polyclinics pricing
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when i mentioned that some medicines are more expensive at polyclinics than in hospitals some of you were asking for proof and some did not belief that its possible in our system.
well, MP Tan Cheng Bok at yesterday's seating questioned the minister who conceded that he was responsible for this change. -
So wats his reason for such a difference?
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you mean his excuse?
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yep
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His explanation was about being Robin Hood.
Getting the rich to subisidize the poor.
I'm serious.
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charlize:
you must be joking, please re-read his exchange with MP Tan CB. -
That was the bits and pieces I got from watching the Parliament reports at the end of the news.Originally posted by claudetnt:charlize:
you must be joking, please re-read his exchange with MP Tan CB.
You are right, I will go check the full transcript when I have the time. -
You are not exactly right but you've got the drift. They charge cheaper drugs a little more to subsidize the more expensive drugs. So the cheaper drugs are more expensive whilst the more expensive drugs are sold below cost in polyclinics...Originally posted by charlize:His explanation was about being Robin Hood.
Getting the rich to subisidize the poor.
I'm serious. -
well .... i reckon that rising health cost is not solely due to rising prices of medicines alone ....
i've been in and out of hospital several times (cos i'm an overly active boy who's always getting himself injured) ... but I notice that the follow-ups lasts forever ! ...
NUH will ask you to go again and again for follow-ups till the day you die .... and what more ... follow-ups triggers follow-ups ! ....
I remember a time when somehow they wanted to take a urine test off me ... turns out that there seems to be a bit of blood in my pee .... so they asked me to go down for another test.... and another ... and another ... it never ends ! .... with each one of them costing money and time of course ....
now I'm no doctor ... but are all these multiple follow-ups neccessary ? .... I wonder how much of the over-all health costs can be traced to such a practise ....
docs here care to reply ? ... -
Actually doctors in public hospitals would LOVE to discharge patients...we don't want to add on to our workload by unnecessary follow-up with new patients added everyday. But you have to be sure the patient is stable and that you have not missed anything. One mistake and you can get sued and being sued in Singapore means the end of your career...Originally posted by Fatum:well .... i reckon that rising health cost is not solely due to rising prices of medicines alone ....
i've been in and out of hospital several times (cos i'm an overly active boy who's always getting himself injured) ... but I notice that the follow-ups lasts forever ! ...
NUH will ask you to go again and again for follow-ups till the day you die .... and what more ... follow-ups triggers follow-ups ! ....
I remember a time when somehow they wanted to take a urine test off me ... turns out that there seems to be a bit of blood in my pee .... so they asked me to go down for another test.... and another ... and another ... it never ends ! .... with each one of them costing money and time of course ....
now I'm no doctor ... but are all these multiple follow-ups neccessary ? .... I wonder how much of the over-all health costs can be traced to such a practise ....
docs here care to reply ? ...
It's worse if you are a subsidized patient and see different doctors at each visit...to the doctor, he is seeing you for a very short while each time and has to rely on the case notes of other doctors. If he discharges you, he takes the responsibility to say that you are ok....the junior doctors and some foreign doctors would rather not take that risk. After all, they have already seen you, let others make the decision the next round.
If you decide you are fine and not turn up, they won't chase you either. If anything goes wrong, it's your decision not to keep the appointment, not their fault... -
KBW had once again hoodwinked many of us. This time unfortunately making reference to my favorite character - Robin Hood but unlike the “real” Robin Hood who robs from the rich to give to the poor. KBW’s Robin Hood takes away more from the poor!
Polyclinics were established to provide affordable health care to the poor in general which KBW had forgotten since he had not only removed the $1.40 for one weekÂ’s supply of medicines but most of the medications are more expensive than in some of our government hospitals. Not only drugs but also if one cares to check the laboratory charges youÂ’ll find that blood and urine tests are also very expensive when compared to Tan Tock Seng hospital for instance. When pointed out by MP Tan CB that some drugs were cheaper in government hospitals than in the polyclinics, KBW response was to consider increasing the prices of these drugs in hospitals to be in par or more than that of polyclinics. Is this what Robin Hood would have done?
KBW is deceiving the public by his reference to Robin Hood! -
oxford mushroom:
i believe what you had outlined to be generally true. However, there are many instances where some specialist doctors in government hospitals are very fond of referring patients to do blood tests every 3 months especially those patients suffering from high blood pressure? Each test will costs between $45 to 60. In my mum's case the specialist doctor agreed when questioned recently that perhaps doing it once every 6 months will do.
Now, is it possible that in some government hospitals especially the senior doctors are referring patients to do unnecessary tests to recuperate the costs of all those expansive equipment they had procured or to "curry" favours with their superiors for bringing more revenue for the hospitals? -
Wah steady lah.Originally posted by claudetnt:When pointed out by MP Tan CB that some drugs were cheaper in government hospitals than in the polyclinics, KBW response was to consider increasing the prices of these drugs in hospitals to be in par or more than that of polyclinics.
Price differential? No problem, raise the lower price to match the higher price.
Uniquely Singapore. -
dats y many people say 'Can die, cannot fall sick'....now u know the rationale...the saying isn't there for nothing.
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chunyong:
Yes, its better to die than fall sick. -
For the sake of equity, they will have to raise the prices of cheaper drugs in hospitals as well. However, we should see the prices of more expensive drugs drop as a result....the Ministry must demonstrate more transparency in this.
