Insurace co. put cap on doc's prescription
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Insurances co. in HK
put the cap on for patients' revisit and referral to specialsts,presriptions
and diagonstic.Why ,save $$$ lah.
at least 3000 out of 10,000 doc in HK have signed contract with insurance co.
2.any similiar contract in Spore?pl share here.
more news in Chinese
Editorals critizing this
cap -
This is about managed healthcare, which is quite common in the US and also in Australia. The healthcare company signs an agreement with a group of doctors who will treat patients who have taken up a medical insurance with them. In turn, the healthcare company pays the doctors for their services.
A big and powerful managed healthcare (MHC) company can monopolize the market and pressure its doctors to cut services, reduce lab investigations and prescribe cheaper drugs to cut costs. New doctors often find it difficult to survive as private practitioners because the MHC is able to offer patients lower healthcare costs by virtue of its size. But patients pay in other ways, as this report illustrates..
We do not face such a big problem in Singapore but company doctors are often under pressure by the company to restrict MCs and there is a cap on prescriptions as well. For example, the company may restrict the doctor to prescribe no more than $20 worth of medication each visit. Some doctors bypass this problem by giving half the course of antibiotics and advise the patient to return when the medication is completed. They can then give the second half of the antibiotic course as it is considered as separate visit. -
Medical costs will always be expensive in the more developed countries. It is just a matter who foots the bill.
In Britain, it is the government, but at the expense of taxing the people more, and having an inefficient service.
In the US, group insurance is the thing.
In the past, and in less developed countries, healthcare costs is cheap because modern drugs and technology, both of which cost lots of money, is simply unavailable.
Paradoxically, our average life-span has increased significantly even before the advent of things like MRI machines, top-of-the-line surgery, or modern chemotherapy. The main factors are better nutrition, simple vaccinations and improved living conditions. The fancy new stuff does make an improvement, but only slightly. Therein lies the problem for our government, trying to keep a cap on healthcare costs (not sure, but I think our government spends very little on health compared to the west), knowing we have reached the stage that pouring a lot more money in would not reap a lot of improvements in return.
Notice how our Health Minister is always harping on cutting costs. Little mention about the government spending more of its budget on health? The minister for law is a lawyer, but the minister for health is an adminstrator. -
is this why i saw on tv, the doctor said that one needs 7 days of rest when infected by Influenza.. then he'll give the patient 2 days medical leave?
happened to me once.. a doctor told me: you'll start to feel better in about 5 days, here's 2 days' MC..
and another time, i could barely stand up and had a fever of 39.2, the dude gave me 1 day medical leave.. the next day, i could barely get up from the bed, so i got my sister to drive me to the same doctor who grudgingly gave me another day's medical leave...
i called in to office and took a couple more days of my own vacation leave because i refused to go back to see that quack...
is this what you mean by "companies pressure doctors" ? -
If the doctor is linked to a managed healthcare company that is likely to happen.NSF MOs are also told to give the minimum period of MC and tell the patient to return if he is not better. The idea is that different people recover at different rates...you can always extend the MC, but you are not supposed to give everyone longer MC than required.Originally posted by the Bear:is this why i saw on tv, the doctor said that one needs 7 days of rest when infected by Influenza.. then he'll give the patient 2 days medical leave?
happened to me once.. a doctor told me: you'll start to feel better in about 5 days, here's 2 days' MC..
and another time, i could barely stand up and had a fever of 39.2, the dude gave me 1 day medical leave.. the next day, i could barely get up from the bed, so i got my sister to drive me to the same doctor who grudgingly gave me another day's medical leave...
i called in to office and took a couple more days of my own vacation leave because i refused to go back to see that quack...
is this what you mean by "companies pressure doctors" ? -
Asking the patient to return for another follow-up check, while capping the amount that is to be spent ?
Is this not contradictory ?
Calling the patient to return for a further check, and extend an MC - will that not incur additonal cost to the patient, and additional down time to productivity ?
Are these not simply money-spinning ploys for the doctors to milk the patients with additional visits ?
Where is the honor in keeping to the oath taken upon graduation, or was that simply hypocritical practise required out of tradition more then true commitment ?
This must be the ultimate in the Psychology of Hypocrisy. -
This is not the result of greed, this is the result of administrators that work in companies that arrange for basic, GP-level healthcare for normal workers. These people stipulate that the charge for each visit be capped at a certain amount. Some medications cost more than the capped charge. To avoid having the patient topping the difference on his/her own, the patient comes back a second time.Originally posted by Atobe:
Asking the patient to return for another follow-up check, while capping the amount that is to be spent ?
