for a review by the specialist to discuss the other possible causes of the problem and decide on the management plan.

Our staff has spoken to Ms Lim to explain the situation. She wanted to know why the Intravenous Urography (IVU) could not have been done on the day her son saw the urologist, and why it takes 13 days to churn out the report from the time the IVU was done until the follow-up date.

The IVU could not be done immediately because the patient's bowels had to be cleared for the examination. Once the radiographer has done the procedure, the films would be reported by the radiologist.

In addition, we would need to find the earliest available slot for the patient to see the doctor for the review of the results.

If Ms Lim needs further clarification, she could contact Ms Grace Segran of Corporate Affairs on 6850-2734.

We thank Ms Lim for bringing this matter to our attention.

T. K. Udairam
Chief Executive Officer
Changi General Hospital



  • Haha! Well the same old story isnt it?

    What these people need is to fall sick while they are on some holiday trip in USA or Australia or Canada or UK and did not buy insurance and see how much it costs them!

    Or perhaps MOH should also make it a point to publish the costs of healthcare in other developed first world countries (please don't start telling how cheap it is in Thailand, Malaysia and Indonesia! I just had a patient saying she has hypothyroid and they are monitoring her with total T4 levels with no free T4 or TSH done!!!!)

    It also doesn't help give Singaporeans a sense of reality by having Polyclinics that buy generic drugs in such great bulk orders that they are so cheap and almost effectively free and then charging such low prices to Singaporeans that they think all medical bills should be about $10.

    Singaporeans don't appreciate the relatively cheap cost (not just in $$ but in efficiency, ease of use, ease of delivery) of healthcare they are provided.

    It's not pleasant reading such things but I guess that's the tone of our society.

    All I can say is that you have to pay for what you get.

    Don't be fooled by dirt cheap prices.

    By Blogger Dr Oz bloke, At October 18, 2006 5:48 pm  

  • agreed. but I still think that most Malaysians/Singaporeans are becoming comfy and complacent about their healthcare. while there may be glaring inequalities and problems, the low charges are still very good comparable to countries like the UK, where you have to fight tooth and nail to get into an Operations Theatre.

    By Blogger The Angry Medic, At October 19, 2006 3:38 am  

  • I went to see a SGH specialist once for tinitus. Like the woman, I had to make a few trips for blood test and all that, which I am quite willing to do.

    But the thing is, after being diagnosed with tinitus, there was no discussion with the doctor over the implications of the findings or discussion of further management options and plan. Quite frankly, he could've sent the results to me via email with hardly any difference. I could still remember with crystal clarity what he said to me because of the brevity of it- "Don't worry, its not serious." WTF man, after spending hundreds of dollars, several rounds of test and many hours of waiting, all I get is that? And you wondered why the doctor/ patient relationship in singapore is so screwedup.

    By Anonymous Anonymous, At October 26, 2006 4:12 pm  

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