Angry Doctor

Thursday, October 26, 2006

Subsidy and other Preoccupations

angry doc wonders why so many people who write to the ST Forum use the word 'shock' in their letters, like this writer here:

Switch to 'private patient' gets quick test

I WENT to the polyclinic recently to get a referral to see a specialist as I had symptoms resembling those of colon cancer, and asked that immediate attention be given to my case.

I was shocked to find out that my appointment would be two weeks later.

When I called up the National University Hospital's colorectal clinic to find out the reason, the nurse told me that the doctor's schedule was packed. After much pleading, the staff managed to schedule an appointment for me in a few days' time.

When I went down to see the specialist, he examined me briefly and recommended a colonoscopy. As a subsidised patient, he told me that the earliest he could perform the procedure was in November, about a month later.

Almost immediately, he went on to suggest that if I became his private patient, he could perform a scope and an ultrasound scan for me the next day.

I felt compelled to take the earlier option as I feared for my health. I was then made to sign a form to remain as a private patient for at least a year, paying the private rate throughout the year for any treatment.

After completing the colonoscopy and ultrasound scan, I had to return the following week to collect my ultrasound report. Surprisingly, I had to pay a further consultation fee just to be briefed on the report.

I have the following questions:

  • Can a specialist reserve earlier time slots for private patients just because they pay more, leaving subsidised patients to wait in the queue?
  • Why are private patients made to commit to paying private rates for one year without the option of going back to subsidised rates?
  • Why did the specialist have to charge for the final consultation after the test when he was merely repeating what was in the printed report? If the patient is deemed to be normal after the test, shouldn't the precious consultation time of the specialist be used for another more-needy patient, subsidised or not?

I urge the authorities to allocate health-care resources based on need rather than on one's ability to pay.

James Chi Han-Hsuan

angry doc is glad that Mr Chi's tests were 'normal'.

The underlying question in Mr Chi's letter is about the rationing of healthcare - once you accept the fact that healthcare needs to be rationed, the question then is how it should be rationed. It's an old debate and angry doc is keen to read the reply from 'the authorities'.

angry doc's question for his readers today is not on the rationing of healthcare though, but one of conviction:

If you were morally opposed to the idea that money should buy a person priority when it comes to healthcare, will you, when faced with the *possibility* of a life-threatening illness like cancer, buy yourself priority?

(At the same time, angry doc wonders if he himself, when diagnosed with a cancer western medicine cannot cure, will try an unproven alternative medicine remedy. angry doc hopes he doesn't live long enough to die of cancer though.)



  • Usually i see the other way in public practice. They will come in as private to cut short waiting time between getting referral from a polyclinic to a government specialist then downgrade to subsidised once they get to see a specialist and gotten a diagnosis.

    By Blogger OJ - Da UNlicensed Pharmacist, At October 26, 2006 11:22 pm  

  • Mr Chi should go to Canada.

    Over there, there is NO PRIVATE health care sector. Everyone is treated the same. You wait long long long for your appointment. The government does not allow anyone to BUY PRIORITY.

    If you want to buy priority then you go South to USA.

    Sometimes these people write letters to the press from Moral Pedestals without even thinking about the issue thoroughly.

    It's a supply and demand issue.

    By Blogger Dr Oz bloke, At October 27, 2006 1:06 pm  

  • It's the same everywhere isn't it? Even here in Britain there's a scandal going on that surgeons are giving preferential treatment to their private patients. But what makes it worse here is that whilst doctors like Dr Oz Bloke may argue in favour of such favouritism, and I tend to agree with some of what he says, in Britain these surgeons are using NHS facilities for their own private operations. NHS staff assist, NHS theatres are used, with NHS anaesthesia and NHS facilities. But of course the money goes straight into their pockets.

    Ah, you gotta love the NHS.

    By Anonymous Anonymous, At October 29, 2006 6:24 am  

  • Actually, Oz Bloke advocates a segregated two-tier system, where the physical facilitites of the subsidised and the private sectors are separate from each other, so they cannot be said to be competing for the same resources (or customs).

    In the Singaporean context, where private-only facilities already exists, this would mean taking the privatised services out of the currently mixed-subsidised-private government/restructured hospitals.

    One reason given for having such a mixed system is that it helps retain the services of senior doctors who may otherwise migrate to a private-only setting, leaving only the relatively less experienced staff manning the public-sector hospitals.

    By Blogger angry doc, At October 29, 2006 12:02 pm  

  • This argument about the senior doctors leaving the public hospitals and having only junior and inexperienced doctors in the public hospitals is a myth in my opinion.

    Let me explain.

    Firstly, at the present moment there is already a big exodus of very good consultants leaving the public sector. So despite this "mixed system" in place, it is already happening.

    Secondly, there will always be senior doctors who prefer life in the institutions. They get the benefits of assistance from junior doctors, the entire administrative service etc. There will also be those who like to teach.

    Thirdly, all the public hospitals have to do is to pay the senior doctors the appropriate remuneration that will keep those senior ones in the public sector. It's a free market isn't it?

    You can't and shouldn't have your cake and eat it. What is happening at the moment is that MOH and ther restructured hospitals are trying to have their cake and eat it.

    The restructured hospitals want to have these senior doctors around MAINLY because they can bring in the $$$$$$$$$$. That's how I see it quite frankly.

    Put it this way. If the senior doctor is really just interested in earning $$$$ then he will be the same whether he is with the "mixed system" or the pure private system.

    We know these doctors from our undergrad days. Not very interested in teaching but made to do so and go into the tutorial with black faces.

    So what's the point?

    Personally I know that the excellent and very senior doctors still in the institutions are there not because of money but because they like being where they are. I for one do not believe one iota that should there suddenly be no private patients for them in the public sector, that they would pack their bags and leave for the private sector. As it is they don't see that many private patients anyway. Much of that is also seen by their "team".

    Singapore doctors will know what I mean.....

    By Blogger Dr Oz bloke, At October 29, 2006 6:58 pm  

  • This is a very interesting dicussion... I am not a doctor, but I am very enlightened to have read the politics of medical professionals... I wish there are more discussions like this!

    By Anonymous Anonymous, At October 31, 2006 3:30 pm  

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