Home > Speaker's Corner

Healthcare: Tale of two nations

snow leopard
23 Apr 06, 11:28

Originally posted by fymk:

Anyways, nurses who want to be doctors can be doctors - same for the pharmacist. Doesn't matter if you are clinical nurse specialist.

In Australia.
If the nurse has the bachelors, Grade point average must be at least 3.5 for everything with double weightage given to the third year.
Then the nurse takes the GAMSAT which is worse than the MCAT - score about 60% percentile to ensure an interview into a recognised university. If they pass the interview which is not too easy- it will be 4 years minimum for the medical degree.

you have gotten me all wrong. maybe i didn't explain myself clear enough. i am not converting these nurses into full fledged doctors, for that would be counter productive. i'm not asking people to spend 3 years getting a nursing degree followed by 4 years to get a medical degree. you spend a total of 7 years to become a doctor when all you need is 5 years.

what i'm saying is we convert the nurses into a new profession with a new title, maybe clinical practitioner or something like that. this new profession will have all the competence that the doctor has in and only in a clinic environment, which is really not too much to ask of them considering it is just common day to day mild illnesses.

But then again snow leopard makes it sound so easy.

First of all you have to get NUS or NTU to agree on a 2.5 shortcut medical degree. Then you have to get people to pick and choose out of the syllables to give the nurse /pharmacists a qualified recognition.
- 1. Everything is evidenced based now - you have to ensure half the degree is made out of how to scrutinise evidence based research.
-2. You need to retrain them on pathophysiology , anatomy which takes at least 3 years from theory to application .

So snow leopard - you have ideas - so how would you implement it?

what you have listed can be done as they have been done in many other faculties. on top of that as i say again, in case you read me incorrectly again, i am not asking for these nurses to be converted into full fledged doctors, only doctors certified for private clinics. surely they do not need three years to cover those parts of the anatomy that a doctor in a clinic setting is required to know?

furthermore, given their experiences, they probably already know. the important thing is that these nurses are already experienced and competent enough to handle patients in a clinic setting. the conversion course is just a formality to cement their status. we can even do away with that and stick to exams and interviews. as long as these folks pass stringent exams and interviews specifically meant to test doctors in a clinic setting, there is no reason to doubt their capabilities.
oxford mushroom
24 Apr 06, 06:01

Snow Leopard's idea of training a doctor in 2 years is just not feasible. He thinks that because MBBS stands for bachelor of medicine and bachelor of surgery, you can cut the course in half by not teaching surgery. This is an oversimplification.

About 3 years of the medical course are devoted to so-called basic medical sciences such as anatomy, physiology, biochemistry, microbiology, pathology and pharmacology. The remaining 2 years are for the clinical disciplines such as general and orthopaedic surgery, internal medicine, paediatrics, obstetrics and gynaecology, community medicine, anaesthesia, ENT, ophthalmology, geriatrics, radiology and psychiatry. And this does not even include the 'minor' subjects such as molecular medicine, medical ethics, biostatistics etc...

Snow Leopard will probably insist that it can be done so there's no point debating this issue further. But as someone who has taught medical students for the past 10 years, I'd say this not be a feasible option.
snow leopard
24 Apr 06, 20:01

Originally posted by oxford mushroom:
Snow Leopard's idea of training a doctor in 2 years is just not feasible. He thinks that because MBBS stands for bachelor of medicine and bachelor of surgery, you can cut the course in half by not teaching surgery. This is an oversimplification.

About 3 years of the medical course are devoted to so-called basic medical sciences such as anatomy, physiology, biochemistry, microbiology, pathology and pharmacology. The remaining 2 years are for the clinical disciplines such as general and orthopaedic surgery, internal medicine, paediatrics, obstetrics and gynaecology, community medicine, anaesthesia, ENT, ophthalmology, geriatrics, radiology and psychiatry. And this does not even include the 'minor' subjects such as molecular medicine, medical ethics, biostatistics etc...

Snow Leopard will probably insist that it can be done so there's no point debating this issue further. But as someone who has taught medical students for the past 10 years, I'd say this not be a feasible option.
Hey Mr Oxford, it's perfectly fine for us to agwee to disagwee but we should at least be precise in our understanding of the viewpoint from the other side.

