Healthcare: Tale of two nations
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Originally posted by fymk:Snow leopard
No such thing as cheap healthcare for all - everything comes with a price tag. Either through taxes or through a private system.
sure , go fight the patents set on those new and fancy and EXTREMELY PRICEY life saving medications/technologies etc. Herceptin for breast cancer at market price is at least 60k for the whole treatment, interferon A and ribavirin ( for hep c treatment) is at least 12k per 2 months . Linezoid ( stronger than vancomycin - an antibiotic to kill a type of super bug ) costs at least 3k per treatment without subsidy . One video gastroscope costs AT VERY LEAST 16 k and 2k per year to maintain at a good condition. Colonscope costs 26 k or so depending . You know the fancy automated blood pressure machines they have in SGH triage and wards? At least one is worth 15k. Not even including in biomedical maintenance . Oh yeah let's not forget surgical sterilisation - ethane oxide , gamma radiation etc
You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well )
Don't forget doctors most likely want to do postgrad studies and get fellowship of some society i.e. Royal College of general practitioners ,American Society of Cosmetic Surgeons etc. To acquire skills of a surgeon or any specialty is long and tedious work . To achieve fellowship of a reputable organisation means alot of hardwork placed in by the medical specialist . He probably won't have time to socialise when he was just starting out unlike other grads in business etc , won't have much sleep at home , he will have been continually updating himself on new knowledge , new treatments etc . Everything is run on an evidence based type of decision. In fact his life since med student to training to consultancy would have meant he has made a personal sacrifice - his social life, his leisure time gone. By then he is wanted all over the world and offers come in . Do they deserve such pay? Yes.
I rather pay the premium to see my current specialist than some cheap doctor because he was the only doctor who managed to figure out my problem out of the other 15 doctors I have seen. I have a rare condition . That's quality for you. So if you rather get quantity instead of quality - too bad.
Oh yeah by the way , demand for doctors are very strong all over the world especially oncologists , pathologists , O&G etc- they get snatched up like hot pies . So if you want a choice of how much to pay your doctor - don't worry , there is another country waiting to offer him a place with a pay to better what he might get. Same goes for nurses . Same goes for physiotherapists . Same goes for speech pathogists.
Alot of people think just because a health professional ( be it doctors or nurses) want to be a health professional , it should mean that they should get paid poorly for their hardwork and long hours and the pressure because of their perceived calling. Why don't you apply the same principle to the pharmaceutical companies and medical technology companies and see if they give a hoot.
The real issue is how much is the government really willing to subsidise you and yet be able to retain quality staff with some incentives.
one of my my ex-bosses is a private specialist with 20 years of experience as well and he earns 26k per month on average. And slightly more than half of his 26k goes back into upgrading his own equipment (medical equipment are good for at least 5 years but after you better have the money to replace them) or maintenance or insurance for equipment and himself or paying to go for professional development courses to upgrade his skills which cost around the figure of 2k-3k per module /workshop etc . Sometimes he would see patients who are really really poor and charge them nothing. He is very well off ,yes , no doubt about it but he worked hard to be where he is today , for years of sleepless nights, on call duties , plus working as a student while studying in medical school to support himself etc . Why would I know all this? Because I once wanted to be a doctor and he told me what to expect : "Once you graduate , you don't expect to just go YIPPEE I AM A DOCTOR - you have to constantly upgrade knowledge or else you are not being fair to your patient. it is a lifelong commitment and you cannot expect to slacken in any areas because you are responsible for your patient's life " -
i quote myself again "they'd probably need at least $10,000 a month to be happy." so on the contrary i'm not limiting their pay to 50% percentile. i'm putting them right on top although i am advocating that between top and the rest, the gap shouldn't be like $17k ($20k - $3k).
I might have misunderstood you then. I think most doctors will be happy with about 10k a month. As I said, there is a huge gap in salaries among doctors as it is. As I said, we have surgeons who earn close to a million dollars a year and on the other hand, a young doctor in the public hospitals 5 years after graduation is getting about 5k to 7k. Unless they specialize, their salary will remain stagnant for a long time. Highly trained consultants get as little as 9k to as much as 30k for surgeons. So far I have been talking about doctors in the public sector. The pay in the private sector is at often 2-3 times higher.
If you look at the average salary of doctors as reported by Asiaweek, the figure of USD 4386 per month is closer to the 10k you spoke of.
(http://www-cgi.cnn.com/ASIANOW/asiaweek/features/salaries/2000/popups/content/sing.html).
However, what the average figure does not reveal is the huge discrepancy in pay between doctors. The doctor you quoted with a salary of 20k a month is definitely not the usual, he is in the minority. Many of your neighborhood GPs can only dream of a 10k monthly salary.
As a result of the wide gap in salary between doctors in the public versus those in the private sector, about half of doctors registered in Singapore are working in the private sector but the public sector sees double the number of patients. Low pay and heavy workload are the two main complaints of doctors in the public sector and as you might have read in the papers in recent years, there has been a continuing exodus of senior doctors to the private sector. To make medical fees lower than they are in the public sector, there is no other way apart from hiring cheap foreign doctors. Lowering doctors' salaries in public hospitals will drive far too many out in the private sector and overseas that we will have to replace them with foreign talent.
BTW, if you are talking about the big gap in salary between Singaporeans, why gripe about doctors? The difference between 20k and 3k is big but what about the difference between the pay of a cabinet minister and the 3k you spoke of?