This may sound controversial but I think one way of cutting healthcare costs is to abolish the medical certificate system. Many patients go to polyclinics for the MCs and nothing else...in the UK, you can just call in sick...no MC required. Let companies give employees a fixed number of sick leave per year...if you exceed that, you go on no-pay leave. As for NS boys, let the army MOs deal with them...
Let the polyclinics deal with those who truly need medical care and that will save costs. -
lol to get equity increase the price of the cheaper drugs.....Originally posted by oxford mushroom:For the sake of equity, they will have to raise the prices of cheaper drugs in hospitals as well. However, we should see the prices of more expensive drugs drop as a result....the Ministry must demonstrate more transparency in this.
This may sound controversial but I think one way of cutting healthcare costs is to abolish the medical certificate system. Many patients go to polyclinics for the MCs and nothing else...in the UK, you can just call in sick...no MC required. Let companies give employees a fixed number of sick leave per year...if you exceed that, you go on no-pay leave. As for NS boys, let the army MOs deal with them...
Let the polyclinics deal with those who truly need medical care and that will save costs.
i would have thought lower to try to lower the prices of the more expensive ones. -
oxford mushroom:
i tend to agree with "hisoka". As i mentioned earlier, polyclinics are meant mainly for the poor so why raise the prices of cheaper drugs in hospitals for equity, why not bring the prices down in the polyclinics to match that of the hospitals? If the hospitals can sell the drugs at a cheaper rate why canÂ’t the polyclinics?
i'm not sure about your contention that “Many patients go to polyclinics for the MCs” even so its mostly for minor illnesses - common colds, fever, headaches etc and not for high blood pressure, diabetes, gastro. In fact its some of these drugs that are more expensive in the polyclinics when compared to hospitals. I agree with you they should look at other ways to tackle the problem of Dodgers and not resolve to increase the prices of drugs.
However you’re right “the Ministry must demonstrate more transparency in this.” -
Well, the reason why they charge more for cheaper drugs is to subsidize the more expensive ones, since the government does not want to put more into healthcare expenses. Without that, they have to charge the full costs for the more expensive medicine which some poor patients need but cannot afford....then how??
The reason the hospitals can charge less for the cheaper drugs is because they charge the full amount for the more expensive ones. With hospitalisation, you can use Medisave to pay and so alot of patients don't feel the pinch as much... -
Sorry, I do not buy this line of argument that they charge more for cheaper drugs so as to subsidize the more expensive ones in order to help the poor.
If so, why then are some of these medicines sold in Malaysia, Thailand, Australia and UK cheaper than those at our polyclinics? I don't think the medicines at those private pharmacies are been subsidized!
The Ministry of Health has to come out “clean” and explain its pricing structure and not hoodwink the public that all health care are been subsidized. -
You know the story about nkf and it's profits from selling "subsidized" medicine.
Nobody wants the same scenario to happen to the polyclinics. -
for all you know it may be happening now!
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If so, why then are some of these medicines sold in Malaysia, Thailand, Australia and UK cheaper than those at our polyclinics? I don't think the medicines at those private pharmacies are been subsidized!
Medicines may be cheaper in Malaysia and Thailand cos' the manufacture and retail costs are lower there, just as computers are so much cheaper to buy in Bangkok. I am living in the UK and I can assure you medicines are NOT cheaper here. I don't where you get the idea...you can get free medication under the NHS if you are eligible but if you buy it off the counter, the cost is atrocious.
I don't know about Australia though.. -
Here's an interesting article posted in another thread in Speaker's Corner on this issue.
http://www.sgforums.com/?action=thread_display&thread_id=181932 -
They are following certain guidelines laid out by expert committees on the way a disease should be managed. Ordering unnecessary tests does happen, but it is not to earn money, but to protect the doctor's backside. Without lab tests, doctors have to rely on their clinical skills and experience to make decisions. All the responsibility falls on them. Sometimes they make a bad decision and they can be sued. On the other hand, even if you make a bad call based on an erroneous lab result, you can blame it on the tests results and the lab.Originally posted by claudetnt:Now, is it possible that in some government hospitals especially the senior doctors are referring patients to do unnecessary tests to recuperate the costs of all those expansive equipment they had procured or to "curry" favours with their superiors for bringing more revenue for the hospitals?
Most patients are subsidized patients anyway, and unless you are a private patient, the hospital actually loses money on lab tests. The government provides a fixed subvention for subsidized patients and if you use it up on unnecessary lab tests and go into deficit, the hospital has to pick up the tab.
You can only earn money on the private patients. So if the intention is to earn money on lab tests, what will happen is that they overservice the private patients and deny subsidized patients even necessary tests. I don't think that is the case because doctors are afraid of being sued, and it is more likely that they would overservice patients just so that they cannot be blamed if something goes wrong. Therefore I really think the reason for unnecessary tests is because doctors don't want to be sued...they want to protect their backsides. I know that is true because I have done it myself
By the way, hospitals earn more money on operations rather than lab tests. That is why they are outsourcing X-rays and other tests to India...to cut their overheads and increase their margins. If we can earn so much from diagnostic tests, why are we so keen to send them away? No, the fact is that we lose money from these tests.
If doctors want to please their administrators, they will do more cosmetic surgery, put in breast implants and do laser keratoplasty (for shortsightedness), not order more lab tests.
BTW, I didn't realize that polyclinics charge more for lab tests than TTSH.....most polyclinic lab services are outsourced to private labs. If TTSH labs can do it motre cheaply, I cannot understand why they continue to outsource the service either...