I say yet again, i am not proposing to train full fledged doctors out of nurses, merely endorsing already experienced, already competent nurses to hold a responsibility that they already have no problems holding. Of the myriad basic medical knowledge they are required to know, they probably already know. but as with any appointment in any discipline, there needs to be some form of endorsement, which could be a short conversion course or simply a series of tests and interviews. in any case as i say again, the idea is to certify beyond doubt the nurse in question has attained a level competent enough to see patients in a clinic setting for everyday common illnesses, nothing more. this, i believe they can deliver with ease and in turn free up many more doctors who would be better utilised at higher levels of application for the benefit of the entire nation.
oxford mushroom
25 Apr 06, 02:12

Originally posted by snow leopard:
Hey Mr Oxford, it's perfectly fine for us to agwee to disagwee but we should at least be precise in our understanding of the viewpoint from the other side.

I say yet again, i am not proposing to train full fledged doctors out of nurses, merely endorsing already experienced, already competent nurses to hold a responsibility that they already have no problems holding. Of the myriad basic medical knowledge they are required to know, they probably already know. but as with any appointment in any discipline, there needs to be some form of endorsement, which could be a short conversion course or simply a series of tests and interviews. in any case as i say again, the idea is to certify beyond doubt the nurse in question has attained a level competent enough to see patients in a clinic setting for everyday common illnesses, nothing more. this, i believe they can deliver with ease and in turn free up many more doctors who would be better utilised at higher levels of application for the benefit of the entire nation.
But you want to give them the power to isse MC and to prescribe controlled drugs as well....those are heavy responsibilities that will require a doctor to shoulder. It is one thing prescribing simple medication to treat symptoms of self-limiting conditions like coughs and cold.

To certify someone as unfit for work or attend court and prescribe addictive controlled drugs will require someone with full medical training and qualifications.

In any case, it will not wortk because as I said, most Singaporeans will insist on seeing a doctor when they go to the polyclinic, not a nurse.
snow leopard
25 Apr 06, 21:44

Originally posted by oxford mushroom:
But you want to give them the power to isse MC and to prescribe controlled drugs as well....those are heavy responsibilities that will require a doctor to shoulder. It is one thing prescribing simple medication to treat symptoms of self-limiting conditions like coughs and cold.

To certify someone as unfit for work or attend court and prescribe addictive controlled drugs will require someone with full medical training and qualifications.

In any case, it will not wortk because as I said, most Singaporeans will insist on seeing a doctor when they go to the polyclinic, not a nurse.
with all due respect, selection criteria can be made stringent so that only well experienced, competent and thoroughly tested nurses would be given the responsibility to take on the role of clinic practitioner.

the doctor didn't take 5 min to come to a decision to prescribe the controlled cough mixture to me. the amount of knowledge that was relied upon in making that decision is but a tiny fraction of what one learns in the full medical course and which can easily be articulated in a few sentences. it is therefore quite unacceptable to say that just because someone did not take the full 5 year course, he or she cannot learn that tiny fraction that can be articulated in a few simple sentences, especially someone who is constantly exposed to such matters on a daily basis, year in year out.
miongisback
26 Apr 06, 01:11

Let me put this straight to you -

our modern hospital, high tech and all, was planned
not solely to care for heartlanders. These hospitals
were built to make money from foreigner patients!

There was no due consideration whether Singaporeans
can afford such expensive hospital facilities
and 'specialist' doctors.

That's why, today, we are all facing huge hospital bills.
And there is nothing Government can do now to reverse
the situation.
Atobe
26 Apr 06, 13:22

Snow Leopard,

Your perseverance is simply admirable to continue with your effort to convince someone who is a specialist - inside-out - and will battle you in his special turf on micro-issues, but will hardly be able to argue on macro issues.

As was mentioned, in all the FORTY-FIVE YEARS of Singapore's history, there has yet to be anyone from any specialist discipline leading any Ministry of the same discipline.

