Healthcare: Tale of two nations
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Originally posted by fymk:
ok, i'm just reading your first and last paragraph ... assuming everything in between is the same bullshit again.
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.
not really. every time you quote from your own experience that because of your special conditions, that's why we need to pay premium, or blame 15 other doctors + one nurse, you're not speaking from a typcial citizen's point of view but from a special patient's point of view.
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.
you are being childish again. i do not wish to keep on admonishing you ... you should be old enough. -
I shall reiterate in this simplified way :Originally posted by snow leopard:
ok, i'm just reading your first and last paragraph ... assuming everything in between is the same bull%*%& again.
Not really. every time you quote from your own experience that because of your special conditions, that's why we need to pay premium, or blame 15 other doctors + one nurse, you're not speaking from a typcial citizen's point of view but from a special patient's point of view.
you are being childish again. i do not wish to keep on admonishing you ... you should be old enough
SHOW ME YOUR EVIDENCE OF A NEED for ADVANCED NURSES - where are your statistical data that show it is needed. Where is the economic data which indicates that it is needed and it will be a long term benefit? Where is the justification for pushing money into educating nurses to a higher level? How would it be sustainable? Which population are you trying to target? What is the added value? Who are the expert panel to trash out the finer details of education for advanced nurse practitioners?
SHOW ME YOUR IMPLEMENTATION PLAN - how much to see a nurse practitioners? Where do they operate? How would operation costs be covered? What is the level of knowledge they need? What can they prescribe and what they cannot prescribe? What are the medical services aka diagnostic referrals they can provide and cannot provide? Who do they go to when they need a second opinion and where does that cost come out from?
ON THE HEALTHCARE PROFESSIONAL LEVEL- how many doctors will support the idea? How MANY NURSES will support the idea? WHAT ARE THEIR CONCERNS?
( and no I don't want to hear just from nurses you know because I probably know MORE nurses , as well as DOCTORS than you)
ON THE CONSUMER LEVEL - which percentage of people are actually willing to pay and see these nurse practitioners? What are their concerns? What are their needs? How would it LOWER THEIR expenditure as compared to the 8 dollar consultation with a doctor in the polyclinic? Which geographical location is willing to run a pilot and feasibility study?
By the way I am not willing to cognitively process YOUR own individual complaints about expensive doctors and coughs and colds because of my apparent youth and immaturity . I am only willing to listen when you have the above questions answered. You have PROVIDED NO JUSTIFICATIONS yet.
If YOU cannot provide the information as in your PREVIOUS POSTS , just say so . No Need For Personal Attacks .
Don't ask me to do your proposal for you because it is your idea and you are old enough to propose it to your MP and government . Let me remind you that every government will not implement something unless it is heavily politicised and there is a demonstrated need with an economic value and a benefit to all because healthcare is a blackhole when it comes to funding - money goes in and you hardly see anything out except for the health of the population.
Btw , I don't want to hear about nanny state type of policy where you enforce it on everyone as it is a highly contentious issue related to health of the population and individual . I think quite a lot of people are sick of being babysitted when they can run and walk in a figurative sense.
Point of the whole thing : even the court of law requires evidence , NOT hearsay, to convict a criminal. Same with policies - you will need to justify it to everyone if you want to be heard. -
Originally posted by fymk:
SHOW ME YOUR EVIDENCE OF A NEED for ADVANCED NURSES - where are your statistical data that show it is needed. Where is the economic data which indicates that it is needed and it will be a long term benefit? Where is the justification for pushing money into educating nurses to a higher level? How would it be sustainable? Which population are you trying to target? What is the added value? Who are the expert panel to trash out the finer details of education for advanced nurse practitioners?
look right under your noses - isn't it there already where you are now?
SHOW ME YOUR IMPLEMENTATION PLAN - how much to see a nurse practitioners? Where do they operate? How would operation costs be covered? What is the level of knowledge they need? What can they prescribe and what they cannot prescribe? What are the medical services aka diagnostic referrals they can provide and cannot provide? Who do they go to when they need a second opinion and where does that cost come out from?
i have better things to do than show someone not in the position to implement anything any implementation plans.
ON THE HEALTHCARE PROFESSIONAL LEVEL- how many doctors will support the idea? How MANY NURSES will support the idea? WHAT ARE THEIR CONCERNS?
( and no I don't want to hear just from nurses you know because I probably know MORE nurses , as well as DOCTORS than you)
doctors may feel threatened, so i'd take their opinions with a pinch of salt. as for nurses, i'd throw that idea to her next time i see her ok?
i'm sure you know a lot of your kind, just don't understand how they can stand you.
ON THE CONSUMER LEVEL - which percentage of people are actually willing to pay and see these nurse practitioners? What are their concerns? What are their needs? How would it LOWER THEIR expenditure as compared to the 8 dollar consultation with a doctor in the polyclinic? Which geographical location is willing to run a pilot and feasibility study?
they're doing very well in aussie aren't they?
By the way I am not willing to cognitively process YOUR own individual complaints about expensive doctors and coughs and colds because of my apparent youth and immaturity . I am only willing to listen when you have the above questions answered. You have PROVIDED NO JUSTIFICATIONS yet.
you are not willing or you don't have to capacity to?
If YOU cannot provide the information as in your PREVIOUS POSTS , just say so . No Need For Personal Attacks.
sounds just like you isn't it?
