Value based healthcare in singapore

[Wind30]

https://www.aic.sg/sites/aicassets/AssetGallery/Forum/Keynote_Prof%20Michael%20Porter.pdf

 

It’s not easy but I really think that is the way forward.

 

Every time I see a specialist I always wonder, do the doctor really want to make me healthy or does he just want to operate on me.... what’s in it for him to keep me healthier as that means I don’t need him and he will be out of work.

 

He needs to pay for all the expensive overheads, u can’t blame him for trying to sell expensive ops.

 

The current volume based healthcare is so fundamentally wrong.

[BenTong]

Who would be so stupid not to want to own a Lambo or a hairy turbo if he or she can afford it? And to afford it must have moolah.. and to have moolah one must charge not send them away..esp those Monday mc must have fellows..

[Soya]

Cheeem.....MCFers onli wanna know if this will lead to COE drop or not

[Vratenza]

In this day and age of free information and social media one up manship, if someone goes to a private doctor for treatment and he is practicing astray from his hippocratic oath to treat without the interest of patient's health as 1st priority, than he will find himself selling his lamboghini /maserati/ferrari really quickly. This is free market play and especially so compared to olden days when information is usually exclusive to the doctor him/herself. 

 

If someone is going to government hospital doctors for treatment, there is no financial incentive to overtreat. 

 

There is a reason why all doctors are in a professional body guided by ethical and patient centric ethos. This professional body has so far been doing more than what CASE or 2nd hand car dealers body have been doing to discipline internally and to help patient/customers defend their rights.

 

 

 

 

 

[Neutrino]

I have twice been advised wrongly by Singapore specialists.

 

One saying I'd had a silent heart attack

and another saying I needed an operation the next day, when he could fit me in, which would mean  a very painful operation recovery period.

 

Luckily I had to travel to UK for work reasons shortly after these diagnoses and was able to see a GP doctor who refered me to a specialist in the UK NHS.

 

Yes I had to wait for the UK consultation a couple of months in both cases.

But after they did their tests I was told I hadn't had a silent heart attack and on taking the results back to my Singapore consultant I was told that after further tests in Singapore that the UK result was correct.

 

Second time I was checked over by a UK consultant who did some tests and told me that the Singapore diagnosis given in Singapore by a Deputy Head Surgeon was plainly incorrect.  I was advised by UK to use Potassium Permanganate three times a day to bathe the effected area which I did and the problem cleared up completely.

 

Of course my experience these two times may well be outriders and not the norm.  But if I had gone along with the Singapore diagnosis my life and lifestyle would be very different and debilitating for no reason at all.

 

Having just read vratanza's post above I should add that my heart attack diagnosis in Singapore was done publically.

 

My second case was done privately in Singapore.

 

I see the Singapore system as excellent to get seen by a consultant very quickly and to get any required tests done.  The result to me seems to be a bit money grubbing though.

 

The UK system can be very time consuming.  I am currently having to wait over 8 months to see a UK consultant for another problem, but of course costwise it costs the individual nothing and doctors aren't likely to make additional money from their diagnosis.

 

Not saying one or the other is better and I find that I am extremely lucky to be able to use both systems.

 

In the end though I believe these days we have to somehow take more responsibility for our own health.  Many people can't do this.

Edited November 14, 2018 by Neutrino

[Kezg1]

I have twice been advised wrongly by Singapore specialists.

 

One saying I'd had a silent heart attack

and another saying I needed an operation the next day, when he could fit me in, which would mean  a very painful operation recovery period.

 

Luckily I had to travel to UK for work reasons shortly after these diagnoses and was able to see a GP doctor who refered me to a specialist in the UK NHS.

 

Yes I had to wait for the UK consultation a couple of months in both cases.

But after they did their tests I was told I hadn't had a silent heart attack and on taking the results back to my Singapore consultant I was told that after further tests in Singapore that the UK result was correct.

 

Second time I was checked over by a UK consultant who did some tests and told me that the Singapore diagnosis given in Singapore by a Deputy Head Surgeon was plainly incorrect.  I was advised by UK to use Potassium Permanganate three times a day to bathe the effected area which I did and the problem cleared up completely.