It took a team of System Engineers to map out the Education System, and came out with the present Production Line - Education System, from Primary to Tertiary (including Medicine) - System Engineers mapping out the Medicine Course but not the curriculum, which is left to Educationist with their wishy-washy ideas.

Similarly, there has yet to be a Medical Specialist to head the Ministry of Health, and can the reason be any clearer ?

I am presently still 'on the move' and have been following the issues posted, but with limited time to give a full response to some of the points raised by Oxford Mushroom.
fymk
26 Apr 06, 19:08

Originally posted by Atobe:
Snow Leopard,

Your perseverance is simply admirable to continue with your effort to convince someone who is a specialist - inside-out - and will battle you in his special turf on micro-issues, but will hardly be able to argue on macro issues.

As was mentioned, in all the FORTY-FIVE YEARS of Singapore's history, there has yet to be anyone from any specialist discipline leading any Ministry of the same discipline.

It took a team of System Engineers to map out the Education System, and came out with the present Production Line - Education System, from Primary to Tertiary (including Medicine) - System Engineers mapping out the Medicine Course but not the curriculum, which is left to Educationist with their wishy-washy ideas.

Similarly, there has yet to be a Medical Specialist to head the Ministry of Health, and can the reason be any clearer ?

I am presently still 'on the move' and have been following the issues posted, but with limited time to give a full response to some of the points raised by Oxford Mushroom.

Ah atobe , you forgot - some of our ministers are economists like GCT or lawyers . Economists set a value at everything including life while lawyers make the rules that govern our society.

Oh Ya Benjamin Henry Sheares, one of our former presidents was an obstestrician at kendang Kerbau.

Oh wait....Mr Vivian Balakrisnan is an opthamalogist....only problem not a minister of health but of community. Dr Ng Eng Han is also another surgeon who is not a minister of health but of manpower.

Do you know why most doctors do not become Minister of health? It is a conflict of interest with their profession . It is not because they are not capable - there are already 2 medical specialists who are ministers . It is to prevent people from saying that they favour another specialty or even profession over others in the healthcare arena.
fymk
26 Apr 06, 19:09

Originally posted by miongisback:
Let me put this straight to you -

our modern hospital, high tech and all, was planned
not solely to care for heartlanders. These hospitals
were built to make money from foreigner patients!

There was no due consideration whether Singaporeans
can afford such expensive hospital facilities
and 'specialist' doctors.

That's why, today, we are all facing huge hospital bills.
And there is nothing Government can do now to reverse
the situation.

Not really. I think it is just targetted at those who can afford to pay and pay they shall.
fymk
26 Apr 06, 19:29

Originally posted by snow leopard:
with all due respect, selection criteria can be made stringent so that only well experienced, competent and thoroughly tested nurses would be given the responsibility to take on the role of clinic practitioner.

the doctor didn't take 5 min to come to a decision to prescribe the controlled cough mixture to me. the amount of knowledge that was relied upon in making that decision is but a tiny fraction of what one learns in the full medical course and which can easily be articulated in a few sentences. it is therefore quite unacceptable to say that just because someone did not take the full 5 year course, he or she cannot learn that tiny fraction that can be articulated in a few simple sentences, especially someone who is constantly exposed to such matters on a daily basis, year in year out.
Doctors sometimes have patients with straightforward illnesses and some with complex problems. You cannot keep judging on coughs and colds.

I remembered a nurse who told me that she had a long time experience with people like me who she assumed was making a huge fuss of a minor cold. She had about 10 years of emergency nursing and I knew her because she and I worked in the same hospital. Well she was wrong , in 5 minutes, I nearly went into respiratory arrest while waiting for a doctor to see me. Not fun to be pushed into the resuscitation bay and see the ett tube standing by with the laryngeal scope. I found out later that I had bronchopneumonia due to influenza and legionella co-infection. It mimicked a cold until I got short of breath on that night.

Sometimes things are easy , sometimes things are hard....just like the cases of the patients. You cannot always assume it will always be a straightforward cough and cold in a person or that the next patient walking in will just have a haemorrhoid problem .
snow leopard
27 Apr 06, 07:32

Originally posted by miongisback:
Let me put this straight to you -

our modern hospital, high tech and all, was planned
not solely to care for heartlanders. These hospitals
were built to make money from foreigner patients!

