Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts

Tuesday, April 26, 2016

Troubled Souls


As our society learns to recognise that more could be done for those who are physically impaired, there seems to be a corresponding rise in social vigilantism that springs up quickly to condemn anyone who seem to show little consideration for the less able-bodied.

Not long ago, there was an impassioned plea in parliament for a better understanding of those who suffer some form of physical disability. There are many small voices that cry out to the able-bodied for more of their patience and understanding. It is important that we learn to hear these voices which are quietly tugging at our heartstrings as we strive to become a more compassionate society.


In sparing thought for those who are physically impaired, we need to realise that there are also many amongst us who do not suffer from any obvious physical impairment but need our patience and understanding no less. They are the ones suffering quietly from emotional distress who do not display the outwards signs of physical impairment that would have otherwise drawn to themselves the spontaneous help from concerned bystanders. Very often, these troubled souls are mistaken by social vigilantes as people who are cold and dispassionate in responding timely or appropriately to the needs of a less able-bodied person standing close to them. And they are caused to suffer from public ridicule and condemnation, adding on to their untold frustration and emotional torment and pushing them to breaking point.

Materialism and elitism have been the twin evils that have come to occupy our minds from the decades spent in a national pursuit for global excellence in every undertaking. Sky-rocketting property prices which are grossly disproportionate to the rise in income levels have shattered the dreams of many young Singaporeans and pushing them into migrating overseas. Keen competition with foreigners for jobs, housing and transport in our own land has displaced many individuals and families and severely dampened morale. Divorces are constantly on the rise and more children are left to the care of domestic helpers as dual incomes from their parents become indispensable. Rising business costs have closed the curtains on many local enterprises and constant skills upgrading have not brought about better jobs. Endless new legislations and regulations have raised the pressures of living in this small city-state and there are many people who look perfectly normal on a perfect day but are too stressed out mentally and emotionally. They are already at wits' end.


For all these troubled souls who appear as normal, healthy- looking people, they too have small voices crying out for patience and understanding as well.

"If I am not giving you my seat, it's not because I am unkind;  I am just lost in my thoughts."

"If I am not giving way, it's not because I don't care; I just do not have much time left."

"If I am not paying any attention to you, it's not because I am cold; I just don't know what I am going to do anymore."

"If I am going too fast, it's not because I am reckless; I am just worried that I may not make it."

"If I don't answer you, it's not that I want to be rude; I just don't know what is happening to me."

"If I don't see you standing in front of me, it's not because I am pretending to sleep. I am just very, very tired."

Let's all learn not to be too quick to point our fingers without sparing a thought for someone who may be one of these troubled souls. He or she needs our patience and understanding too.

Wednesday, September 9, 2015

THEME: Medical - Healthcare Matters

Medicine is a subject that requires the practitioner to have a passion to heal the sick and save lives. Historically, doctors take the Hippocratic oath to uphold their calling and high ethical standards.


Many of our local students aspire to study medicine because of its noble calling but there are very high bars for entry into our local medical schools and medical schools admit students based on their stellar academic results and not so much on their disposition to practice medicine. 

Each year, our intake of medical students is less than 300 and this is hardly enough to meet increasing demands. A great number of our students with the right aptitude for medicine are forced to leave for overseas medical schools, spending huge sums of money to earn their medical degrees. Yet, instead of expanding the local intake, foreigners are recruited to make up the numbers. This scene is repeated in the nursing line which has become heavily reliant on foreign nurses (Click HERE).


There is a need to seriously review our policies and to expand our intake of medical students to allow more of our own students with the right aptitude but less stellar academic results to train and become medical practitioners. From a social perspective, the more doctors and nurses there are, the more our aged and sick will have ready access to medical attention. An increase in the supply of doctors and nurses, and medical practitioners in specialisations that are in growing demand, will go towards lowering overall medical costs and waiting time.

Government polyclinics in Singapore fulfill the primary healthcare role. These are managed by the National Healthcare Group and Singapore Healthcare Services which were formed in 2000 (Click HERE). They provide subsidised outpatient medical care, health screening and pharmacy services. However, the percentage of government polyclinics vis-a-vis private clinics stands at only 20%. This is certainly less than ideal.