In a globalised economy and when our doctors have qualifications that are recognized internationally, we have to pay competitive rates to keep the best people. If cheap healthcare is more important than quality (which fymk opposes), then the only way is to bring in cheap foreign doctors and accept lower quality medication and treatment. Mind you, the quality is lower but still high compared to many third world nations....but we must be willing to accept one form of treatment for the rich, another for the poor.
However, I do agree that the salary of some doctors are just far too high. If someone posseses a unique skill then he can certainly command a high salary...I have no issue with that. If he is the only person in the world who can do heart transplants and we need this operation, then we have to pay whatever price he calls. But why should all surgeons be paid more highly than say, psychiatrists of equivalent senior and experience? -
You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well
I do agree with you, fmyk that quality comes at a price and the government in Singapore is already subsidizing alot, especially relating to hospital treatment for C class patients.
However, for some Singaporeans that is not enough. Perhaps they have difficulty holding to a job that pays reasonably well, perhaps their jobs have been outsourced to China and India, perhaps they are just too weak and ill to work...whatever..
For Atobe and others who demand a cheaper healthcare system comparable to hospitals in JB and Thailand, I cannot see a solution unless we offer a more basic level of healthcare and import foreign labour. Like the factory workers from Maxtor whose jobs got outsourced, our doctors will have to upgrade their skills to offer a premium service for the wealthy, emigrate or accept a much lower salary with the influx of foreign talent.
However, I suspect that Singaporeans will also complain. The fact that the rich get Herceptin and the poor do not will be a source of unhappiness. I fear that there are those who want the best at the lowest price and still think it is the government's job to get them that impossible deal. Even if the governmemt agrees, they will have to raise taxes to finance a cheap, high quality healthcare system but then the citizens will also complain about paying more taxes..
Damned of you do...damned if you don't. -
This is where I disagree. Surgeons have a technical skill and a certain set of physical criteria they have to have. They have to have steady hands to operate. Now a psychiatrists sit and talk to patients - prescribe medications etc . Surgeons are different - they are at risk of being exposed to biohazards especially when they doing their jobs in a body cavity full of blood, serous fluid etc.Originally posted by oxford mushroom:However, I do agree that the salary of some doctors are just far too high. If someone posseses a unique skill then he can certainly command a high salary...I have no issue with that. If he is the only person in the world who can do heart transplants and we need this operation, then we have to pay whatever price he calls. But why should all surgeons be paid more highly than say, psychiatrists of equivalent senior and experience?
Depending on what type of surgery they do as well. Cosmetic surgeons come pricey because they do mostly aesthetics on the human and fine sewing . let's say if a person's hand get sawed off by accident - who do you think will be doing delicate microsurgery? a psychiatrist?
Not forgetting their personal equipment like those magnifying glass googles etc . How about maintenance or even sterilisation ? -
You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well
wtf...
12 pills of that costs 70 bucks?
OMG...i rmbr seeing the price on the tablets..
250mg costs like 30 malaysian cents...
the pharmecuticals must be making a big killing there..
* faints *
70 bucks..does it includes treatment too?..
or consultation? -
Originally posted by fymk:
No such thing as cheap healthcare for all - everything comes with a price tag. Either through taxes or through a private system.
i never used the word 'cheap', i said 'affordable'. if we resign to the fact that health care has to be expensive, then it will forever remain expensive. but ingenious businessmen didn't stick to that thinking but sought ways and means to bring down costs, like outsourcing. perhaps we should put on our thinking caps as well?
sure , go fight the patents set on those new and fancy and EXTREMELY PRICEY life saving medications/technologies etc. Herceptin for *#$*^@ cancer at market price is at least 60k for the whole treatment, interferon A and ribavirin ( for hep c treatment) is at least 12k per 2 months . Linezoid ( stronger than vancomycin - an antibiotic to kill a type of super bug ) costs at least 3k per treatment without subsidy . One video gastroscope costs AT VERY LEAST 16 k and 2k per year to maintain at a good condition. Colonscope costs 26 k or so depending . You know the fancy automated blood pressure machines they have in SGH triage and wards? At least one is worth 15k. Not even including in biomedical maintenance . Oh yeah let's not forget surgical sterilisation - ethane oxide , gamma radiation etc
but these are rare illneses that consitute only a small percentage of total hospital / clinic visits. Mr Oxford has already helped us categorise illnesses and specifically targeted the common diseases like cough and flu for cost cutting. i think so too and in fact made the same suggestions in another thread much earlier. we can't save on the expensive procedures nevermind, but we can do something about the expensive doctor being used to diagnose our coughs and flus right? surely these can be performed by the nurse or the phamacist or in Mr Oxford's opinion, doctors from low cost countries?
You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well )
it doesn't matter how much the govt is subsidising. it is still a costly issue, otherwise it wouldn't have been so fervently debated both in and out of parliament. we need to do something and not say "oh, we actually have more subsidies than USA therefore we should shut up".
Don't forget doctors most likely want to do postgrad studies and get fellowship of some society i.e. Royal College of general practitioners ,American Society of Cosmetic Surgeons etc. To acquire skills of a surgeon or any specialty is long and tedious work . To achieve fellowship of a reputable organisation means alot of hardwork placed in by the medical specialist . He probably won't have time to socialise when he was just starting out unlike other grads in business etc , won't have much sleep at home , he will have been continually updating himself on new knowledge , new treatments etc . Everything is run on an evidence based type of decision. In fact his life since med student to training to consultancy would have meant he has made a personal sacrifice - his social life, his leisure time gone. By then he is wanted all over the world and offers come in . Do they deserve such pay? Yes.
you sound as though doctors are the only ones who work long hard hours while people from other occupations laze around and sleep. a fresh accounting grad who works in the audit line will easily work past midnight for months on end for a miserable pittance. a software engineer may have to camp in office during project milestones. a teacher has to stay at home and mark books while his / her friends are out partying on weekends. come on, who doesn't work hard?
as for whether or not he deserves his pay, your opinion is as good as mine. but in case you're thinking that i don't think they deserve their pay, i would like to repeat again that society accords them a premium and prestige and no one, not even me can take away from them. however, market forces of supply and demand needs to be in place to bring about a fair price and hopefully and affordable one for all.
