I would suggest that you read Michael Marmot and Richard G. Wilkinson's socioeconomic determinants of health. Might give you a perspective of what I just said.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.
sounds like great books, have you got any summaries?Originally posted by fymk:I would suggest that you read Michael Marmot and Richard G. Wilkinson's socioeconomic determinants of health. Might give you a perspective of what I just said.
If rising healthcare costs are a problem , look into the main healthcare policies and related policies before making an assumption. There might be more out there than meets the eye.
Amazon link http://www.amazon.com/gp/product/0198565895/002-3108278-4300042?st=%2A&v=glance&n=283155Originally posted by snow leopard:sounds like great books, have you got any summaries?
sometimes, a little common sense is all we need to tackling problems ...
Originally posted by oxford mushroomCongratulations for some good responses to your thread, and surely you could not be missing a sparring partner - who is a mere lay person.
12 April 2006 – 04.20AM
I wonder where Atobe is
Originally posted by Atobe:I can only say : economically feasible short term , penny wise pound foolish long term after I read the WP manifesto on health.
If the Government can hand out BILLION Dollars in refunds from surplus tax collections - would it not have been more effective for the Billion Dollars to be placed in a NATIONAL HEALTH "SINKING FUND" so that those who need it most will stand to benefit from it, rather then placing the entire family in desparate situation to source for funding at the last minute.
A National Insurance Scheme to protect ALL SINGAPOREANS - with the ANNUAL HANDOUTS will be sufficent to help implement the proposal mentioned in the Workers' Party Manifesto.
About your remarks concerning raising proposal without any implementation plans - would you not believe that MM LKY will dream up many proposals for his faithful minions to research and find ways to implement ?
Singapore is certainly not the only country seeking the answers to the topic raised, as can be seen in the following paper prepared by an Indian National submitting his thesis on: [b]Technology, Competition and Costs of Medical CAre: Some Emerging Issues and Policy Imperatives in India"
An Abstract is as follow:
"The private sector plays a significant role in meeting the health care needs of the people of India. With increasing international drive for privatization, scholars and policymakers have been debating the efficacy of market forces in financing and delivering health care in developing countries.
Containing costs of care has been an important concern in devising appropriate health care policy all over the world.
In this essay, we first summarize a body of evidence (drawn from the US) that addresses the question whether competition will contain costs of medical care, and improve access and outcome (Section II). We then raise certain issues and questions that need to be examined empirically alongside issues that require explicit value judgment on the part of those involved in the production, distribution and consumption of health care. In Section III, we present an argument for technology management and health promotion as two essential public policy measures, whether or not one believes in the efficacy of market mechanisms, to contain costs of care. "
[/b]
Originally posted by Atobe:I always enjoy a paper of theory. However what I like better is a feasibility paper in application to the context. This paper which talked about the 2 myths does not apply. It is talking about the indian system and american system which is vastly different from ours.
It is important to mention here two widely prevalent "myths" (particularly among the policy makers): one is that greater access to better medical care and containing cost of care do not go together. To put it differently, if you are to have the finest medical care system, be prepared for high costs.
The second myth (some would call it "public expectation") recognized by many scholars, is that high technology is essential for improved health and longevity.
There are several examples (of community-based health care projects in India as well as in other parts of the world) which explode these myths.[65]
Policy lessons emerge and can be learnt not only from our own past mistakes and achievements, but from the experiences of developed economies as well.
The recent developments in the medical care market in the US have a clear lesson for the health policy makers in India.
While there are forces that seem to be pushing up the costs of medical care beyond our control, there are also ways and means that are well within our reach and control that can be used effectively to reduce costs of care and thus effect some savings for the society."[/i]
A further referenced piece that you may wish to consider reading - instead of limiting the comparison of Singapore with some of the costlier National Systems such as UK, Sweden or USA, perhaps the following article may give you some diversity of views:
Private Alternatives to Social Security in Other Countries
- prepared for the National Centre for Policy Analysis
Is it any wonder if Singapore do not have Doctors taking care of Public Policies in matter related to Health Care ?