 

Of course my experience these two times may well be outriders and not the norm.  But if I had gone along with the Singapore diagnosis my life and lifestyle would be very different and debilitating for no reason at all.

 

Having just read vratanza's post above I should add that my heart attack diagnosis in Singapore was done publically.

 

My second case was done privately in Singapore.

 

I see the Singapore system as excellent to get seen by a consultant very quickly and to get any required tests done.  The result to me seems to be a bit money grubbing though.

 

The UK system can be very time consuming.  I am currently having to wait over 8 months to see a UK consultant for another problem, but of course costwise it costs the individual nothing and doctors aren't likely to make additional money from their diagnosis.

 

Not saying one or the other is better and I find that I am extremely lucky to be able to use both systems.

 

In the end though I believe these days we have to somehow take more responsibility for our own health.  Many people can't do this.

 

 

  ...so to say, we really should get a 2nd opinion even if  the diagnosis is from our top hospitals doctors...on a side note...health care is getting more n more expensive and the limitation to use the Medi-Save account(our $$) is far more frustrating when the situation arises.

[Ash2017]

In this day and age of free information and social media one up manship, if someone goes to a private doctor for treatment and he is practicing astray from his hippocratic oath to treat without the interest of patient's health as 1st priority, than he will find himself selling his lamboghini /maserati/ferrari really quickly. This is free market play and especially so compared to olden days when information is usually exclusive to the doctor him/herself. 

 

If someone is going to government hospital doctors for treatment, there is no financial incentive to overtreat. 

 

There is a reason why all doctors are in a professional body guided by ethical and patient centric ethos. This professional body has so far been doing more than what CASE or 2nd hand car dealers body have been doing to discipline internally and to help patient/customers defend their rights.

 

 

I believe government hospital doctors also do see private patients.

 

 

 

forgot to add

 

Hippocratic oath is obsolete, I believe the newer batch of doctors never took them but need to confirm with your dean of medicine.

 

private or public - is a choice the patient can make; unfortunately the blatant truth is animal farm exist everywhere

 

the medical authorities should do away with these middle man company, manage care company eg MHC

 

SMA/SMC - recently had been persecuting doctors from frivilous patients' complains. you can see the record yourself. I believe they should stand impartial and not bend to public unreasonable expectations and toll the line of the government. They should be independent where medical issues are concern. 

 

I disagree with you about the professional body is doing more than CASE or 2nd hand car dealer. If it is was so why didn't the professional body came out strong against the way hepatitis incident occurred and not forgetting how many died and how many suffered subsequent complications.

 

 

 

Overall I can understand your frustrations but do something about rather than complain and make remarks like that.

 

 

I response and see you as another member of MCF, I only see the postings and nothing else, even if you wipe chairs and not table doesn't matter. It is all discussion. Sometimes right and sometimes wrong. At least it is healthy.

 

Edited November 14, 2018 by Ash2017

[Lala81]

https://www.aic.sg/sites/aicassets/AssetGallery/Forum/Keynote_Prof%20Michael%20Porter.pdf

 

It’s not easy but I really think that is the way forward.

 

Every time I see a specialist I always wonder, do the doctor really want to make me healthy or does he just want to operate on me.... what’s in it for him to keep me healthier as that means I don’t need him and he will be out of work.

 

He needs to pay for all the expensive overheads, u can’t blame him for trying to sell expensive ops.

 

The current volume based healthcare is so fundamentally wrong.

 

Why is there volume?

1. People are more aware of treatment options and general health issues. You don't see any of our generation proudly proclaiming that they last saw a doctor 20 years ago.

 

2. Medico-legal issues. Cover cover cover ass is the mantra. The lawyers don't give an rat's bottom that you are giving "VALUE" to pts. With the MOH trying to push value, this is the over-riding concern of every doctor out there why it will inevitably defeat value IMO.

 

3. Specialisation

Our specialists are mostly at first world level. Specialisation is so deep now. The amount of knowledge u need to know now to be a specialist in your own field vs say 20 years ago. No way to compare. Last time, specialists (non surgical) are more broadbased with only a slightly deeper understanding of their own fields. 