I rather pay the premium to see my current specialist than some cheap doctor because he was the only doctor who managed to figure out my problem out of the other 15 doctors I have seen. I have a rare condition . That's quality for you. So if you rather get quantity instead of quality - too bad.
that's the thing, you have a rare condition. no one else has that. it is right that you pay a premium for your conditions but it is not alright for us to be paying the same price to see the same doctor.
Oh yeah by the way , demand for doctors are very strong all over the world especially oncologists , pathologists , O&G etc- they get snatched up like hot pies . So if you want a choice of how much to pay your doctor - don't worry , there is another country waiting to offer him a place with a pay to better what he might get. Same goes for nurses . Same goes for physiotherapists . Same goes for speech pathogists.
that's why i said from the beginning that if we can, lower the cost of doctor's wages up to a level where they can still feel proud about their profession.
Alot of people think just because a health professional ( be it doctors or nurses) want to be a health professional , it should mean that they should get paid poorly for their hardwork and long hours and the pressure because of their perceived calling. Why don't you apply the same principle to the pharmaceutical companies and medical technology companies and see if they give a hoot.
i'm not quite sure about that. on the contrary, most people i know expect doctors to be highly paid.
The real issue is how much is the government really willing to subsidise you and yet be able to retain quality staff with some incentives.
you see, that's all you see. try and go through the level 1, 2, 3 proposal by Mr Oxford ...
one of my my ex-bosses is a private specialist with 20 years of experience as well and he earns 26k per month on average. And slightly more than half of his 26k goes back into upgrading his own equipment (medical equipment are good for at least 5 years but after you better have the money to replace them) or maintenance or insurance for equipment and himself or paying to go for professional development courses to upgrade his skills which cost around the figure of 2k-3k per module /workshop etc . Sometimes he would see patients who are really really poor and charge them nothing. He is very well off ,yes , no doubt about it but he worked hard to be where he is today , for years of sleepless nights, on call duties , plus working as a student while studying in medical school to support himself etc . Why would I know all this? Because I once wanted to be a doctor and he told me what to expect : "Once you graduate , you don't expect to just go YIPPEE I AM A DOCTOR - you have to constantly upgrade knowledge or else you are not being fair to your patient. it is a lifelong commitment and you cannot expect to slacken in any areas because you are responsible for your patient's life "
he's a good doctor no doubt. i understand what you're saying, for it is the same with my brother, although he is perfectly happy with it.
i too once sat in front of a panel of interviewers for enrolment into medical school. i'm happy it didn't come through, not because i could avoid all those late nights and long hours, for meaningful work is a fulfilment in itself, but rather, it simply wasn't my calling ... -
Originally posted by oxford mushroom:
I might have misunderstood you then. I think most doctors will be happy with about 10k a month. As I said, there is a huge gap in salaries among doctors as it is. As I said, we have surgeons who earn close to a million dollars a year and on the other hand, a young doctor in the public hospitals 5 years after graduation is getting about 5k to 7k. Unless they specialize, their salary will remain stagnant for a long time. Highly trained consultants get as little as 9k to as much as 30k for surgeons. So far I have been talking about doctors in the public sector. The pay in the private sector is at often 2-3 times higher.
no problems, i don't know many doctors but in general, what i'm saying is that if we really have a situation whereby some doctors are grossly overpaid, then the disciplines where these doctors come from can surely afford to take in more market forces to bring about a balance between pay excesses and public healthcare quality and costs ...
BTW, if you are talking about the big gap in salary between Singaporeans, why gripe about doctors? The difference between 20k and 3k is big but what about the difference between the pay of a cabinet minister and the 3k you spoke of?
well, i've always taken issue with ministerial pay right from the day i stepped into this forum ...
In a globalised economy and when our doctors have qualifications that are recognized internationally, we have to pay competitive rates to keep the best people. If cheap healthcare is more important than quality (which fymk opposes), then the only way is to bring in cheap foreign doctors and accept lower quality medication and treatment. Mind you, the quality is lower but still high compared to many third world nations....but we must be willing to accept one form of treatment for the rich, another for the poor.
i agwee with you about the common flu and cough category (i can't remember the terms u used). in addition, i also feel that nurses and pharmacists have a role to play in this respect.
However, I do agree that the salary of some doctors are just far too high. If someone posseses a unique skill then he can certainly command a high salary...I have no issue with that. If he is the only person in the world who can do heart transplants and we need this operation, then we have to pay whatever price he calls. But why should all surgeons be paid more highly than say, psychiatrists of equivalent senior and experience?
well ... i wouldn't stop at that, if there is only one doctor who can perform that operation, then surely we're not training enough? -
[/b]Originally posted by snow leopard:
Originally posted by fymk:
i never used the word 'cheap', i said 'affordable'. if we resign to the fact that health care has to be expensive, then it will forever remain expensive.Singaporean healthcare is affordable as it is for the quality you are getting . Want to compare? To see an australian gp - you pay around 30-39 dollars (of course medicare rebates 27 dollars or so) . Essential drugs separate - but they come under PBS with a limit of 23.70 per medication you buy . Singapore gps , last I heard from my mom cost around 35 with drugs inclusive.
we can't save on the expensive procedures nevermind, but we can do something about the expensive doctor being used to diagnose our coughs and flus right? surely these can be performed by the nurse or the phamacist or in Mr Oxford's opinion, doctors from low cost countries?