There was no due consideration whether Singaporeans
can afford such expensive hospital facilities
and 'specialist' doctors.

That's why, today, we are all facing huge hospital bills.
And there is nothing Government can do now to reverse
the situation.
agwee somewhat. the way i see it is hospitals like raffles medical have sprung up to serve the rich indonesians. they take doctors away from govt hospitals and we have shortage.

there is a somewhat unorthodox way of filling in the shortfall, upgrading competent, experienced and tested nurses to a clinic practitioner level.
snow leopard
27 Apr 06, 07:34

Originally posted by Atobe:
Snow Leopard,

Your perseverance is simply admirable to continue with your effort to convince someone who is a specialist - inside-out - and will battle you in his special turf on micro-issues, but will hardly be able to argue on macro issues.

As was mentioned, in all the FORTY-FIVE YEARS of Singapore's history, there has yet to be anyone from any specialist discipline leading any Ministry of the same discipline.

It took a team of System Engineers to map out the Education System, and came out with the present Production Line - Education System, from Primary to Tertiary (including Medicine) - System Engineers mapping out the Medicine Course but not the curriculum, which is left to Educationist with their wishy-washy ideas.

Similarly, there has yet to be a Medical Specialist to head the Ministry of Health, and can the reason be any clearer ?

I am presently still 'on the move' and have been following the issues posted, but with limited time to give a full response to some of the points raised by Oxford Mushroom.
Gee, thanks Atobe, must chiar you lim kopi liao.

what you're saying is interesting ... perhaps you can share more when you've 'settled down' ...

all the best ...
snow leopard
27 Apr 06, 07:37

Originally posted by fymk:

Ah atobe , you forgot - some of our ministers are economists like GCT or lawyers . Economists set a value at everything including life while lawyers make the rules that govern our society.

like the swiss standard of living?

Oh Ya Benjamin Henry Sheares, one of our former presidents was an obstestrician at kendang Kerbau.

he is definitely a well respected man but at the end of the day, he was, like his counterpart is today, just a figure head ...
snow leopard
27 Apr 06, 07:38

Originally posted by fymk:
Doctors sometimes have patients with straightforward illnesses and some with complex problems. You cannot keep judging on coughs and colds.

I remembered a nurse who told me that she had a long time experience with people like me who she assumed was making a huge fuss of a minor cold. She had about 10 years of emergency nursing and I knew her because she and I worked in the same hospital. Well she was wrong , in 5 minutes, I nearly went into respiratory arrest while waiting for a doctor to see me. Not fun to be pushed into the resuscitation bay and see the ett tube standing by with the laryngeal scope. I found out later that I had bronchopneumonia due to influenza and legionella co-infection. It mimicked a cold until I got short of breath on that night.

Sometimes things are easy , sometimes things are hard....just like the cases of the patients. You cannot always assume it will always be a straightforward cough and cold in a person or that the next patient walking in will just have a haemorrhoid problem .
you seem to always forget, you are special remember? if 15 other doctors couldn't diagnose what you had, i would not be too hard on that one nurse who couldn't as well ...
BillyBong
27 Apr 06, 08:21

Originally posted by fymk:
Do you know why most doctors do not become Minister of health? It is a conflict of interest with their profession . It is not because they are not capable - there are already 2 medical specialists who are ministers . It is to prevent people from saying that they favour another specialty or even profession over others in the healthcare arena.
I find it somewhat strange that a DOCTOR is not leading the MOH. Yet you are claiming a conflict of interest?

What kind of conflict could possibly adhere to a professional in the same profession as his fellow colleagues? Wouldn't he/she (politically correct) be in the best position to dictate policy in the medical industry?

Isn't THE DOCTOR in the best possible position to understand the complexities and obstacles faced and in doing so able to address their needs appropriately?

And incidently, why should people claim government bias on what profession is favoured? Isn't it worse for the medical community to have a non-medical professional helming them?