Currently, government polyclinics open only from 8 a.m. to 4 p.m. and are closed on Sundays and Public Holidays. It is perhaps time to look at operating government polyclinics on a 24/7 basis to cater to the needs of an expanding ageing population to help bring down the costs of healthcare. Consultations at polyclinics should be free for all elderly citizens above 65 years old and for those younger, the consultation fee could be fixed as low as possible. Drugs for coughs and colds and other common ailments should be provided free.

Prevention is better than cure and steps should be taken to provide early detection and treatment of diseases. However, breast screenings, pap smears and other health screenings are getting more and more costly and they deter people from going for their yearly check-ups. There can be a national health screening programme which charges a nominal fee for our citizens to encourage them to take care of their own health. Early treatments will also be less costly and increase the chances of full recovery. As it is often said that our people are the only natural resource that we have, it is surely worth the investment to ensure that they are healthy and strong.


The Community Health Assist Scheme (CHAS) provides subsidies for citizens from lower- and middle-income households for medical and dental care in participating clinics. Presently, applicants are means-tested by taking their total household income divided by the total number of family members living together. The calculated income must not exceed $1,800. This income ceiling should be raised to reflect the rising costs of living. Further, the criteria for those without income to not possess a home with an annual value of not more than $21,000 should be reviewed along with any increase in annual values.

There are also caps on the subsidies for Blue, Orange and Pioneer Generation CHAS cardholders pertaining to chronic conditions. Whilst the caps ($360 and $540 for simple and complex conditions as defined) are published, it would be useful if the balance of the cap remaining provided to the cardholder after every deduction. These cards are currently valid for one year periods and cardholders must apply for renewal. One suggestion is to provide for automatic renewal to save trouble for these cardholders who are generally old and illiterate. 


Rising medical costs have led to various healthcare policies like the Pioneer Generation Package ("PGP") for elderly folks, whose need for financial assistance to reduce their medical costs was neglected for quite a long time. It is estimated that 450,000 Singaporeans, whom the government identifies as the pioneer generation, will benefit. 

Although this is a rather artificial categorization and has led to unhappiness from those who miss the cut-off age, the PGP package serves to help a group of elderly Singaporeans who are 65 and above w.e.f. 31 December 2014. Since the idea behind this package is to show appreciation for their contributions, the PGP ought to cover all their medical costs of the "pioneers" without requiring any of them to make any balance payment.

Wednesday, August 12, 2015

THEME: Medical Care and Costs

There is an old saying by Singaporeans that derides the medical costs in Singapore. It says that in Singapore, you cannot afford to fall sick and it is better to die. The underlying sentiment is that the costs of medical care and treatment is beyond affordability.


Medical costs have been constantly rising like the earth's surface temperature and in the last five years, there has been a sharp rise in private healthcare costs (Read HERE). The fastest rising component appears to be doctors' bills. According to a report, the costs of doctors in private practice have jumped very significantly and even a simple lumbar disc surgery by a junior doctor has shot up 5 times from S$5,000 to S$ 25,000. The other components that have risen rapidly are clinic costs and overheads.

When private medical costs shoot up, there will be a flow of private patients into the public healthcare system. Medication and lab tests fee have risen across the board. Over at the 18 neighbourhood polyclinics, even the costs of consultation have risen. Singaporean adults pay up to S$11.90 and children and non-pioneer generation patients pay a maximum of S$6.80 for basic consultation. Up from S$11.00 to S$11.30 and S$6.10 and S$6.40 in October 2014. The reason given was that operating costs such as utilities, infrastructure, equipment and inflation, have gone up.


There does not appear to be a ceiling to the medical costs that patients have to pay and the sky is the limit. The recent case of a Singapore surgeon charging a foreign patient S$ 24.8 million has sent shock waves throughout the land. Doctoring is seen as the most lucrative professions to be in and many doctors prefer to practice plastic surgery and aesthetic medicine which are considered the most profitable. With high medical costs, "pay as charged" medical insurance became popular but these policies began to see medical costs rising even higher as they encourage doctors to charge higher fees with insurers footing the bill. Medical tourism brought in well-heeled patients who are willing to pay high charges for health screenings and various surgical procedures, leading to a vicious cycle of higher and higher medical costs.

How can we address the concerns of ever-rising medical costs in a fast expanding population where the number of aged people is growing rapidly and further ensure that all those who need medical care will not be left out? I will share some of my thoughts in my next blog.