Who use the doctor to diagnose in the first place? How many people used to abuse the emergency system to see doctor for cough and cold before they started charging for non emergency cases? Flu is a different thing from a cold - smiliar to a cold but with more complications. And rare illnesses - it is a human right to universal health care regardless of how rare your condition is . I went to see private specialists because I was sick of how the public system was bouncing me about to see registrars only or gps
it doesn't matter how much the govt is subsidising. it is still a costly issue, otherwise it wouldn't have been so fervently debated both in and out of parliament. we need to do something and not say "oh, we actually have more subsidies than USA therefore we should shut up".
I am not saying we should shut up . I am telling you to look at the prices of things, from medication to equipment to biomedical engineering maintenance , everything has to be maintained for patient safety - not everything is about wages. Everyone wants the world class service but no one wants to pay. Why not look at who is getting the pay - the hospital doctors aren't the ones earning 1 million dollar salaries - the nurses aren't the ones who earn 1 million dollar salaries.
The administrators are earning more than what the health professionals earn. Why not say cut their pay after all CEOs just do managerial stuff instead of the dirty work - they are the ones earning the premium. Cut management ? Ask your policy makers to centralise everything instead of dividing things in regions when Singapore is so small. You will make healthcare affordable but of course the staff in those regional divisions will complain about their jobs getting cut. Look at the bigger picture where your money goes .
Everyone can get the C class ward but not so much treatment options then. Shut down the 24 hr fancy radiology clinic . Everyone waits to get an xray done from the emergency clinic according to priority. No fancy electronic beds. Get relatives to do the cleaning , clothing and feeding of the patients instead of the nurses - this way you don't need to pay for health assistants, food and laundry service. Now that is a cost cutting measure for you. Just pay for the bed. No frills for affordability
.
Oh by the way , forget the nice triage areas in SGH. More cost cutting measure. Just consolidate it into one triage area and one triage nurse and everyone waits. That is what one australian hospital did to me . I had to stand in line til I nearly turn blue from my pneumonia - but hey it is free , no complaints there - just wasn't nice to end up in the resus bay when the triage nurse saw me . No need to employ foreigners since it is to cut off staff and cut off costs. If you want to employ foreigners, don't blame them if they cannot catch what you are saying. There was a few complaints in australia already about overseas health workers not understanding english and that impediment costs lives. But hey never mind, you did say you want it affordable.
Oh yes and always give the willing payers what they want - if they pay - they jump the queue. Fair for those who want no frills , no fancy specialist and just long waitlists .
No guessing how many singaporeans will angrily write in about "service".
Do you seriously want a second hand MRI machine to do an MRI scan on you with all those electromagnetic and radiation fields ?
If computers spoil , it is ok since you can replace it. If a human dies, you cannot replace that individual. You can outsource everything but at what risk? Penny wise pound foolish. -
Originally posted by snow leopard:
you sound as though doctors are the only ones who work long hard hours while people from other occupations laze around and sleep. a fresh accounting grad who works in the audit line will easily work past midnight for months on end for a miserable pittance. a software engineer may have to camp in office during project milestones. a teacher has to stay at home and mark books while his / her friends are out partying on weekends. come on, who doesn't work hard?Worked in an acute clinical setting before?
A teacher has to mark her books , a software engineer has to fix something before a deadline, accounting grad has to work for her miserable pittance. Software late only mean profit loss and auditing - but money can be earnt again. Marking books - make a mistake and you just cancel the mark and change it . Lose a life and you remember it for the rest of your life.
Oh WHO IS ACTUALLY MAKING THE MOST MONEY? It most certainly isn't the doctor. It is the CEO who probably has an MBA running the system and his managerial minions.
I think the interns when I was working in singapore were working non stop when they are on call for 72 hours. Then they have consultants who will come down in the middle of the night because the patient require their expertise for treatment. I remembered I had to call one consultant in the middle of his sleep because a patient was vomiting buckets of blood . He came down asap . And no, I am just a nurse, not a doctor.
The doctor, the nurses are exposed to a sick environment , a life to save , a life to treat, they have to think on their feet , they are exposed to lithigation , they are exposed to the risk of HEP C , HIV , HEP B during a procedure , they are exposed to abuse from relatives or patients. Doctors have to pay medical indemnity insurance - they don't come cheap.
Remember SARS? It attacks the frontliners too like doctors and nurses in the workplace while the accountant grad , teacher , and engineer can just stay at home safe from the pandemic . Everytime a doctor or a nurse attends to a patient , they run a risk of getting exposed to a disease.
Just funny during the SARS period , someone from MOH called my mom up to ask if I was around to do nursing in Singapore or to come back to help out. WHY? because their health professionals are dropping like flies from SARS. SARS was a big one since it killed young , old , healthy and unhealthy people. I knew ex colleagues and ex schoolmates from my nursing school getting quarantined or hospitalised from exposure. High risk job = better pay .
Frankly I think they should pay nurses more but they are controlling the pays because the govt need to keep cost down. There u go - cost cutting!