Should a medical doctor lead the MAS instead? Or will an economist be better off leading the SAF?
fymk
27 Apr 06, 17:22

Originally posted by BillyBong:
I find it somewhat strange that a DOCTOR is not leading the MOH. Yet you are claiming a conflict of interest?

What kind of conflict could possibly adhere to a professional in the same profession as his fellow colleagues? Wouldn't he/she (politically correct) be in the best position to dictate policy in the medical industry?

Isn't THE DOCTOR in the best possible position to understand the complexities and obstacles faced and in doing so able to address their needs appropriately?

And incidently, why should people claim government bias on what profession is favoured? Isn't it worse for the medical community to have a non-medical professional helming them?

Should a medical doctor lead the MAS instead? Or will an economist be better off leading the SAF?
I would assume it would be a conflict of interest if they choose to continue to practice. I cannot practice as a nurse in certain areas because it conflicts with my work according to the protocol of where I work.

So don't ask me about it . Go ask the Singaporean government (coz I ain't working for them so I don't know) . Some countries allow it some countries don't depending on their protocol.
fymk
27 Apr 06, 17:34

Originally posted by snow leopard:
you seem to always forget, you are special remember? if 15 other doctors couldn't diagnose what you had, i would not be too hard on that one nurse who couldn't as well ...
So are you saying that I should deserve to suffer ?

I don't present normally because of my condition , so is it my fault?

Yes there are plenty of experienced nurses around. I have been trained as one - I worked in the acute sector and yes sometimes intern have to consult the senior nurse specialist on how to handle problems. However a nurse only specialises in one area , that doesn't mean she sees other clinical problems, unlike the houseman/intern they rotate around for about 2-3 years to gain a wider experience of other clinical areas before deciding on a specialty .

They don't rotate nurses around for long periods of time . Nurses stick to their ward and the designated specialty. yes you have community health nurses but some of them are long out of touch with independent diagnosis of acute problems.

I know of specialist nurses in cardiology but they cannot deal with intensive care area while the stoma nurse only knows how to assess a stoma, how to teach a patient how to deal with his/her stoma, whether the stoma is working but give her an 12 lead ECG and a arterial blood gas reading - she is lost . Sure we have competent nurses, no doubt about that - just in the area they always practise in that they are very competent. Put a cardiology specialist nurse to deal in the infectious disease area or work in an orthopaedic area- you get a literal fish out of the water. Community health nursing education in Singapore is not too advanced . They focus more on primary prevention , primary health care delivery , health assessment and community education. Even a nurse like me can do community nursing in Singapore.

You want nurse practitioners?Sure
Think of all your potential problems

Firstly which singaporean wants to see a nurse practitioner. In singaporean culture, don't forget about the kiasu and the kia see people.

Secondly , if the pay is crap at the end of their program , do you think nurses will be retained ? Plus added responsibilities, make a mistake and the nurse lose her registration which means end of a career. Most nurses will think like that - it is like a loss of livelihood. It is just like a lawyer getting debarred - loss of a livelihood - it means that the lawyer cannot practice anywhere
I remembered a hospital in Singapore wanted to teach nurses to cannulate so that they can free up time for the houseman to get around his business. Do you want to know what my ex colleagues and schoolmates said to me? They said why should they get the responsibility and the blame if something goes wrong through no fault of theirs especially when there is no money involved .
I am all for nurses getting more responsibilities - however more responsibilities must come with more income earnt and indemnity protection . How much MORE do you want to pay senior nurses? I am well aware that some senior nurses earn as much as a houseman does .

The reason why nurse practitioners are good in rural areas of australia is because they are like the doctors there - rely on the basics of health assessment and basic equipment. In addition they know the people around well enough, their habits , the town gossip etc plus people in small towns will know almost everyone around. However regional and rural health is still below par compared to big metropolitan areas because of the lack of manpower, advanced equipment and lack of specialists. I won't do rural nursing because it is too basic in equipment and all you pray is that the medical helicopter comes fast while you try to stabilise the patient using BASIC methods. I have plenty of respect for rural nurse practitioners . I came from the major metropolitan hospital and I seen the patients who the rural general practitioner and rural nurse practitioner stabilised long enough to ensure their survival with just PLAIN BASICS. I spoken to a few nurses who worked in the rural areas and they are good as any doctor in health assessment because they see the whole community - they actually go to the homes to see sick kids and adults. If they cannot deal with it - they have to call up the rural GP and if he cannot deal with it - he calls the bigger regional or metropolitan hospitals. If it is just one nurse practitioner - she can radio a doctor to discuss the problem and it will decided if the patient goes to the better equiped hospital . That is EXTREMELY different from Singapore.