[/b]
Originally posted by fymk:
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.
and what does health of the population relate to? time for exercise? how to afford more time for exercise when one is laden down with tons of work and family duties? so you've seen one step beyond health care - health itself. why not see even further, the overall quality of life here, of slogging long hours, stress, competition, worry about being retrenched and replaced by foreigners ... just because you've seen one extra side, you think you've seen 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.
anti-smoking campaigns i agwee but riding a bike to MRT? that is being encouraged here? you know how dangerous it is to ride a bike on our roads? remember the group of cycling enthusiasts who ended up with one dead? i once read about an ang moh who complained in the forum that he had to carry his bike across five overhead bridges to reach his destination. if you're referring to riding bike to the MRT as an example of the govt's promotion of a healthy lifestyle, you get zero marks for that.
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.
but have we done enough to ensure that the expensive doctor is not being used to examine coughs and flus?
Why blame society? Health is your own responsibility . Don't give excuses.
who's blaming anyone? we just merely reflected the simple inbalance between demand for and supply of doctors. do we blame society for lack of doctors? no, we blame the institutions that churn out doctors for not producing enough doctors. we blame the institutions that doctors work in for not utilisiing their specialist skills appropriately.
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.
wait a minute, where did i say i have a problem that i need you to pay for? i said i am young and healthy and have no problems and despite the fact that i have no problems, i feel a lot of old people have problems. most problems occur to old people, you should know that better than i do, you're a health professional.
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.
like Zoe Tay climbing up the stairs? you know what else she does besides climbing up the stairs (just once for the TV shoot)? she goes to expensive gyms and does all the Tai Tai stuff that Tai Tais do. what do we have to do? slog all day my friend! you think we're like President Nathan, nothing better to do, go East Cost for jogging?
you look two ways doesn't mean this world is two sided only ok?
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?
you are right. but how do you get people to exercise, when they come home late from work and plonk straight into bed?
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.
actually, you don't have to read health economics books, common sense will tell you that. and health economics books probably won't tell you that exercise needs time, precious time from family and work.
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 don't focus on doctor's wages, you focus on chain smoking and cycling? i say despite all the anti-smoking campaigns we've always had, what else do you suggest? lock them away like they do to drug addicts? and what about cycling? more deaths on the roads?
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.
well, you started with brushing off our suggestions to increase doctor supply. now you're saying i forgot about the char kuay tiao and the chain smoking. you're getting more and more out of point ...
well, we probably have to tighten up our rules but we're not like in the US, we should be ok.Originally posted by fymk:You forgot the part about enhanced lithigation as well. And more nurses might run off since the pay for nurse practitioners are premium elsewhere compared to Singapore.
In Australia, nurse practitioners earn about 3.5k -4k per month after taxes. Try beating that.
I want to know what alternative you have. I have laid out the implications of a two-tiered healthcare, one for the poor with very basic but cheap healthcare and one for those who can afford the first-world standard of medicine that people like fymk expect..Originally posted by Atobe:surely you could not be missing a sparring partner - who is a mere lay person.
Is Singapore's model the best - with Singaporeans being made to pay for their needed medical attention, especially at your stated "secondary and tertiary levels" ?Do you have an alternative? Are you and Singaporeans prepared to pay higher taxes to fund a system like the NHS in the UK or a co-payment scheme like in Finland with taxes that are many times what we pay?
In a report prepared by the National Center for Policy Analysis - "Medical Savings Accounts: The Singapore Experience" - it was stated that Singapore only spendAnd what are those figures? Look at this website which has listed the salaries of US doctors from various sources:
"..... about 3.1 percent of gross domestic product. Even with these low expenditures, the income of Singapore doctors is about the same in relation to average wages as physician income in the United States ..."
"Because mandatory Medisave deposits are a percent of wages, deposits are smaller for lower-wage workers, and the least affluent may not be able to pay much out of pocket. Thus the combination of out-of-pocket, Medisave and Medishield payments may not cover all of their medical expenses.Everyone knows that but what is the alternative? Welfare states that fund a comprehensive system based on taxes are finding it difficult to cope all over the world. With an aging population in Singapore, we will face a similar problem with such a scheme. Would tax payers in Singapore be prepared to pay more for those who do not? There are people like fymk who feel that there must be more individual responsibility as well. Surely smokers should pay more for the consequences of their habits..