Want to know why Singaporean nurses are going to other countries? They pay better. Same for your doctors. Go and deprive your well qualified doctor of his incentive to stay with you and I am sure foreign countries will welcome him.
as for whether or not he deserves his pay, your opinion is as good as mine. but in case you're thinking that i don't think they deserve their pay, i would like to repeat again that society accords them a premium and prestige and no one, not even me can take away from them. however, market forces of supply and demand needs to be in place to bring about a fair price and hopefully and affordable one for all.
that's the thing, you have a rare condition. no one else has that. it is right that you pay a premium for your conditions but it is not alright for us to be paying the same price to see the same doctor.
that's why i said from the beginning that if we can, lower the cost of doctor's wages up to a level where they can still feel proud about their profession.
I am not saying about rare or not rare condition. I am saying I rather pay for quality. Would you be seeing my doctor at all? You could go and see the polyclinic doctors. I used to see polyclinic doctors for mild ailments - they are cheap. Lower the cost of the doctor's wages? Sure . Get lithigation control laws in so that indemnity insurance don't rise. Get indemnity limits on how much the insurance company can raise premiums.
i too once sat in front of a panel of interviewers for enrolment into medical school. i'm happy it didn't come through, not because i could avoid all those late nights and long hours, for meaningful work is a fulfilment in itself, but rather, it simply wasn't my calling ..
I got into graduate medical school in australia. Couldn't pay for the education upfront so decided not to risk it because I am no longer young and the pathways to become a specialist is long and tedious and I didn't want to sign a bond to do six years of outback medical service . So now I do data analysis in the public health sector for something related to nursing but involves no nursing. -
This is where I disagree. Surgeons have a technical skill and a certain set of physical criteria they have to have. They have to have steady hands to operate. Now a psychiatrists sit and talk to patients - prescribe medications etc . Surgeons are different - they are at risk of being exposed to biohazards especially when they doing their jobs in a body cavity full of blood, serous fluid etc.
That is not true...actually surgeons are the easiest to replace precisely because their work is more about skill with the hands than knowledge-based. You can train an Indian surgeon to do a colectomy as well, if not better, than our local surgeons. Psychiatrists have to understand the local culture and background cos mental illnesses are culturally coloured. So it is easier to replace our surgeons than psychiatrists.
Depending on what type of surgery they do as well. Cosmetic surgeons come pricey because they do mostly aesthetics on the human and fine sewing . let's say if a person's hand get sawed off by accident - who do you think will be doing delicate microsurgery? a psychiatrist?
That's probably the first thing we will do to lower healthcare costs. We will continue to pay high fees for those with skills that cannot be replaced easily, like some transplant surgeons but the bulk of our surgeons can be replaced.
And in case people don' know, the surgeons do not make the diagnosis of a tumour. That's often detected by the radiologists or physicians and the diagnosis is made by a pathologist, whom people don't know about or see. The surgeon is just like the plumber who takes out diseased parts and straighten out the plumbing.
No intention to denigrade the surgeons here but our surgeons are paid far too much compared to those in the UK, when their skills are replaceable by those in Indian in the large part. -
Originally posted by blackchickenahkai:
30 malaysian cents? must be generics lor
[b]You will be surprised at what the government is subsidising. In USA ,12 pills of amoxycillin 250 mg costs 70 bucks ( this is from an american friend who got a shock thinking there was a pharmaceutical sale when he was told to pay 11 dollars in australia for his antibiotic and in Singapore the antibiotic would be cheaper as well
wtf...
12 pills of that costs 70 bucks?
OMG...i rmbr seeing the price on the tablets..
250mg costs like 30 malaysian cents...
[/b] -
well ... i wouldn't stop at that, if there is only one doctor who can perform that operation, then surely we're not training enough?
You have to get the person with the specialized skill to train your new doctors right? So if I am the only one in the world with a particular skill, why should I train you unless I can paid an obscene amount for it? So that's where patents come in...without patent protection of some kind, we will not get the transfer of knowledge that we need to bring our medical treatment to world class standard.
So we will always have to pay a premium for specialised skills. Just as Singapore doctors must acquire higher skill sets than doctors from third world countries. Patients who only require and are happy with more basic medical treatment can get it cheap from cheap foreign doctors. Those who require and are prepared to pay can have access to cutting edge medicine provided by doctors with the specilaised skills. -
sorry..Originally posted by oxford mushroom:30 malaysian cents? must be generics lor
it's rm1.20
got y stats wrong
-
Fymk has a point about CEO though. We seem to be quite happy for CEOs and fund managers to earn mllions of dollars a year but people object to doctors getting rich in their jobs. I wonder why? The talent, training and responsibilities of a doctor are more than those of a CEO and fund manager. Of course you can lose millions if a fund manager makes a mistake, but a doctor who makes a mistake can lose a human life.
Yet perhaps we think we need to pay more to safeguard our millions rather than a single human life... -
The doctor, the nurses are exposed to a sick environment , a life to save , a life to treat, they have to think on their feet , they are exposed to lithigation , they are exposed to the risk of HEP C , HIV , HEP B during a procedure , they are exposed to abuse from relatives or patients. Doctors have to pay medical indemnity insurance - they don't come cheap.
About paying medical staff more for the risk they are taking, I do agree with you, for we had been involved with SARS patients as well. That is the reason those who work in oil rigs and soldiers in the frontline of battles get extra pay.