Don't ask me to do your proposal for you because it is your idea and you are old enough to propose it to your MP and government. Let me remind you that every government will not implement something unless it is heavily politicised and there is a demonstrated need with an economic value and a benefit to all because healthcare is a blackhole when it comes to funding - money goes in and you hardly see anything out except for the health of the population.
ok come on stop being childish.
Btw , I don't want to hear about nanny state type of policy where you enforce it on everyone as it is a highly contentious issue related to health of the population and individual . I think quite a lot of people are sick of being babysitted when they can run and walk in a figurative sense.
Point of the whole thing : even the court of law requires evidence , NOT hearsay, to convict a criminal. Same with policies - you will need to justify it to everyone if you want to be heard.
many things are imposed on us, whether we like it or not, like GST, CPF, casino despite a lot protests ... so if our heavenly mandate wants it, it is justfication enough. -
You do have a choice to vote for another government if you are not happy (just in case you were not aware)
As for the rest of those nasty comments you made- you don't even know me. I applaud you for making me feel like I am being in Singapore again where a common citizen would be made feeling very stupid of asking questions. -
Don't get so worked-up.
Anyway my 2 cents worth.
I did medical training in Europe, did 1 year of training in Singapore and then , then USA training for years.
I can tell you some of the good points and bad points about each system.
The bottomline - THERE IS NO PERFECT SYSTEM.
The system has to work for the people on what their healthcare beliefs and philosophy are.
Issue 1: Life expectancy - Why are we so hung up about comparing life expectancies between Singapore and other countries vis a vis healthcare expenditure as a portion of the public budget?
Many of the countries with high expenditures are developed nations with mainly white populations - maybe they are expected to live to 70 to 80 years old and if we spend just as much, Singaporeans will live to 90 to 100 years old.
Issue 2: We generally only have one acute illness reimbursement system and no chronic illness insurance/reimbursement system.
Some folks live to 60 years and finds out that they have renal failure and need chronic dialysis but they don't want it (their attitude towards life) so they perhaps should purchase insurance that does not cover dialysis. Others may want everything done so they should spend on the top-tier medical insurance that roughly runs about US$300 to 1000 per month that covers also experimental therapies. These are personal choices and freedom of choice can be encouraged if the current government guides the development of these choices instead of just leaving it to the private sector.
We need about 5-6 classes of nationally (mutualized - not private medical insurance companies) run medical insurance to provide coverage according to people's attitudes towards healthcare.
Issue 3: Folks not in the know - there is truly a biomedical revolution going on here. But all these require funding to maintain doctor's competency and also gets ploughed back for further R&D.
Singapore does not do much and does not have proprietary techniques, medications, technology, etc. becuase we don't put our money into our healthcare sector for all these to be self-sustaining in generating these new ideas - so newer drugs/devices that have been shown to improve morbidty and mortality - we pay through our nose to other developed countries which then again funds their technological drive.
Issue 4: More doctors means they will treat more, so costs go up. That is a fallacy, in keeping with the biomedical revolution, doctors are, have and are now actively conducting clinical trials to translate these advances into practical applications. In time they get incorporated into practice guidelines. In my training the same amount of time to cover a specialty is now expended to cover a lot more areas that have developed into further super-sub-specialties, and I can tell you, I am drowning in information overload.
You can only get good in smaller areas becuase all these smaller areas of expertise have further bloom to full-fledged sciences and training - so you need more doctors if you want really competent and knowledgeable doctors.
The basics are basics - stop smoking, proper diet and public health measures are cruicial in avoiding repetitive insults to the chronically ill and precipitating acute illnesses. However, like me and other Singaporeans - how many of you still eat junk food and all sorts of crap?
Because it is the Singaporean way of life - besides, healthy food costs more - so we save and enjoy our food and plop it down for a bypass surgery later on in life.
Healthcare funding and costs of healthcare is a complex issue and a multiprong approach is required.
The fundamental truth that underlies "service" is the same - what you pay is what you get.
When you pay "peanuts" you get NKF, when you pay properly for services to cover yourself - you get less ambiguity on the type and quality and assurance of treatment. -
Bravo Dogtor for a well balanced review of the situation in Singapore.
Not that Singapore is poor by any First World Standard - not with the largesse that Temasek and GIC have in splurging across the globe - but we could have done better with the resources that have been applied for the real benefit for Singaporeans.
The annual reimbursement from tax collection surplus - that was recently wasted as an $ONE Billion Election Sweetener - could have been placed into a National Health Insurance Scheme or a National Health Trust Fund that could have managed our individual resources better than each of us as ignorant individuals can.
Singaporeans could have the best of the First World at the lowest cost based on the fact of our being in the midst of a Third World Resource Area.
Being laymen with limited exposure - except for the occassional encounter - to bio-medical developments, even the government will need expert panels to guide them in their decisions.
Can Singaporeans be left to its own limited ability to fend for itself in its old age ?
This is the Political Time Bomb that is ticking with a declining population that is creating havoc with the CPF scheme. -
Singaporeans could have the best of the First World at the lowest cost based on the fact of our being in the midst of a Third World Resource Area.
Hire more Indian, Mainland Chinese and Bangla doctors and nurses? Bring in medicine from Thailand and Malaysia? -
Don't forget Laos , Vietnam , africa for nurses . India manufacture medicine now also.Originally posted by oxford mushroom:Hire more Indian, Mainland Chinese and Bangla doctors and nurses? Bring in medicine from Thailand and Malaysia?