If the Government can hand out BILLION Dollars in refunds from surplus tax collections - would it not have been more effective for the Billion Dollars to be placed in a NATIONAL HEALTH "SINKING FUND" so that those who need it most will stand to benefit from it, rather then placing the entire family in desparate situation to source for funding at the last minute.Do we have billions in surplus tax collections every year? What about the years when we go into deficit? Tell the patient with cancer to wait for a good year before he gets treated?
It is important to mention here two widely prevalent "myths" (particularly among the policy makers): one is that greater access to better medical care and containing cost of care do not go together. To put it differently, if you are to have the finest medical care system, be prepared for high costs.If you have read my earlier posts carefully, you will note that studies have shown that although there is a general trend globally that with greater health expenditure, life expectancy increases, the correlation is not perfect. In this respect, Singapore has done better than Sweden and the US. The US spend more money on healthcare with the least improvement in life expectancy.
The second myth (some would call it "public expectation" recognized by many scholars, is that high technology is essential for improved health and longevity.
Originally posted by fymk:
Snow Leopard :
I think you just missed the whole point by jumping behind the chronological order of what I posted.
Read Marmot and Wilkinson's book
I rather focus on the root of the problems to decrease healthcare costs rather than focus on the tip of the pyramid where only one side is tackled.
not at all, i get your point perfectly though the point itself is far from perfect ...
from your summary, there isn't much one can take away from the book that common sense won't tell.
and your so-called root of the problem is that we are all too fat and lazy to exercise? well if that is the root of the problem, then the swiss standard of living where we all lead prosperous, stressfree lives is probably the solution we need heh?
If you cannot understand that , then too bad.
it is precisely because i understand what you're saying that i could reply at length and even point out the incompleteness of what you're saying.
Oh yeah - go employ more foreign doctors to tackle the problems and you find more problems on top of it all. Wonder why most developed nations have stringent criteria on recognition of qualifications? Go figure that one out by yourself.
that's where my suggestion deviates from Mr Oxford's, it is to better harness the abilitites of our own nurses and pharmacists. haven't you figured out the gist of my ideas yet? it's plain english really.
Nursing - I think probably you and I went off the tangent .
better use of the nurse's abilitites is exactly my suggestion. your insistence about they being lowly paid is probably what went off tangent.
Like I said , read the book - it will give you the commonsense of how healthcare costs can be tackled head on while salvaging affordability. Ever heard of prevention is better than cure? Happy to discuss when you have read it .
but you don't have to read a book to make common sense do you? so how to prevent? work less hours? forget about skills upgrading? forget about having more kids and more worries? happy to discuss when you incorporate these into your ideas.
By the way , you keep talking about paying an expensive doctor to treat cough and cold . I have no idea where that came from but hey if a person choses to see a respiratory specialist for some minor ailment - they deserve to pay full price. If they chose to see a polyclinic doctor - then they pay 8 dollars - which I think is fair enough.
give you an example. when you see a private practitioner, you easily pay something like $20 for a simple ailment. if we get a nurse or pharmacist to handle these, prices can be lowered. more importantly, we free up these doctors to go into surgery and other expensive specialties which will in turn lower these big ticket healthcare costs.
the crux of the issue is that we do not have enough doctors so we can ill afford to have well qualified doctors treating coughs and flus. their knowledge and skills should be better used in specialist applications.
To be fair to those who have chronic obstructive lung disease - coughs and colds for them can lead to severe complications - of course they deserve to see a respiratory specialist since pneumonia will cause increased cost to the health care system and person when it comes to hospitalisation versus just paying a specialist to control the problem.
so isn't my suggestion, to have nurses and phamacists treat simple coughs and colds so that more qualified doctors can be freed to be trained as respiratory specialists help lower your costs?
frankly 'world class' have been too oft quoted. all we need is good healthcare, with dedicated and competent medical professionals. as simple as that. you don't trust an indian doctor to perform surgery on you that's why we need more of our own doctors to end up doing surgery and not diagnose coughs and flus ...Originally posted by fymk:At this moment in time ,
I rather pay for world class standard treatment rather than to have to deal with the consequences of some doctor misdiagnosing me because of poor training. Mistakes can happen everywhere but heck ....I got enough of the Dr Death in Queensland fiasco in Australia.