Remember SARS? It attacks the frontliners too like doctors and nurses in the workplace while the accountant grad , teacher , and engineer can just stay at home safe from the pandemic . Everytime a doctor or a nurse attends to a patient , they run a risk of getting exposed to a disease.
Just funny during the SARS period , someone from MOH called my mom up to ask if I was around to do nursing in Singapore or to come back to help out. WHY? because their health professionals are dropping like flies from SARS. SARS was a big one since it killed young , old , healthy and unhealthy people. I knew ex colleagues and ex schoolmates from my nursing school getting quarantined or hospitalised from exposure. High risk job = better pay .
Unfortunately, our government does not see it that way. I am not even talking about pay here but medical benefits. It used to be that medical staff (doctors, nurses) in the public sector get free medical care. That is also a remnant from the Hippocratic oath that says that we doctors will treat our teachers and their families for free. In the past, it used to be a professional courtesy to treat fellow colleagues for free.
All that changed when LHL, now our PM, scrapped the free medical benefits for health professionals. When he was asked specifically that since medical staff are exposed to infections and can contract illnesses from their patients, don't they deserve free medical benefits?
His reply was, "Just because you are a gynaecologist doesn't make you pregnant."
Wonder why nobody asked him for a response when our doctors and nurses came down with SARS... -
Originally posted by fymk:
Worked in an acute clinical setting before?
no. so?
A teacher has to mark her books , a software engineer has to fix something before a deadline, accounting grad has to work for her miserable pittance. Software late only mean profit loss and auditing - but money can be earnt again. Marking books - make a mistake and you just cancel the mark and change it . Lose a life and you remember it for the rest of your life.
you belittle other professions. a teacher molds characters and ultimately help shape lives, not just one or two but many, many lives. a piece of software operating the Boeing 777 cannot go wrong, for the entire aircraft's passengers' lives depend on it. the engineer or architect whose design or construction goes wrong can mean an entire building's collapse, along with the people working in it. i think it is meaningless haggling over whose work is more impt.
Oh WHO IS ACTUALLY MAKING THE MOST MONEY? It most certainly isn't the doctor. It is the CEO who probably has an MBA running the system and his managerial minions.
yes, CEO pays everywhere are shamelessly high. however, there are a lot more doctors than there are CEOs. our quest is to bring down medical costs and high doctors' pay is one consideration factor.
Frankly I think they should pay nurses more but they are controlling the pays because the govt need to keep cost down. There u go - cost cutting!
if i'm not mistaken, nurse pay is quite good now ...
Want to know why Singaporean nurses are going to other countries? They pay better. Same for your doctors. Go and deprive your well qualified doctor of his incentive to stay with you and I am sure foreign countries will welcome him.
its ok, we top up with china nurses, have come across some of them in hospital ...
I am not saying about rare or not rare condition. I am saying I rather pay for quality. Would you be seeing my doctor at all? You could go and see the polyclinic doctors. I used to see polyclinic doctors for mild ailments - they are cheap. Lower the cost of the doctor's wages? Sure . Get lithigation control laws in so that indemnity insurance don't rise. Get indemnity limits on how much the insurance company can raise premiums.
i quote what you wrote earlier:
"I rather pay the premium to see my current specialist than some cheap doctor because he was the only doctor who managed to figure out my problem out of the other 15 doctors I have seen. I have a rare condition . That's quality for you. So if you rather get quantity instead of quality - too bad."
why do you have to pay a premium? because the other 15 doctors couldn't diagnose your problem. why the other 15 couldn't? because you have a rare condition. so you are paying for your rare condition.
yes we should make appropriate changes to indemnity insurances but i have faith it would not be a big problem here. we are not like the US ... -
Originally posted by oxford mushroom:
You have to get the person with the specialized skill to train your new doctors right? So if I am the only one in the world with a particular skill, why should I train you unless I can paid an obscene amount for it? So that's where patents come in...without patent protection of some kind, we will not get the transfer of knowledge that we need to bring our medical treatment to world class standard.
there are two things involved here - specialists and patents. i do not know of any surgical skills that are actually patented. i only know of drugs that are patented. even if there are surgical skills that are patented, most of what we need aren't patented. the only problem is only a handful of overworked surgeons have those skills and if you expand the base of surgeons with those skills, the surgeons can cope better and the patients can have more choices at hopefully lower prices.
So we will always have to pay a premium for specialised skills. Just as Singapore doctors must acquire higher skill sets than doctors from third world countries. Patients who only require and are happy with more basic medical treatment can get it cheap from cheap foreign doctors. Those who require and are prepared to pay can have access to cutting edge medicine provided by doctors with the specilaised skills.
yes we will always pay a premium for specialised skills so the only way not to is to de-specialise those skills by training more doctors with those skills. -
snow leopard:
You keep saying make healthcare affordable and you target doctors' wages . Before you and I go around in circles, let's clear some points here :
Which healthcare system are you referring to? Private or public.
it seems like you are directing at doctors who earn good living and if I am not wrong - they might be private specialists.
What part of the AND SUBSIDIZED restructured system are you not happy about costing?
Are you not happy about paying for polyclinic doctor ? What's wrong for $8 per consultation . You only need to wait outside for a long long looooong time.
What's wrong with polyclinic tests costings? 2 dollars for standard blood tests. other tests variable.
I am sure medicines are cheap at polyclinics. Just ask for generics. Buy generics. No problem .
Affordability is dependent on how much you can afford to pay. If you cannot afford B class, I am sure the government will allow you to stay in C class. I think in Singapore, that is fair enough as it can get.
C class get you medical attention still. Just not so much of expertise.
