Forum: Healthcare set to get better, but for whom?

Senior health correspondent Salma Khalik outlines the change in the mindset of the Ministry of Health (MOH) from one of treating patients to one of preventive medicine (

Healthcare set to get better, if the little impediments are flagged and fixed

, April 23).

In any healthcare system, there are only three players who carry the burden of the cost involved – the government, medical insurance providers and the patient.

The system Ms Khalik describes is similar to the National Healthcare System in Britain. The government sets out a healthcare budget in its annual budget, and the funds are distributed to the various regions based on the density of the population. The hospitals work within the budget and once the funds are used, non-essential surgical procedures and treatments are put on hold until the next year’s budget comes out. 

This system allows the government to control healthcare costs, but results in longer treatment waiting times.

Regardless of the philosophy behind the system proposed here, I foresee a few things happening. 

First, waiting times for consultation at polyclinics and specialist clinics will increase.

Second, waiting times for surgery (especially for subsidised patients) will increase. After all, why should the hospital try so hard to squeeze 10 subsidised cataract operations in one day when it can take its time and do seven? The hospital pays more for doing more, and the doctor earns the same amount whether he does 10 or seven.

Third, more patients will move to private hospitals. Unlike patients in Britain, most Singaporeans have private insurance. If they are not happy with the waiting times and service at restructured hospitals, they can consult doctors at private hospitals. 

Fourth, insurance payouts will increase as more patients move to private hospitals.

Fifth, an increase in insurance premiums will follow.

So when Ms Khalik says healthcare is set to get better, what does she mean? I think it will be better for MOH because healthcare costs will be controlled or at least be more controllable.

The medical insurance companies may not feel the change either way as they can simply increase their premiums to cover any increase in payouts. The patient may find a leaner healthcare system but waiting times will still be longer and medical insurance premiums will rise.

I’m all for changing the mindset of the population from one of disease treatment to one of disease prevention. All of us should eat less, exercise more, quit smoking and drink less alcohol.

But this mindset change will take time to fully set in.

In the meantime, what happens to those with current chronic illnesses such as diabetes, hypertension, and smoking-related conditions? These require admission to the hospital when the condition flares up.

What happens to those with non-life-threatening conditions that affect their quality of life, such as sleep apnoea, backache, chronic headache and mental illness?

Better is always good. But in this case, better for whom? 

Gerard Chee Hsien (Dr)