Better safe than sorry.
Is healthcare about the "Quality of Life" or about "Life Expectancy" ?Originally posted by oxford mushroom:If you have read my earlier posts carefully, you will note that studies have shown that although there is a general trend globally that with greater health expenditure, life expectancy increases, the correlation is not perfect. In this respect, Singapore has done better than Sweden and the US. The US spend more money on healthcare with the least improvement in life expectancy.
So I agree with your first myth but is life expectancy is only relevant measure? Does it matter if one stays in hospital for a shorter period and with less pain following a keyhole surgery compared to a long incision? An improvement in survival of 3 months may not be cost effective for the thousands you pay. But is it worth it? Why don't you ask the patient?
Before sweeping statements are made, please review the information that is freely available and accessible through the internet search engines and get more free information on the subject of the Japanese Tax System.Not being a medical doctor yourself I don't expect you to understand how advances in technology has transformed healthcare. But you are still avoiding the question. If we restrict non-patent drugs (drugs lose their patent protection after 20 years) to patients in public hospital, we can lower healthcare costs tremendously. If we combine that with outsourcing lab tests to non-accredited labs overseas, employ cheap foreign doctors who do not hold similar internationally recognized qualifications of our doctors, we can lower healthcare costs in public hospitals even more.
Is that what you want? Do Singaporeans want that? It is easy to criticize but are you prepared to accept the implications? [/quote]
Not being a doctor does not necessarily mean that one cannot appreciate the advances that technology has transformed healthcare - similar to a doctor not being trained in electronics, does not necessarily prevent him from appreciating the advance in electronics to help in his work.
You seem to be fixxated with the idea of high taxes being needed to help Singaporean to enjoy a high standard of healthcare.
In my reply to one of the respondent - dated 28 January 2006 - 06:29AM in the thread : "Should Singapore subsidise medical care ?", I had posted the following which perhaps maybe pertinent to your reply concerning your fixed idea of "overtaxing the citizens to have a high standard of health care":
[quote]Originally posted by ndmmxiaomayi:Compare apple with apple lah. How much tax they pay? How much tax we pay? I think we pay lesser tax than them lor. That's why the lower income groups can get more subsidize.
Do you mind paying more tax to get more subsidized healthcare system? British tax is much larger than us. That's why they can afford to have free healthcare.
Even if the "average wages" do not give a better picture, surely you will not deny that the doctors' earnings are above the average Singaporean blue and white collar workers - 90% of whom live in HDB flats.Originally posted by oxford mushroom:The reason is that if you look at average wages, you do not see the big picture because the high salaries commanded by a minority (mainly surgeons, O&G doctors) obscure the true income of the majority. It is a basic error in statistics...Particularly in Singapore, where there is a huge discrepancy in salaries between different specialties and between doctors in the private versus government sector, you cannot talk about average wages...the median or mode will give you a better picture...
Being a ONE PARTY state dominating and controlling all LIFE EVENTS in Singapore, let us drop all pretense of being anything but a COMMUNIST STATE - except that the POWER OF ONE prefer to have the best of both worlds for themselves.
Everyone knows that but what is the alternative? Welfare states that fund a comprehensive system based on taxes are finding it difficult to cope all over the world. With an aging population in Singapore, we will face a similar problem with such a scheme. Would tax payers in Singapore be prepared to pay more for those who do not? There are people like fymk who feel that there must be more individual responsibility as well. Surely smokers should pay more for the consequences of their habits..
Do we have billions in surplus tax collections every year? What about the years when we go into deficit? Tell the patient with cancer to wait for a good year before he gets treated?Why do we narrow our views merely on the surplus of the economic performance of Singapore ?
Relying on surpluses to fund a healthcare system is no better than the chronic gambler hoping for a 4-D strike to put food on the table.
Originally posted by fymk:
Ai ya , I just gave examples . The book will just tell you HOW Social policies influence health policies . There are alot of things in the book which I didn't talk about - why do you think it is a book?
are these the best examples you could give? if there are better examples why aren't you showing them? unless those lameduck examples you gave are about as good as the book gets?