There's absolutely no way, that a generalist can keep up. It's very obvious that the generalist is not held in high regard in the hospital hierachy.

 

 

The way forward is inevitably volume. IMO, the 2nd point, is a double edged sword. It's good (more accountability) and bad for patients (cover ass in the only option not to miss any medico-legal red flag). 

Edited November 14, 2018 by Lala81

[Jamesc]

https://www.aic.sg/sites/aicassets/AssetGallery/Forum/Keynote_Prof%20Michael%20Porter.pdf

 

Itâs not easy but I really think that is the way forward.

 

Every time I see a specialist I always wonder, do the doctor really want to make me healthy or does he just want to operate on me.... whatâs in it for him to keep me healthier as that means I donât need him and he will be out of work.

 

He needs to pay for all the expensive overheads, u canât blame him for trying to sell expensive ops.

 

The current volume based healthcare is so fundamentally wrong.

Some doctors have boats right? And those things are like pouring money down a hole.

 

Some docs have Italian sports cars and those things cost a lot to maintain.

 

Some have wives who collect expensive handbags.

 

That's why if I was a doctor I would choose to be a vet.

 

Doing an unnecessary hip replacement on an old dog I won't feel as bad as doing unnecessary operations on people.

 

Maybe first time and second time is hard but after a while won't feel anything and those Italian sports cars are really nice.

 

Rev the exhaust a few times and the beautiful music drowns out all the thoughts of over medication.

 

People just become numbers. 3000 for a new exhaust 6500 for new tyres . . . .

 

[Ender]

Don't know if patient are still being over treated after this article a few months back. Doc also operate like car workshop, see insurance coverage, start add on unnecessary treatments or test.

https://www.straitstimes.com/singapore/doctors-warned-against-overcharging-overtreating

[Enye]

[Adrianli]

Some doctors have boats right? And those things are like pouring money down a hole.

 

Some docs have Italian sports cars and those things cost a lot to maintain.

 

Some have wives who collect expensive handbags.

 

That's why if I was a doctor I would choose to be a vet.

 

Doing an unnecessary hip replacement on an old dog I won't feel as bad as doing unnecessary operations on people.

 

Maybe first time and second time is hard but after a while won't feel anything and those Italian sports cars are really nice.

 

Rev the exhaust a few times and the beautiful music drowns out all the thoughts of over medication.

 

People just become numbers. 3000 for a new exhaust 6500 for new tyres . . . .

 

One of my fren is a vet and he gives me sound and logical advise. When my late rabbit had tumour, he was the one who advised me against doing expensive treatments. Just end its suffering.

 

Not all Dr want drive italian marquees. He driving a normal 5 series.

 

 

He was the one who told me not to do it(euthanized + cremate) at his clinic and go directly to the place to do it is cheaper.

Edited November 14, 2018 by Adrianli

[Jamesc]

You got good frenly advice.

 

[Wind30]

In this day and age of free information and social media one up manship, if someone goes to a private doctor for treatment and he is practicing astray from his hippocratic oath to treat without the interest of patient's health as 1st priority, than he will find himself selling his lamboghini /maserati/ferrari really quickly. This is free market play and especially so compared to olden days when information is usually exclusive to the doctor him/herself. 

 

If someone is going to government hospital doctors for treatment, there is no financial incentive to overtreat. 

 

There is a reason why all doctors are in a professional body guided by ethical and patient centric ethos. This professional body has so far been doing more than what CASE or 2nd hand car dealers body have been doing to discipline internally and to help patient/customers defend their rights.

 

It is not that simple. I am not saying doctors treat the patients against the interest of their health.

 

Example, the concept of value is very different for patients. A patient wants cost effective treatment and cost is huge consideration. Doctor, they want the most profit. If operation A and B gives similar outcomes for the patient, it is wrong for the doctor to suggest operation A which is more expensive because he is better at operation A and it gives him better profit margins. Would he recommend operation B to the patient and tell him to find another doctor who is good at it and save money for patient, insurance, healthcare costs in general?

 

To me, the current healthcare is so wrong, everywhere in the world and I am glad that people are pushing for an alternative model. I am just surprised that our government is not trying harder here.

