Sunday, July 07, 2013

Privatized healthcare vs universal access

While chatting with my boyfriend DD today, he mentioned that one of the factors (amongst several) of his decision to return to Canada was the way healthcare system works in USA (pre-Obamacare). [Note: USA was a country with better job prospects in his industry compared to Canada at the time of his relocation.]

I shared with DD that, IMHO, the Singapore healthcare system is even more "right-wing" than USA's. E.g. A couple, who despite having bought insurance for their child and both holding well-paid professional jobs, going into credit card debts to pay for healthcare for their child with congenital issues. E.g. An elderly childless-woman who was told to sell the remaining lease of her 3-room HDB apartment (leaving her with no home of her own and having to live under her niece's equally small HDB) before she could apply for Medifund funding for her repeated acute hospital care.

As I am currently working in paediatric home health nursing in B.C., Canada, I can see the difference in the kind of support (from the provincial government) given to parents with children who lucked out on rare, chronic or deadly illnesses. In addition, Uncle Wing's (bless his soul) own experience is testimony to how the B.C. healthcare system takes care of its seriously ill elderly. [Click here to see my year-2009 blog entry about BC nurses petition against healthcare underfunding and Singapore's privatization of healthcare.] While I do not deny that Canada's system has its weaknesses, I feel that it caters well to “不怕一万,只怕万一。” ["Not afraid of the common scenarios (that one can plan for), but fear the exceptional scenarios."] After all, how many of us would choose (for the sake of maximizing our usage of universal healthcare): 
  • to be involved in major road traffic accidents (and thus requiring extended intensive care and probably repeated restorative surgery and extended rehabilitation); or
  • to have children with rare, chronic and/or deadly illnesses; or 
  • to have elderly parents with chronic, debilitating and/or incurable illnesses?
Yet there will always be Singaporeans who would defend that the Singapore healthcare system is better (e.g. more efficient and/or more cost-effective, or more equitable because specific-user-pays instead of risk-sharing) than Canada's, Australia's, UK's, etc. [Just check out the comments on those blog posts.] I hope that these "loyal", "patriotic", defensive Singaporeans will never have to encounter any major/repeated healthcare issues personally and/or amongst their loved ones.

Another issue I have with the way private healthcare works in Singapore is that until recently (see below), there was little control on the runaway costs/mark-ups in private healthcare. Note: I have met a significant number of private specialists who would waive/discount their fees to help the "needy" patients, thus it would not be fair to tarnish all kind-hearted doctors because of one black sheep. Nevertheless, IMHO, it is human nature to compete to be the better paid specialist. After all, it is so very much in Singapore's culture to judge people by the size of their income.


Dr Susan Lim loses appeal against SMC's guilty verdict
Published on Jul 01, 2013 1:39 PM

By Selina Lum And Kc Vijayan

The highest court in Singapore on Monday dismissed an appeal by general surgeon Susan Lim against her conviction on charges of professional misconduct over the amount she charged a patient from the royal family of Brunei.

In a 109-page written judgment, the three-judge Court of Appeal said Dr Lim's case was "clearly one of the most serious cases - if not the most serious case so far - of overcharging in the medical profession in the local context". The court dismissed her claims that she was justified and there was no ethical obligation to charge a fair and reasonable amount and pointed out her approach showed she had shown no remorse.

In the judgment, the court ruled there is an objective ethical limit on medical fees that operates outside contractual and market forces, The court found that, given a doctor's specialised knowledge and training, there arises an ethical obligation on the part of a doctor not to take advantage of his patient. And this ethical obligation to charge a fair and reasonable fee is not superseded by a valid agreement between the doctor and his patient, the court held.

In 2012, Dr Lim was found guilty of 94 charges of professional misconduct by a Singapore Medical Council (SMC) disciplinary committee for charging about $24 million for the services provided to Pengiran Anak Hajah Damit Pg Pemancha Pg Anak Mohd Alam for 110 treatment days from January to June 2007. Dr Lim was then given a three-year suspension and fined $10,000 - which was upheld by the appeal court.

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