Pharmacists cannot diagnose , they can only recommend you medications to solve a symptom. Nurses practitioners? - how many singaporeans will take up to the idea . Done a survey yet? Kiasee culture might be a hindrance factor.
do doctors perform any differently when it comes to coughs and colds? they also serve you the same medication don't they?
unwilling perhaps if you give them more job without giving them greater authority and prestige. but if you elevate them to a status where they can set up their own practices, surely many will be motivated?
You have to pay a nurse practitioner more since she has more responsibilities .
the important point, as i try to make you understand again, is that she helps bring down the price of private clinics to the point where opening up a clinic to diagnose coughs and flus becomes financially unattractive so that more doctors would be inclined to become specialists to perform expensive operations and procedures. that way we can cut down the cost of expensive procedures, by encouraging more doctors to do what they are most needed to do. society as a whole benefits as a result.
The nurse practitioners in Australia earn as much as an intern does because they have to get at least 5 years experience and a preferable specialty in Emergency nursing. You want competence - you pay for competence
it seems to me any occupation, other than those of the president and the prime minister pays better in aussie so its more an issue of pay differences in general between two countries more than it is about pay for competence. our pay is lower than those in the aussies therefore we are less competent?
Election is here. Go make your destiny . The book highlights ideas from other countries in policy making which influence the health of the populations. This may help answer your above queries
our elections do not make destinies, they merely reaffirm the mandate from heaven. if the book can really offer what common sense can't, you would be showing us already wouldn't you?
Go see a polyclinic doctor. Haven't I said that so many times? 8 dollars per consultation. If I can see a polyclinic doctor and wait - why can't you?
you can say it a hundred times and i still think it is a gross mismatch between job and ability when a full fledged doctor is being used to man the polyclinic. surely there are better things he can do? surely we are under utilising him and preventing him from contributing at a higher level where there is a shortage and hence high costs?
Why do you think you have the polyclinics in the first place?
polyclinics used to be around the neighbourhood. nowadays you have to take 1/2 hour to 45 min bus ride to go to your nearest polyclinic. when you're down with a heavy fever and just want to see the doctor quickly, would you still take bus to the polyclinic and spend half the day waiting for your turn?
Now mind if I ask why I heard no mention of polyclinic doctors from you? Each time I said there is a polyclinic , you divert the focus on "expensive" private doctors.
you should know that better than i do. you have to queue up and wait your turn for polyclinics right? you want instant answers, stick to private doctors.
Look at what oxford mushroom said. Again I say to people ,who are not happy to see a private gp , to go to polyclinics to see simple coughs and cold. Polyclinic MCs is just as good as any other MCs
Mr Oxford actually concurs with what i'm saying, that the common ailment that the doc treats in a clinic (which is really most of what he does) can be largely done by a pharmacist. it's not a matter of happy or not happy, a doctor can do much more than man a clinic and if we can relieve doctors of their clinic duties or lessen them, surely their time can be put to better use, like help spread out the heavy work load of specialists and bring down the cost of expensive procedures?
Originally posted by oxford mushroom:
Snow leopard, coughs and cold seem to be your prime concern. Let me say that as a medical practitioner I agree with you that most of these colds can be handled by a nurse or pharmacist. Most people in UK just get some medication off the counter at the recommendation of the pharamcists anyway, although the price of the medicine may be more than a consultation with medicine in Singapore.
not concerned with coughs and cold per say but concerned with well qualified doctors treating coughs and colds. glad we see eye to eye. unfortunately, we don't have the same practice here and someone from the clinic once told me that certain medication for coughs are controlled items that cannot be dispensed from pharmacies. so a lot can be changed here really ...
Most people wih simple cough and colds don't need to see a doctor. The conditions are self limiting and they will get better even without treatment in most instances. The only reason why they see a doctor...and that is a VERY IMPORTANT reason: because their employer needs to see an MC.
you are right but a cough can be terribly painful and prevent you from sleeping all night. the MC part i agwee.
I have previously advocated that the MC system is flawed. Let employers give a variable bonus equivalent to 14 days' salary which will be given in full if the employee does not report sick at all. If the employee reports sick for any reason, no MC is required...just deduct the variable bonus pro rata..
then you're discriminating against the old because they genuinely tend to fall sick more than their younger colleagues and you're not encouraging people to take a rest when they really need to take a rest, especially when they are having a flu and in danger of spreading to everyone else.
