Angry Doctor

Monday, June 09, 2008

OK, I'll be good

A reader had this to say about angry doc's posts:

"You seem almost reluctant to take a firm stance on any issue without engaging in an overdrawn rationalization with yourself. Playing "devil's advocate" on a topic is fine if done once or twice, but to do it at every post is, frankly, quite irksome."

In response angry doc would like to mention this news article from Today last weekend:


Take it easy, We have the 3cs
Richard Hartung

ON A recent Sunday morning, a sick young boy stopped at the private clinic near his home with his parents. Less than $30 and 30 minutes later, he was on his way home with a diagnosis, medicine and the reassurance that his illness wasn’t serious.

On a weekday, however, the cost at a polyclinic would have been even lower.

Amid recent complaints in Singapore about high prices and low standards of medical care, this commonplace scene presents a distinct contrast with that of other countries and shows how fortunate we are with healthcare.

Both anecdotes and statistics bear out the high quality overall. If we look at three of the more important factors in healthcare, which one might call the 3Cs — care quality, convenience and cost — we in Singapore should feel good, rather than complain.

There can be little doubt that care quality in Singapore is high. Singapore is ranked sixth globally by the World Health Organisation (WHO), well above developed countries like the United States or the United Kingdom. This high ranking reflects good care in many areas, from paediatrics to geriatrics.

To some, quality of care might also mean spending more time with the doctor. Not in Singapore, though, where faster speed of consultation seems more important. Doctors spending an average of 18 minutes with patients, as they do in the US, might be far too long. If anything, Singaporeans want faster turnaround time for patient-doctor consultations, says a Ministry of Health study.

Healthcare in Singapore is also convenient and available seven days a week. Polyclinics are scattered around the island and private clinics are found in most areas. While some clinics here are open on Sundays or in the evenings so that you can see a doctor almost anytime, just try to find a doctor on a weekend in most other countries. Unless it’s an emergency, it can be difficult at best.

The waiting time to see a doctor here is also comparatively short. In Singapore, the average waiting time at a polyclinic, even without an appointment, is 20 to 40 minutes, according to the MOH survey. This compares favourably with that of other countries.

In the UK, Canada and the US, Commonwealth Fund-supported research shows that most patients can’t even get an appointment on the same day they’re sick and have to wait one to six days to see a doctor. The average waiting time to see a doctor in the US, even with an appointment, is 20 minutes, according to the American Medical Association.

Emergency care is also readily available here. While recent data showing a nine-minute response time for ambulances reflects a longer wait than the best practice of less than seven minutes, the speed has still improved from 11 minutes in the early ’90s and it’s below the average target of 12 minutes in Hong Kong.

Along with the speed of arrival, ready availability of medical care at hospitals means that cases like the widely-publicised story where a woman in an ambulance in Japan died after 30 hospitals refused to accept her seem unlikely to happen here.

Cost is another important component of healthcare, yet it is among the most difficult to measure. With differences in the cost of public and private care, as well as in insurance or government reimbursements, international comparisons are challenging at best.

Still, Singapore appears to fare well on this measure, too. The US remains one of the most costly places to see a doctor, with a visit averaging $84 and a visit to the emergency room at $536, according to health insurer Blue Cross. Even if insurance pays 80 per cent, the cost is high.

Compare that with Singapore, where the average polyclinic visit costs the patient $8.80. This cost is similar to visiting a doctor in Australia, where direct expenses average the equivalent of $8 to $10, or in Hong Kong, where the cost of visiting a clinic is about $10 in Singapore currency.

On a broader national basis, Singapore achieved these levels of carewhile spending about 3.8 per cent of its gross domestic product on healthcare, compared to an average of 8.9 percent in all Organisation for Economic Cooperation and Development countries.

Singapore thus has a good combination of high care quality, high convenience and relatively low cost. Rarely does a country excel in all the 3Cs. Japan may have high quality, being at No 10 in the WHO study, but the cost is also higher. Costs in Australia are similar to Singapore, but on care quality, it is ranked 32nd by the WHO and 46 per cent of Australians said they waited at least a day to see a doctor when they were sick. Other comparisons show similar results.

Despite their complaints, Singaporeans should feel fortunate to have such easy access to affordable, high-quality healthcare. If you need to see a doctor, Singapore hits all 3Cs.

The writer is a consultant who has lived in Singapore since 1992.


angry doc would like to state (without engaging in overdrawn rationalization) that he agrees firmly with the writer's opinion.

We hope this post has been informative.

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