Chin Jing Jih

Pioneering chance for docs to boost seniors' quality of life

At the clinic and bedside, doctors should help patients select treatments known to be effective. They should also minimise the use of marginally beneficial tests or interventions unless there is no better option. -- ST FILE PHOTO
At the clinic and bedside, doctors should help patients select treatments known to be effective. They should also minimise the use of marginally beneficial tests or interventions unless there is no better option. -- ST FILE PHOTO

With the implementation of the Pioneer Generation Package, doctors will have an enhanced responsibility to ensure that treatment decisions are supported by a combination of good evidence, sound judgment and cost-effective analyses.

The recently announced Pioneer Generation Package (or "the Package") has generated much excitement and buzz. As the Package primarily fortifies health-care benefits for a well-defined cohort of senior citizens, it has naturally generated much discussion among medical practitioners and other health-care providers.

Concerns about the Package

ONE of the issues raised about the Package is whether it signals a shift towards "medical welfarism". But this concern has quite been dispelled by the key conditions of the Package itself.

First, it is a one-off gift to a very clearly delineated cohort of senior citizens, in honour of their role in nation-building. The number of individuals eligible for the Package is also limited.

Second, unlike the usual social welfare programmes in Singapore, the entitlement is not based on any form of means testing.

Another point to note is that it is not intended to completely substitute family and children's obligations to provide for their parents.

The Package is also unlikely to cause a significant surge in health-care demand.

Geriatricians and doctors who regularly provide medical care for seniors will probably agree that senior patients tend to resist treatment, and require a significant amount of persuasion before consenting to clearly beneficial treatments.

There are also those who fear surgery to the point of irrationality, and would stop seeing any doctor who tries to persuade them to undergo an operation. In general, seniors tend to avoid going to a hospital as much as they can.

Some observers are worried that MediShield Life, being a health insurance that covers acute and catastrophic illnesses, will inevitably lead to a slant towards a contractual, rights- based posturing in patients. It is also possible that seniors or their families may demand care with little regard for medical appropriateness. Indeed, we have seen countries where such behaviour, if left unmanaged, can lead to uncontrollable escalation in health- care costs with no better outcomes.

An unmanaged and irrational free-for-all buffet system for the health-care sector is certainly not where we want to go.

Responsibilities of the medical profession

DOCTORS should advocate policies and practices that reduce waste and unnecessary medical interventions, while improving efficiency in areas of appropriate care.

Most seniors prefer to age in place, rather than spend time in hospital and institutional care.

Therefore, doctors need to focus more on primary and preventive care.

Where possible, dollars should be made available to pay for health maintenance at the primary and community care level.

This is better than treating acute and catastrophic illnesses. The latter are far more costly and result in much more pain and suffering for patients.

At the clinic and bedside, doctors should help patients select treatments known to be effective.

They should also minimise the use of marginally beneficial tests or interventions unless there is no better option.

When confronted by tests or treatments that will accomplish similar diagnostic or therapeutic goals, cost-benefit analyses should be made in order to produce reasonable recommendations.

Doctors should be happy if the Package results in an increase in appropriate treatments (supported by legitimate medical indications) for seniors who previously declined them due to affordability issues.

In addition to an increase in quality and quantity of life, such treatments may also have long- term benefits for patients.

For example, a total knee replacement in an otherwise healthy and independent senior who desires to be active again may now be less prohibitive in terms of cost.

This will not only provide the senior with a new lease of life of enhanced quality, it may also potentially improve this senior's cardiovascular health as he or she becomes more active and mobile.

This may potentially reduce future health-care burdens on the individual, family and society.

On the other hand, it would be meaningless and medically inappropriate if the same total knee replacement was proposed for treating the osteoarthritis of a group of seniors who were permanently disabled, bed-bound and uncommunicative due to advanced vascular or neurodegenerative disease.

With a rapidly ageing population, the Pioneer Generation Package is an excellent opportunity for doctors to take up the challenge of improving the health and quality of life for seniors in Singapore.

As more resources are made available, the medical profession must ensure that they are well utilised.

Doctors can do this by applying their technical expertise appropriately, and holding fast to the principles of medical ethics and professionalism.

stopinion@sph.com.sg

The writer is president of the Singapore Medical Association (SMA). This article is excerpted from the March issue of SMA News, the association's monthly newsletter. A longer version is available at http://sma.org.sg