I have come across malingerers in my clinic who admit they want an MC because they 'lugi' otherwise: they are entitled to 14 days' MC.
yes, the system is open to abuse but it is self-reinforcing. you can't have someone constantly taking MCs without getting penalised in some way by his own company can you?
However, forget about coughs and cold for the moment. What about the patients with more serious illnesses? You can't possibly expect them not to be seen by a doctor?
good, you're coming along with me rather than brushing me off with some stupid ideas about fat and lazy. let's say you're in a polyclinic where there are many people. you install a machine manned by some attendent that dispenses ticket based on your illness category. if it's cough or flu you go straight to the pharmacist. no need to waste time, a short interview by pharmacist and you're off with your medicine. more serious categories, you go to the real doctors. so instead of having say five doctors manning the polyclinic, you can have one doctor and four pharmacists / nurses. you just freed up four doctors to do expensive procedures!
for private clinics, i'm of the opinion if we can get more people to take medication from pharmacists (and allowing them to issue MCs as well), opening up a clinic may become less profitable for doctors who would then be more inclined to perform surgeries that we really are in need of.
You seem to think that by taking in more locals, we will have more doctors willing to accept lower pay. Our non-specialist doctors in public hospitals are being paid about 5k-7k , with a 100k debt from medical school here, do you seriously expect them to get less? If you are going to pay them 10k a month, that's more than what they are currently getting anyway.
no, no. you see, of course the doctors won't be willing to accept lower pay. so what will happen is that they will pursue the specialist route instead of opening up a clinic, which will be made less profitable. so instead of being paid less, they will end up being paid more and we end up having more specialists that would ease the acute shortage, bring down costs and make better lives for specialists themselves who would see more of their kind helping one another out.
For senior doctors, there is an exodus to the private sector in recent years. This movement is so marked that that even LKY is concerned about it, as he said in a recent speech. We may have a situation where all the high-tech medicine is concentrated in the private sector. That can work if Singaporeans are happy with a lower standard of medical care in public hospitals for more serious illnesses than your cough and cold. Are you and Singaporeans prepared for that?
you are right. this is what is happening now and it is a vicious cycle. all doctors are required to serve a bond of a few years in govt hospitals. many become jaded with the heavy workload and choose to open their own private practice instead. it's the most natural tendency, decent life, self employed, good earnings. when most of the doctors we train end up checking coughs and colds, there aren't many left for specialist roles. so we need to reverse that trend by pushing them in the right way ...
If you are, that's not an issue. We can provide relatively good value basic medical care with cheaper foreign doctors and non-accredited labs but of course, don't expect the same standard as those in private hospitals. People like fymk will just have to fork out the money to go to private hospitals for the higher standard of medicine they desire.
i'm still more comfortable with our own people. i got my teeth cleaned for free by a nurse as a kid. i don't mind, its an equally good job. now i pay $80 per session, that's daylight robbery! if we allow nurses the licence to providing cleaning services for us all, you can be sure that $80 fee will plummet like a shooting star. before fymk asks me to go to the polyclinic again, i'd like to say that appointment dates can be six months down the road, too painful for any jaw to take ...
I can agree with you on the million dollar salaries of those who manage the funds. Those can be diverted into healthcare funds for the needy.Originally posted by Atobe:Why do we narrow our views merely on the surplus of the economic performance of Singapore ?
What about the earnings from the PUBLIC FUNDS that have been invested by GIC and Temasek Holdings ?
I have been saying quite a few times that part of the earnings can be used to fund Singaporean needs, instead of ONLY paying the MILLION DOLLAR SALARIES of those who manage the funds.
Unfortunately, I have to take leave at this point.
Even in the People's Republic of China, the Health Care System maybe backward by Western Standards, but it is in no way lower than the standards of Singapore when looking at the vastness of the country and the size of its population.Don't talk about China - china is now capitalist rather than communist , they do have rich people there now who can afford quality privatised healthcare overseas - why not take a look at the rural /remote areas of china, care of the minority groups and talk about them. Stratify them by economic status and geographical location , I am sure you will find a huge disparity in their health status which cannot be compared to Singapore.