A class don't say lah , that one is for consultants' attention and of course it is private paying class .
So what is the true problem here?
I am not belittling other occupations. I am just saying they don't have a direct link into preserving a human life and they don't have occupational risks as high as frontline hospital staff have.
Nurses in Singapore are not paid well , not for the workloads they are getting. Why did you think I came to Australia? But that is not the issue since you never seen how a hospital runs from an employee point of view . You want china nurses - fine - some of them cannot even read the medication name in english. Don't complain about the service you get . -
What if the specialised doctors are not interested in the pittance you want to pay them to teach their high specialised skill ? Cannot force them right? Some skills , they have to send doctors to USA/Europe to learn since that is the hub of all new medical technologies. We are not talking just a few days there. Theory is one thing , practical experience is another to attain.Originally posted by snow leopard:
yes we will always pay a premium for specialised skills so the only way not to is to de-specialise those skills by training more doctors with those skills.
You think it is so easy? -
Originally posted by fymk:
snow leopard:
You keep saying make healthcare affordable and you target doctors' wages . Before you and I go around in circles, let's clear some points here :
Which healthcare system are you referring to? Private or public.
it seems like you are directing at doctors who earn good living and if I am not wrong - they might be private specialists.
What part of the AND SUBSIDIZED restructured system are you not happy about costing?
Are you not happy about paying for polyclinic doctor ? What's wrong for $8 per consultation . You only need to wait outside for a long long looooong time.
What's wrong with polyclinic tests costings? 2 dollars for standard blood tests. other tests variable.
I am sure medicines are cheap at polyclinics. Just ask for generics. Buy generics. No problem .
Affordability is dependent on how much you can afford to pay. If you cannot afford B class, I am sure the government will allow you to stay in C class. I think in Singapore, that is fair enough as it can get.
C class get you medical attention still. Just not so much of expertise.
A class don't say lah , that one is for consultants' attention and of course it is private paying class.
So what is the true problem here?
let me say again what i've been saying throughout my posts. i am not complaining specifically about anything. the fact that i am young and healthy means i hardly find a need to see doctors beyond the simple cough and sore throat. but that doesn't mean there is nothing wrong with the system for if our healthcare is as perfect as you deem it to be, we wouldn't even have this topic raised here in the first place, would we? i hope you understand what i'm saying. i'm only making suggestions to improve our healthcare situation. by finding ways and means to lower healthcare costs, it would benefit everyone. it does not matter whether it is with public or private healthcare, both should be scrutinised to find avenues for optmisation and improvement.
we all know that doctors are overworked and that's because there isn't enough doctors to go around. rather than lament about their hard lives, why not do something to improve their lives by balancing the demand and supply? coz obviously that is not in balance.
I am not belittling other occupations. I am just saying they don't have a direct link into preserving a human life and they don't have occupational risks as high as frontline hospital staff have.
why differentiate direct and indirect? when the Nicoll highway collapsed, can the engineer who got sacked claim he had an indirect link to the lives of the construction workers who were killed?
so maybe we should also pay the banghra workers a premium for working under such hazardous conditions?
like i said, haggling over whose work is more impt is meaningless ...
Nurses in Singapore are not paid well , not for the workloads they are getting. Why did you think I came to Australia? But that is not the issue since you never seen how a hospital runs from an employee point of view . You want china nurses - fine - some of them cannot even read the medication name in english. Don't complain about the service you get .
i've friends whose wives are nurses or whos' sisters are nurses. they're doing quite alright actually ... even better than my non-nurse friends ... maybe you and them have different expectactions? you're not the only person who has left home but this is not the right topic to lament about why you had to leave.
as for china nurses, i've spoken to some of them. they speak with an accent, as all china born people do, but they are perfectly understandable and it is not as if i can't speak chinese. in any case, what's most important is that they are competent and before the doctor gave his advice, she already could tell me what the doctor would be advising ... -
of course its not easy, whoever said it was? but the important thing is, it is worth doing, despite all the obstacles, as the most viable way of increasing our pool of doctors and specialists and bring about a balance between demand and supply ...Originally posted by fymk:What if the specialised doctors are not interested in the pittance you want to pay them to teach their high specialised skill ? Cannot force them right? Some skills , they have to send doctors to USA/Europe to learn since that is the hub of all new medical technologies. We are not talking just a few days there. Theory is one thing , practical experience is another to attain.
You think it is so easy?
if Darth Vader refuses to teach the art of the Jedi, we can always learn from Yoda himself for ultimately, Darth Vader had to learn from someone right? -
snow leopard
we are going around circles for this issue . I might have a plan to give people a choice of what service they want and keep healthcare costs down . Healthcare costs are related to the health of the population. You are right in a way saying because I have a rare genetic disorder that I have to pay for treatment so therefore it will be unfair to burden the rest of the others for the fault of my ancestor genes.
1. Tax obese people more. At the end of the year, all employers and schools have to give the weight of their employees and students. Those above BMI of 28 has to pay an extra 20% on top of their income tax for being obese - parents who allow their kids to grow fat have to pay as well.
Obesity is a large contributory factor to chronic diseases . Reduce obesity and you reduce the burden of chronic diseases in the society.
2. Tax all providers and manufacturers unhealthy food by 20% - preserved/canned/hawker greasy food.
Tax alcohol and cigarettes by 50%
Unhealthy diets and lifestyle lead to chronic diseases, such as cancer, heart disease, diabetes.
Use the money to offset costs of vegetables, healthy cereals etc and pump the remainder of the taxes into healthcare to lower costs.