Is this not contradictory ?
Calling the patient to return for a further check, and extend an MC - will that not incur additonal cost to the patient, and additional down time to productivity ?
Are these not simply money-spinning ploys for the doctors to milk the patients with additional visits ?
Where is the honor in keeping to the oath taken upon graduation, or was that simply hypocritical practise required out of tradition more then true commitment ?
This must be the ultimate in the Psychology of Hypocrisy. -
Originally posted by sourketchup:
Is this not ironical that - on one hand, the bean counters try to save expenses but at the same time is creating additional costs to the sick, to its employers, and to the general economy ?
This is not the result of greed, this is the result of administrators that work in companies that arrange for basic, GP-level healthcare for normal workers. These people stipulate that the charge for each visit be capped at a certain amount. Some medications cost more than the capped charge. To avoid having the patient topping the difference on his/her own, the patient comes back a second time.
Will it not be more economical to have the sick being cured at one go, instead of having to make a second visit to get fully cured ?
Whatever rules and regulations that a bean counter can create, there will be alternative clever ideas to beat the silly rules that are created that supposedly safeguard the original purpose of Healthcare.
Can we no longer depend on the basic Professional Ethics ?
Surely the number of visits before the sick will get cured - depending on the type of illness - will show the profficiency of the attending medical staff in attending to the illness ?
Can we be assured that - as paying members to the Healthcare Program - we are getting our money's worth in the manner that bean counters dispenses medical help ? -
I don't know what "bean counters" mean. As explained, there are companies that are not set up by doctors, but by administrators that arrange for other companies to subscribe for healthcare. These middlemen would then source for GPs who are willing to join up. It is these middlemen who ask for the charges for each visit to be capped at a certain amount. The GPs could either acquiese in this arrangement, or not join up. They DO NOT have a say. Rather then blame the medical staff, it is the middlemen who made this arrangement. And by being the middlemen, they get a chunk of the money, as you can imagine.Originally posted by Atobe:Is this not ironical that - on one hand, the bean counters try to save expenses but at the same time is creating additional costs to the sick, to its employers, and to the general economy ?
Will it not be more economical to have the sick being cured at one go, instead of having to make a second visit to get fully cured ?
Whatever rules and regulations that a bean counter can create, there will be alternative clever ideas to beat the silly rules that are created that supposedly safeguard the original purpose of Healthcare.
Can we no longer depend on the basic Professional Ethics ?
Surely the number of visits before the sick will get cured - depending on the type of illness - will show the profficiency of the attending medical staff in attending to the illness ?
Can we be assured that - as paying members to the Healthcare Program - we are getting our money's worth in the manner that bean counters dispenses medical help ?
And to get to the bottom of it, it is ultimately the employers who ask for this as a means to reduce the amount of money they have to pay up. The only way doctors would be able to get around this is to set up a "middleman" company themselves.
And as I have explained, some diseases need a certain course of medications, that would cost more than the capped charges. Hence to avoid having the patient from paying up the difference, the patient returns for a second visit, which would again be paid for by his/her employer. It has nothing to do with inefficient medications. And anyway, some illnesses take time to run its course. -
bean counters = derogatory term used to refer to administrators or accountants who care more about their books than people..
as for "the cost is too much for 1 claim, make the guy come and split it into 2 claims"... that's insane isn't it?
think about it...
it's akin to: this machine is made for someone with three arms.. we've perfected the art of grafting a 3rd arm to the operator...
but then, that's how bean counters think... it's like the whole computer systems thing at my place of work now... people are now secondary to the IT systems.. and the IT systems are making things more expensive, more difficult and less efficient for less effect.... but it's really hi-tech!
we see it in the NEL where a very expensive unmanned train is favoured over a cheaper train system driven by men...
oh well.. in the meantime, i'll sing Sandi Thom's ditty:
When the head of state didnÂ’t play guitar,
Not everybody drove a car,
When music really mattered and radio was king,
When accountants didnÂ’t have control
And the media couldnÂ’t buy your soul
And computers were still scary and we didnÂ’t know everything
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i think u should just change doc...Originally posted by the Bear:is this why i saw on tv, the doctor said that one needs 7 days of rest when infected by Influenza.. then he'll give the patient 2 days medical leave?
happened to me once.. a doctor told me: you'll start to feel better in about 5 days, here's 2 days' MC..