Edited November 14, 2018 by Wind30

[Staff69]

i usually try to exercise more and eat less unhealthy food to prevent from seeing all my expensive BFF

 

allow me to share and give my 1 man's 2 cents worth of comments

 

 

yes, medical is expensive...when you see the specialist driving cars worth more than your home....eyes do turn green or red, depending if you had your coffee or not

 

 

 

but but think back, would you rather have the convenience of taking the public transport or drive your car to see the bloody expensive specialist or

 

 

would you rather ,like the Indonesians or Malaysians or even some of my high net worth customers flying into Singapore just to see the doctor cos the medical professional in their home countries is .....for a more brutal word....shit

 

 

 

think about the inconvenience you have to put up with , book air tickets, hotels and arrangements for annual leaves just to see the doctor for a mere 15mins

 

 

or which medical institutions has more credibility

 

 

 

i have paid my fair shares of expensive consultation fees to see a good specialist here 2k for 1 hour.....i could go nightclub and drown myself in beer with that money

 

so as history has taught us time after time

 

 

pay the piper for doing his job

 

 

 

 

disclaimer....all these is my 1 man's view

 

 

you might agree or disagree with me

 

 

but do i really care about your views

Edited November 14, 2018 by Staff69

[Lala81]

It is not that simple. I am not saying doctors treat the patients against the interest of their health.

 

Example, the concept of value is very different for patients. A patient wants cost effective treatment and cost is huge consideration. Doctor, they want the most profit. If operation A and B gives similar outcomes for the patient, it is wrong for the doctor to suggest operation A which is more expensive because he is better at operation A and it gives him better profit margins. Would he recommend operation B to the patient and tell him to find another doctor who is good at it and save money for patient, insurance, healthcare costs in general?

 

To me, the current healthcare is so wrong, everywhere in the world and I am glad that people are pushing for an alternative model. I am just surprised that our government is not trying harder here.

 

Healthcare systems can be there. But the individual choices that each person makes in regards to their own health are very varied.

 

When MOH or public health experts talk about VALUE, then in most places, it would be interventions that improve OUTCOME effectiveness. 

ie say general population/less people get diabetes complications, less people die of cancer without palliative care etc. 

 

The best local example of OUTCOME effectiveness will be how the polyclinic practices or in the hospital, how the A&E manages their patients. Cos due to various reasons, the protocols there are more standardised to benefit general outcomes.

Are most people happy with it? Generally so, but do you see a substantial percentage of people unhappy with it? Yes cos everyone has different expectations and what they perceive as value to themselves.

 

Outcome effectiveness for the general population actually has a smaller role to play in what the individual patient want.

Cost effectiveness for yourself (as a patient) is really between the patient and the doctor.

 

 

 

 

 

A lot of public health interventions actually don't go down easily even among medical professionals.

 

Recently the decision to ban e-cigarettes here is one that has divided opinion between MOH public health vs a fair number of doctors.

 

Our president who "endorsed" milo kosong as a healthier choice. Many people say bloody hell, it's still milo right.

 

Who is right? It's just who has more power to make changes.

[RadX]

You cannot please everyone

 

Period!

 

Have to do what’s in the interest of the majority and with the best ethical outcomes

Some doctors have boats right? And those things are like pouring money down a hole.

 

Some docs have Italian sports cars and those things cost a lot to maintain.

 

Some have wives who collect expensive handbags.

 

That's why if I was a doctor I would choose to be a vet.

 

Doing an unnecessary hip replacement on an old dog I won't feel as bad as doing unnecessary operations on people.

 

Maybe first time and second time is hard but after a while won't feel anything and those Italian sports cars are really nice.

 

Rev the exhaust a few times and the beautiful music drowns out all the thoughts of over medication.

 

People just become numbers. 3000 for a new exhaust 6500 for new tyres . . . .

 

My take is always

 

“It’s who you know, not how much!”

 

Even in the field, we are aware of who is good and who is otherwise in their field of specialization.

[Angcheek]

I believe government hospital doctors also do see private patients.

 

 

 

 

You damn super KNN , Lucky I wasnt drinking anything . Almost Puked