Healthcare costs have been increasing over the years in Singapore, and there has been much discussion on the reasons for it.

One factor that has not received much mention is mismatched care.

Singapore is a small city state. Distance is not a barrier to accessing healthcare services. Also, Medisave, subsidies and various insurance schemes help to pay for care.

These schemes often disincentivise general practitioners (GPs) to treat, and cause them to opt to give referrals instead.

For instance, it is faster, and more rewarding, for a GP to refer a patient who needs ear wax removed to an ear, nose and throat surgeon instead of syringing the ears himself.

In Singapore, it is customary for some to seek a specialist even when the condition does not require one. For example, some parents take their children to a paediatrician for the common cold or a childhood vaccination.

Various policies have also been crafted with the specialist in mind.

For instance, should a resident suffer a medical condition and require a downgrade of his army status, he needs a specialist assessment. This process takes time and wastes the limited specialist resources.

Some conditions, such as asthma and valvular defects of the heart, which can be objectively diagnosed, should not require specialist endorsement.

Many chronic conditions such as dementia and benign prostatic hypertrophy can be diagnosed and treated at the primary care level.

However, many turn to specialists in the public hospitals because of the heavy subsidy.

We should make use of IT and other innovative products to regularly push care downwards to the primary care level and reduce the unnecessary preference for specialist services.

Focusing on appropriate care for all will help cut healthcare costs.

Leong Choon Kit (Dr)