Even in Singapore, the polyclinics are better equiped than the rural outback hospitals.
BillyBong
27 Apr 06, 18:28

Originally posted by fymk:
I would assume it would be a conflict of interest if they choose to continue to practice. I cannot practice as a nurse in certain areas because it conflicts with my work according to the protocol of where I work.

So don't ask me about it . Go ask the Singaporean government (coz I ain't working for them so I don't know) . Some countries allow it some countries don't depending on their protocol.
An article about a former CEO labasting one of his close surbordinates appeared in the TODAY paper yesterday or the day before.

In it, it depicted the sad reality of boardroom meetings where everyone simply nodded their heads in unison, none offering so much as a disagreement with company policies. The CEO blasted his surbordinate because he never disagreed with him and always served as a YES-MAN. Without deviating from the norm or challenging the validity of certain policies, the company would almost fall into the model of a pseudo-dictatorship.

Perhaps we shouldn't always stay apathetic; if it affects you, shouldn't you ask why the policy is so?

If we all adopted your policy of "Go ask the Singaporean government", then i guess the singaporean government is truly a first world team leading a bunch a 'YES-MEN'.
fymk
27 Apr 06, 19:22

Originally posted by BillyBong:
An article about a former CEO labasting one of his close surbordinates appeared in the TODAY paper yesterday or the day before.

In it, it depicted the sad reality of boardroom meetings where everyone simply nodded their heads in unison, none offering so much as a disagreement with company policies. The CEO blasted his surbordinate because he never disagreed with him and always served as a YES-MAN. Without deviating from the norm or challenging the validity of certain policies, the company would almost fall into the model of a pseudo-dictatorship.

Perhaps we shouldn't always stay apathetic; if it affects you, shouldn't you ask why the policy is so?

If we all adopted your policy of "Go ask the Singaporean government", then i guess the singaporean government is truly a first world team leading a bunch a 'YES-MEN'.
LOL . If I was a yes man , I would be in Singapore now working my head off for pittance and worrying about foreign talents coming after my job.

I said ASK the government why. Why isn't a doctor be a health minister since they have 2 on the ministerial cabinet . I MOST CERTAINLY DID NOT SAY agree with them. I did HOWEVER say I don't know since I don't work for them.

I ask when in doubt and your analogy is all wrong. i don't keep silent or nod when I disagree with something . I tend to ask before I get the basis to disagree.
Ask and you shall be answered
Seek (change) and you shall find (change)

By asking , it indicates that you might have a problem with why it is implemented , it rarely means you agree with the policy.

I may disagree strongly with policies of the government but sometimes there might be good reasons for why things are not the way they are.

Like me (bearing in mind I work overseas now) , I cannot work as a nurse in the hospitals anymore because it presents a conflict of interest in my present work. That could be the reason. Who knows?

Go read my statement you quoted again.
BillyBong
27 Apr 06, 19:37

Originally posted by fymk:
LOL . If I was a yes man , I would be in Singapore now working my head off for pittance and worrying about foreign talents coming after my job.

Like me (bearing in mind I work overseas now) , I cannot work as a nurse in the hospitals anymore because it presents a conflict of interest in my present work. That could be the reason. Who knows?

Go read my statement you quoted again.
So i guess it means you fall under SM GOH's Catagory of 'quitters' ? Pleased to meet you. (Non-sarcastic)

No disrespect. Indeed it is the issue of questioning policies that we lack locally. Too many followers, too many yes-men.

I know not why the minister (and past ministers) of health have not been doctors. But i do know the medical profession is suffering because of it.