3. Give people a choice of paying options for their tests
If they choose the cheap option - everything goes to an outsourced area and they get their test results from india/china where ever
if they choose the full priced expensive option - it will be done a singaporean based radiologist group/pathology group etc.
4. Keep healthcare affordable by giving people the option of providing their own relatives in hospitals with home cooked meals and feeding them , bathing them and clothing them. If they want the hospital to feed them - they pay the usual market price . If they want the nursing aides to bath them - they pay the full price for that service. That way you cut costs on employing staff
5. Medical technology upgrades shall only occur every 7 years since medical technology is a major cause of rising healthcare costs. Keep only one facility or hospital equiped with new medical technology for those who are willing to pay for it in full.
6. No patient has a right to ask for extra tests when the doctors deem it unnecessary and they have to sign a waiver indemnifying the doctor treating them or else they can pay for the extras in full.
Now that way , you get a healthy society and lower healthcare costs and options for the consumers.
how good is that? -
no one wants to be obese to begin with, their suffering self image is enough penalty. obesity has also to do with lack of exercise and in a society that pushes us to work longer hours for lesser pay and to have more children, who has the luxury of time for exercise?Originally posted by fymk:snow leopard
we are going around circles for this issue . I might have a plan to give people a choice of what service they want and keep healthcare costs down . Healthcare costs are related to the health of the population. You are right in a way saying because I have a rare genetic disorder that I have to pay for treatment so therefore it will be unfair to burden the rest of the others for the fault of my ancestor genes.
1. Tax obese people more. At the end of the year, all employers and schools have to give the weight of their employees and students. Those above BMI of 28 has to pay an extra 20% on top of their income tax for being obese - parents who allow their kids to grow fat have to pay as well.
Obesity is a large contributory factor to chronic diseases . Reduce obesity and you reduce the burden of chronic diseases in the society.
2. Tax all providers and manufacturers unhealthy food by 20% - preserved/canned/hawker greasy food.
Tax alcohol and cigarettes by 50%
Unhealthy diets and lifestyle lead to chronic diseases, such as cancer, heart disease, diabetes.
Use the money to offset costs of vegetables, healthy cereals etc and pump the remainder of the taxes into healthcare to lower costs.
3. Give people a choice of paying options for their tests
If they choose the cheap option - everything goes to an outsourced area and they get their test results from india/china where ever
if they choose the full priced expensive option - it will be done a singaporean based radiologist group/pathology group etc.
4. Keep healthcare affordable by giving people the option of providing their own relatives in hospitals with home cooked meals and feeding them , bathing them and clothing them. If they want the hospital to feed them - they pay the usual market price . If they want the nursing aides to bath them - they pay the full price for that service. That way you cut costs on employing staff
5. Medical technology upgrades shall only occur every 7 years since medical technology is a major cause of rising healthcare costs. Keep only one facility or hospital equiped with new medical technology for those who are willing to pay for it in full.
6. No patient has a right to ask for extra tests when the doctors deem it unnecessary and they have to sign a waiver indemnifying the doctor treating them or else they can pay for the extras in full.
Now that way , you get a healthy society and lower healthcare costs and options for the consumers.
how good is that?
your examples are becoming meaningless and i'd rather spend time on more meaningful issues. take care and best wishes. -
Maybe it is a wrong approach I have taken.Originally posted by snow leopard:no one wants to be obese to begin with, their suffering self image is enough penalty. obesity has also to do with lack of exercise and in a society that pushes us to work longer hours for lesser pay and to have more children, who has the luxury of time for exercise?
your examples are becoming meaningless and i'd rather spend time on more meaningful issues. take care and best wishes.
You have to understand then : healthcare costs are actually related to health of the population. Every health economist will tell you that too.
You want to cut costs on one side only . You forget to see all sides.
Meaningless or not, look at your social policies in Singapore. the anti smoking campaign - financial disincentives by increasing cigarette costs- banning of smoking in certain areas - those are health-social-economic policies.
Riding a bike or walking to MRT - health-social policies.
On the other side, they are already outsourcing alot of jobs out ( i.e. outsourcing x rays to india - that is what I heard from a few singaporeans) which are trying to cut down your health costs. They already got alot of china nurses in to keep costs down.
Why blame society? Health is your own responsibility . Don't give excuses. Don't ask everyone else to pay for your own problem - isn't that what you implied when I told you that I have some rare genetic problem. You can at least eat healthy instead of hawker food. Walk for 1/2 hr everyday before or after work. Or at least just do some stretching exercises around the house. Housework is also a form of exercise.
Health care costs works both ways - on the government and on the individual. Don't just look at one side without getting to both sides of the story.
If you have a healthier society , then the economic burden of chronic diseases will decrease . Less people with less problems mean less costs to the public health system. Am I right in saying so?
If the society is not healthy , then the burden of disease increases and the healthcare costs of the public increases.
Read any health economics book - they will tell you the same thing.
Don't just focus only on doctors' wages . Use your polyclinic doctors if you cannot afford private general practitioners. Use the public system and wait if you cannot afford to pay private specialist's consultation fees . All this while you have been focusing on wages but that is only one part of the picture. You cannot just suggest improvements on one or two factors without realising there are other factors involved and inter-related.
You want to make healthcare affordable? You can. Implement Social policies to complement your healthcare policies. Everything must be related to benefit each other instead of being a separate entity. Read about the reforms on NHS and social/economic policies in UK . They are trying to merge health together with other policies to save the healthcare system there.
That is my point.