YOu seriously must be kidding and yeah Pigs will fly.
Snow leopard's quotes :
no, no. you see, of course the doctors won't be willing to accept lower pay. so what will happen is that they will pursue the specialist route instead of opening up a clinic, which will be made less profitable. so instead of being paid less, they will end up being paid more and we end up having more specialists that would ease the acute shortage, bring down costs and make better lives for specialists themselves who would see more of their kind helping one another out.
you are right. this is what is happening now and it is a vicious cycle. all doctors are required to serve a bond of a few years in govt hospitals. many become jaded with the heavy workload and choose to open their own private practice instead. it's the most natural tendency, decent life, self employed, good earnings. when most of the doctors we train end up checking coughs and colds, there aren't many left for specialist roles. so we need to reverse that trend by pushing them in the right way ...
Originally posted by fymk:
By the way you are arguing about "lameduck" examples in a defensive way- even if I put a better example on about social determinants of health, you won't see the link . You will take it apart and criticise it in separate parts. Go to the library - borrow the book and read it. No one is asking you to buy it.
it is precisely because it is not good enough that is why it can be torn apart. if you have thought through the ideas instead of merely regurgitating them, no one would be able to tear them apart.
You want healthcare cheap - you have to give something up like travel .
it wasn't as if it used to be expensive when it was located around the corner ...
Not that I am saying I always use private specialists but I do use polyclinic doctors mostly when I was in Singapore because of my lower pay scale in Singapore and I want to save money. Now I can afford specialists in Australia , of course I would pay to use them since I have been stuck with certain problems which never went away and which even polyclinic doctors missed out on .
again, you pay for your special conditions, nothing more.
Waiting lists will be in effect once you start cutting down on specialist's pay . Most specialists might move off to private sectors. 6 months won't be a problem for you , 12 months will be. Australia has the problem of this already if you are on the public system. Only people with private health insurance will be able to afford what is termed as queue jumping.
just endorse the dental nurse to do it, the waiting lists will vanquish in no time. anything more than a month is pathetically inefficient. so australia has a problem therefore its ok for us to have the same problems?
Yes we can all free up the poor overloaded doctors to work on more important cases. Get nurse practitioners in . But then again , would the community accept them readily? If going to a polyclinic is so difficult for one person like you , then how about seeing a nurse practitioner?
when we have lots of nurse practitioners, we can afford to open up many more branches at more convenient locations, going to polyclinics would be easy once again ... for a person like me ...
I liked the dental nurses when i was in school. But they needed to get a dental surgeon in to fix my broken tooth in the end .
yeah but how often you get a broken tooth versus how often you need to get your teeth cleaned and polished? how many times must i say so that you can understand? most of what the dentist does can easily be done by a dental nurse or anybody who gets six months training on the machine.
So if the nurse practitioner cannot treat the problem of the patient - what would happen? You have to pay her and then she refers you to a doctor - then you have to pay the doctor for treatment . Double payment when you can just go see a polyclinic doctor in the end for 8 dollars a consult. We are not talking about diabetic nurse educators , stoma nurse educators - we are talking about a semi independent nurse practitioners. How about training? Their training has to be more stringent.
you saw 15 doctors all of whom could not diagnose your problem and you end up seeing a specialist. so do you go back to those 15 doctors and ask for a refund?
if the nurse can treat 80% of what we need at a fraction of what dentists charge, we are more than happy to accept them.
The only reason why they use nurse practitioners in UK and Australia is because of the large areas they have to service. UK is more of an economic reason since NHS is slowly eroding and seriously NHS system does not impress me at all. Nurse practitioners in Australia is there because of the reason that there are not enough doctors in the rural/remote areas and it is better to have someone experienced who still can control symptoms or treat injuries ,at a more advanced level than a lay person , than NO one at all. It is cost efficient for countries who use them because of geographical size. Unless there is a demand for them , pursuing the cause of nurse practitioner may not be efficient at all.
really? they use nurses in the UK and aussie? my goodness, my idea's not that bad after all eh? so you see? it doesn't matter if it's the nurse or the doctor who treats you as long as he/she is properly trained. how do you know there is no demand if you don't even supply it? how can you say it is not efficient when it's being practised elsewhere and we used to have it too?