I am surprised however when you suggest that being a nurse conflicts with your current job vocation when from your background, it seems you are in a related industry.
fymk
27 Apr 06, 20:09

Originally posted by BillyBong:
So i guess it means you fall under SM GOH's Catagory of 'quitters' ? Pleased to meet you. (Non-sarcastic)

No disrespect. Indeed it is the issue of questioning policies that we lack locally. Too many followers, too many yes-men.

I know not why the minister (and past ministers) of health have not been doctors. But i do know the medical profession is suffering because of it.

I am surprised however when you suggest that being a nurse conflicts with your current job vocation when from your background, it seems you are in a related industry.

Yes. I cannot however afford peanuts.....heard that one peanut is too expensive in singapore.

I do not work as a nurse anymore. I am working in a different sector which deals with the healthcare system but in terms of policy implementation and costs. I can tell you how frustrated I am about it but I learnt quite a bit more.

Anyhow , I think the health system is best co runned by a health economist , a doctor and a nurse. Health economist will tell you the costs , a doctor will tell you what is required and a nurse will tell you the impact on the patients .

I think a good health minister will always consult the major medical and health professionals as well as the consumers before implementing something. Does not matter if he or she is a medical professional. Just matters that policy does not flow just from top down but both ways which includes the grassroots .
fymk
27 Apr 06, 20:47

I did have an idea on cost cutting for Singapore Health System

Centralise everything again. You cut out unnecessary agencies.

I remembered a WHO consultant who went to Singapore to help out with SARS outbreak telling a group of us on how wonderful he thought the technology was there but there was a problem with the collation of data because everything was not centralised. They actually had to get more people to try and fix the surveillance database to fit it into central data collection. Each hospital was reporting on different wards and there was difficulty acquiring actual new cases . To be fair to the government , he however did say the health minister was very helpful in providing resources and would try his best in that testing time . I am not sure if that system was improved but that was the problem back then.

I think too much concentration has been given on ISO quality control. They should switch it to a performance based measure on producing a result within an acceptable standard rather than to compare and upgrade in terms of EVERYTHING from customer service to medical care to even the bloody laundry service or the cleanliness of the toilet.

With performance measures, you can actually determine if the CEOs or the minister is actually delivering, rather than to waste time and alot of money on beautiful ISO results and glossy reports or some stupid crystal decoration . Delivery of the results will give them a bonus but non delivery means a cut to their pay.

In addition, you will actually spare the health professionals and doctors from performing MORE paperwork than necessary for legalities. They could actually concentrate on treating people.

Polyclinic will do well with income means test but Singapore has the problem of the poor "rich" who have a mercedes benz and a condominium and a heck lot of debts to pay off.

I think best thing is to have an inverse income means test and debt test as well for those who are trying to qualify for private class because if they cannot pay - the healthcare system is actually burdened with unrepaid costs until it can be fully paid off. Not only that the family gets stuck with a massive bill and that will conversely affect their own health when they see the actual bill.

I think social policies , in terms of employment, need a bit of tweaking as well because snow leopard did say that work can wreak havoc on a person's health. That is where you can actually save the most money by lowering the healthcare burden in the long term rather than looking at short term results.

Nurses will come in useful for preventative health and direct hospital nursing referrals to community nurses to deal with simple post admission problem. I am not sure if you have it now since I have been out of the loop . Involve the allied health professionals as well since physiotherapists and occupational therapists can prove useful for an ageing population.

Cough syrups, lozenges , panadol should not be subsidised in any case. They are cheap as they come. Cough syrups and lozenges only relief symptoms and have limited benefits.
fymk
27 Apr 06, 21:16

II can agree with Atobe's version of a sinking fund for the elderly but I cannot agree with a public healthcare insurance for all.

However I propose to Atobe - why not encourage private healthcare insurance uptake if it is made available . That is what Australia does. The government subsidises 30% of the costs. If the person is above a certain income and have no private health insurance - tax them extra according to an income strata. It will reduce the impact on healthcare costs.
snow leopard
27 Apr 06, 23:26

Originally posted by fymk:
So are you saying that I should deserve to suffer ?