and another time, i could barely stand up and had a fever of 39.2, the dude gave me 1 day medical leave.. the next day, i could barely get up from the bed, so i got my sister to drive me to the same doctor who grudgingly gave me another day's medical leave...
i called in to office and took a couple more days of my own vacation leave because i refused to go back to see that quack...
is this what you mean by "companies pressure doctors" ?
eh.. at woodlands, near 888 plaza, there's this clinic call lee n lee clinic.. the doc very nice de... he will give u 2 days if he thinks u need it. maybe 3 days... den he will ask u to come back again if u're still not well.. cos they're NOT ALLOWED to give more than 3 days mc (this i heard from another doc in yishun -
You want cheap healthcare, you pay in other ways. Companies impose a cap on doctors either directly or through a managed health care company, limiting the amount of fee that can be charged per visit. If patients require an expensive drug such as an antibiotic, the cap would have been easily exceeded.
Doctors can either NOT prescribe the required medication and give a prescription for the patient to buy from Guardian pharmacy on his own, or break the medication into two visits to keep within the cap.
The situation is generated by patients who demand cheaper healthcare without consideration of its implications and companies who want to cut costs whilst claiming to provide healthcare for its employees. The doctor did not create the system. He is only working within the system to do the best he can for his patient.
The intentions of the doctor are entirely honorable and the logic is simple given the circumstances. Of course it may not be that easy to understand for some who are intellectually challenged. But Atobe does not have to worry...as he has said before, he can simply see a bomoh and get some herbs on his way home
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But of course!Originally posted by oxford mushroom:But Atobe does not have to worry...as he has said before, he can simply see a bomoh and get some herbs on his way home 
As I mentioned above, healthcare is cheap in poor countries, because it is, well, er non-existen....., anyway it is cheap.
Yes, of course it can be cheap in Singapore too. There is always the good old bomoh. And the bomoh is not employed by the "bean counters". Doubly good. -
How would patients - being lay person - know what is the best medicine or medical methods to cure his illness ?Originally posted by oxford mushroom:You want cheap healthcare, you pay in other ways. Companies impose a cap on doctors either directly or through a managed health care company, limiting the amount of fee that can be charged per visit. If patients require an expensive drug such as an antibiotic, the cap would have been easily exceeded.
Doctors can either NOT prescribe the required medication and give a prescription for the patient to buy from Guardian pharmacy on his own, or break the medication into two visits to keep within the cap.
The situation is generated by patients who demand cheaper healthcare without consideration of its implications and companies who want to cut costs whilst claiming to provide healthcare for its employees. The doctor did not create the system. He is only working within the system to do the best he can for his patient.
The relationship between the sick and the doctor is one based on trust and respect.
"Affordable healthcare" does not necessarily mean "cheap".
No person will want to be sick longer than necessary, and is there any advantage to be sick constantly and let the healthcare system make a profit ?
The system is created in response to a situation that is largely a result from the greed of ordinary humans practising in the healthcare industry - both in the medical and administrative professions.
Both see the huge profits that can be made - either from one time chargeable high fees, or through a long term systematic and regular provision of healthcare.
The bottom line is that the ignorant lay person end up paying the brunt of costs in a monopolistic environment controlled by specialists hungry for the good life than to fulfill the Oath.
Can Doctors be honorable when represented by "younger upstarts" - who will put words into the mouths of others, instead of dispensing proper medicines ?
The intentions of the doctor are entirely honorable and the logic is simple given the circumstances. Of course it may not be that easy to understand for some who are intellectually challenged. But Atobe does not have to worry...as he has said before, he can simply see a bomoh and get some herbs on his way home 
Where on earth did you come to such a conclusion about my "reliance on bomoh and herbs" ?
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I think mushroom was just teasing you. Now, don't be so upset.Originally posted by Atobe:Can Doctors be honorable when represented by "younger upstarts" - who will put words into the mouths of others, instead of dispensing proper medicines ?
Where on earth did you come to such a conclusion about my "reliance on bomoh and herbs" ? -
Originally posted by sourketchup:
Upset ? Me upset ?
I think mushroom was just teasing you. Now, don't be so upset.
I was "seriously" commenting the integrity of a mushroom - whose claim to be a doctor is as good as the usefulness of any type of mushroom for medicinal use.
How often do you see smileys in my post ?
Upset ? -
It's alright, daddy loves you. It's alright.Originally posted by Atobe:Upset ? Me upset ?
I was "seriously" commenting the integrity of a mushroom - whose claim to be a doctor is as good as the usefulness of any type of mushroom for medicinal use.
How often do you see smileys in my post ?
Upset ?
