Angry Doctor

Friday, December 24, 2010

A penny for your thoughts? 5

Just to give an example of how much information may be required in the filling of a medical report, angry doc snapped a picture of a typical medical report request from an insurance company:

So how much do you think a doctor should charge for providing this medical report?

Friday, December 17, 2010

A penny for your thoughts? 4

At first, it was a case of overcharging.

Then, when it was pointed out that it's in fact a case of undercharging, it became an issue with inefficiency.

Now, it seems that how much it costs isn't really an issue, as long as the "consumer" doesn't have to pay for it.

angry doc buys medical and travel insurance, and he would rather the insurance company "pay" for the medical report than if he paid out of his own pocket. However, even though angry doc is a doctor and not an ex-CEO of an insurance company, he is not naive enough to think that the medical report becomes "free" to him just because it is "paid for" by his insurance company.

The wonderful thing about insurance companies, like casinos, is that they have a whole bunch of people curnching numbers to make sure that the odds are always in their favour, and that their employers' profit margin is always looked after - if the cost of the medical report is absorbed by the insurance company, angry doc is pretty sure that it will be worked back into the equation, either through higher premiums, and lower payouts, such that the company's bottom-line stays where it is.

So at the end of the day, we still have to pay for what we want or need, regardless of how reluctant we are, and regardless of how little we price (note that I say 'price', not 'value') other people's work.

angry doc is pretty sure Mr Tan knows that; he's just confused as to why he would write as if he didn't.

Tuesday, December 14, 2010

A penny for your thoughts? 3

Mr Tan defends his $30 price-tag for a medical report on his blog.

angry doc is no longer surprised by how people who cannot and do not produce a goods or a service nevertheless feel they have a right to tell those who do how much to charge for what they produce; but he *is* surprised by how someone with Mr Tan's work experience views the issue of medical report.

What exactly does Mr Tan mean when he refers to a "routine report", which he suggested doctors charge $30 for? If it was simply a case of to "write down what is the problem with me relating to a specific medical condition", then angry doc would say that most doctors will probably not charge a separate fee at all, but consider it as part of the consultation. But is that really all that is required "to support an insurance claim or application for insurance"?

Doctors (and patients) who have been asked to fill up a "routine" insurance claim form will realise that that is not the case; the typical insurance claim form runs to nearly a dozen pages, and oftentimes requires a doctor to report the reason for consultation, diagnosis made, and treatment rendered for *every* visit the patient made to a clinic!

Blogger Cyke also points out that the cost of a medical report do not just go to the doctor's fee, but includes the administrative work required.

Those facts aside, we are still left with the subjective question of when a fee is considered "excessive".

Doctors, and the institutions they work for, charge at the end of the day "what the market will bear", which is to say what they can get away with. So if, as Mr Tan seems to believe, "there is no free market here - but a monopolistic situation", why aren't doctors charging say $800 instead of $80 per medical report? Why do most restructured hospitals charge a fee around that mark?

Well, because there is a market here, despite what Mr Tan claims - a doctor (or hospital) who charges $800 per medical report on a routine basis will find himself off the approved list by insurance companies, and unless he is really that good, find that few patients will go to him.

Mr Tan asks: "The consumer would want a low cost, and the doctor would want a high cost. How can this be resolved in the "free market environment" in Singapore?"

Well, angry doc asks: "What is driving the demand for medical reports?"

If you know why people want medical reports, if you understand why they need medical reports, then perhaps you will begin to have a clue as to how to lower the cost for medical reports (or do the reverse...).

Wednesday, December 08, 2010

A penny for your thoughts? 2

Q1: What does it take to claim that doctors charge "excessively" for writing medical report?

A1: A Blogger account.

Q2: What does it take to write a medical report?

A2: Five years of medical school, a year of housemanship, several years of relevant post-graduate training, time to read through a patient's medical records and investigation results, knowledge to understand the significance of each, the ability to synthesise all that information and present it in a format that addresses the relevant issues required by the side requesting the medical report, and finally the balls to stand by and back up what you wrote in a court of law if necessary.


Saturday, December 04, 2010

Standing up for the 'godless'

angry doc wasn't aware this special report (who reads newspapers these days anyway?), but thanks to this letter in the ST Forum, he is clued in:

You don't need faith to be good

THE Saturday Special report last week ('God wants youth') stated that religious groups were determined not to lose a generation to godlessness, especially now with youth gangs in the news.

It also noted that what is at stake is the potential of losing the youth to cynicism, violence and even fanaticism.

These remarks suggest a prejudice against those without any religious affiliation.

The last census in 2000 showed that roughly 15 per cent of Singaporeans did not have any religious affiliation.
The article essentially suggested that this group, 'the godless', are cynical and prone to violence.

As a society for non-believers, the Humanist Society (Singapore) disagrees.

The reality in societies everywhere is that there is no difference between non-believing youth and the religious youth in their propensity towards violence. There are actually higher levels of violence among those who identify themselves as 'religious' or 'faithful'.

As for cynicism, there is certainly no correlation between non-belief and a cynical attitude. Many non-believers are involved in the world around them, trying to make it a more humane, compassionate place.

The two largest charitable donations in the history of the world were by atheists: American investor Warren Buffett and his fellow American Bill Gates of Microsoft donated US$30 billion (S$39 billion) and US$11 billion respectively to the Bill and Melinda Gates foundation, a charitable organisation whose main goals are to enhance health care and reduce poverty worldwide.

I know of many non-believers, people who identify themselves as humanists, atheists and agnostics, who regularly donate to charity. Many also do volunteer work for humanitarian causes.

One does not need to have a religion to lead a good, happy and meaningful life and to have compassion for our fellow human beings.

Paul Tobin
Humanist Society (Singapore)

Now angry doc thought the statements:

"The reality in societies everywhere is that there is no difference between non-believing youth and the religious youth in their propensity towards violence. There are actually higher levels of violence among those who identify themselves as 'religious' or 'faithful'."

were contradictory, and so he went to look up the Humanist Society's webpage; sure enough the original letter submitted by Mr Tobin read (emphasis mine):

"The reality in societies around the world is that there is either no difference between non-believing youth and the religious youth in their propensity toward violence or there is actually higher levels of violence among those who identify themselves as "religious" or "faithful." [See, for instance, the studies cited in Michael Shermer’s book “The Science of Good and Evil” 2004 pp. 235-236]"

That made more sense...

If the Humanist Society sounds familiar to you (as it did to angry doc), it may be because you've read about them earlier in this news report; a bit of equal air-time, perhaps?

angry doc is ambivalent about the idea of a group that aims to shape our society based on humanist ideals ('ethical' and 'humane' aren't really angry doc's favourite words, you understand...), but he can see why some people feel the need for those without religious affiliation to come together to represent their interests - the fact that "community leaders" believe that the social problems such as gangsterism and dysfunctional families can be solved by making young people believe in the same gods as they do is a scary thought indeed.

angry doc will not be rushing to join the Humanist Society yet, but he certainly thinks it is an organisation to watch.

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Thursday, December 02, 2010

My Foot!

(Posted on the Singapore MD blog)

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Sense and Sensitivities

(Posted on the Singapore MD blog)

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