I don't present normally because of my condition , so is it my fault?
pardon me for not reading the rest coz its too darn long. anyway, never once had i harboured intentions of slighting you for your conditions. just that, apart from looking from your own perspective which is heavily shaped by the special conditions you are in, it would be nice if you would also look from a typical citizens' point of view where major policies should be geared towards while making allowances for special patients such as yourself.
fymk
29 Apr 06, 11:10

Originally posted by snow leopard:
pardon me for not reading the rest coz its too darn long. anyway, never once had i harboured intentions of slighting you for your conditions. just that, apart from looking from your own perspective which is heavily shaped by the special conditions you are in, it would be nice if you would also look from a typical citizens' point of view where major policies should be geared towards while making allowances for special patients such as yourself.
Well I am looking from a typical citizen's view of what a citizen might want for themselves. Good competent medical care and not dying as a result of a policy move or rather a say so. I look at the macro view not your micro view of promoting cheap but unnecessary manpower.

All you ever talk about is paying some doctor to see coughs and cold . Then when I said polyclinic - you said that you are not interested in travelling and why not have advanced nurse practitioners etc . Now let me put it to you this way - where do you think advanced nurse practitioners will be placed? IN A POLYCLINIC WHERE DOCTOR'S FEE are just 8 bucks per pop . There is no profitability of doing advanced nursing in a private setting all around for people who do not want to travel - cost of renting a private premise? Cost of running a "cheap" nursing clinic ? HOW much will the patient be actually paying ? You have a long term sustainability issue . If something is not sustainable - it will just fall apart and public money just gets wasted. Nothing learnt , nothing gained except for a bunch of nurses who will get lost in the system if the idea fall apart.

Seriously people would just pay to see a doctor nearby, like you said - you rather get to a nearby gp .

I think most people still would rather see a doctor except for yourself. The SARS or Avian Flu scare was enough to remind quite a few people when they get symptoms resembling either one of these but when they are actually in fact having a mild cold.

I don't think Singapore will be able to handle advanced nurse practitioners - it is not necessary in terms of economic costs or workforce shortage. You have gps who are happy being gps . It is only when there is no gp or the gp cannot cope then you bring in advanced nurse practitioners.

What you have suggested so far is akin to paying for paying 20 dollars for a shoe that lasts 1 year instead of a 100 dollar shoe that last you 10 years which actually more value for money. 20 x 10 years = 200 dollars while on a 100 dollar shoe, it is just a 100 dollars . So like I said before penny wise pound foolish.

Singapore already have a nursing shortage in the acute/ hospital sector - nurses come and nurses go and you want some new scheme to take away nurses where they are most needed - it will be hard to balance it out. Now doctors are slowly going into the ranks of international shortage as well - they will come and they will go as well . Singapore is doing its best to retain healthcare professionals but against international demand and offers - it is hard for a small country. Sure some nurses may be happy where they are - good for them. Half of the people I knew from my nursing days have already left for greener pastures. Go address the problem of retention first.

If you want to make the healthcare system cheaper - look at the whole system and how it is runned and understand how money flow through it. Healthcare is always a blackhole for funding. Don't blame me for the lack of comprehension of your proposal or me for being intelligently stumped by your ideas - I debated my fair share and so far you have shown me nothing to support your case.

Atobe's idea of a sinking fund is good although I might not agree with his public health insurance for all. At least he bothered to research . You just shut off books and use "commonsense" . May I remind you that all governments run on a different level of commonsense. Policies are made for economic efficacy and efficiency because governments have to justify to their citizens the costs . No working model , no proven feasibility = no funding , unless it is heavily politicised with alot of pressure like SARS which was an pandemic . I don't think Singaporeans in general would want to pay to see an advanced nurse practitioner in a polyclinic - they want their money's worth of seeing a doctor. Unless the current government says they have to and make it so.

First thing to do if you get a new government on may 6 instead of the same regular one is to ask them to open the books - be very transparent and then examine where the true costs are going to. Don't bother telling me to get that for you - you are the typical citizen with rights to know where your tax money is going, just like me but I am overseas so I don't have the same access like you do.

If you have something solid , then bring it out instead of giving me the "cough and cold " reason of not paying for a gp or whinging about how private doctors earn their money . That is the impression I am getting.