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Posts Tagged ‘Public health’

Medishield: Totful tots on loss ratio to determine premiums

In Financial competency on 14/07/2014 at 5:26 am

With regards to the use of  incurred loss ratio to determine the level of premiums, I don’t like it for a few reasons:

  • A lot of premiums is collected upfront and Medishield ends up having a lot of money to invest, which might not be its core expertise.
  • It is not easy to determine future liabilities and brings another uncertainty to the calculation of the loss ratio.
  • With Medishield Life going to be a compulsory scheme, there is even less of a need to collect too much surplus as it is possible to adjust the premiums accordingly whenever overall claims go on a sustained uptrend. As a nationwide scheme, the pool is also huge and total claims will be less volatile and predictable.
  • Private health insurance that has a smaller pool will have claims that are more volatile and cannot easily raise their premiums without the risk of their customers leaving and making their pool even smaller.

http://www.martinlee.sg/medishield-reserves-loss-ratio/

From an honest financial planner. Feel safe to buy second-hand car from him. Smart guy too. Given that he has a masters in engr from NUS, I once asked him why was he wasting his time selling insurance. Never got a gd reply.

Check out his other articles explaining Medishield. Under insurance, healthcare.

No worries abt one-yr wait to see renal specialist

In Financial competency, Humour on 27/09/2013 at 5:00 am

I refer to http://mysingaporenews.blogspot.sg/2013/09/medical-appointments-in-world-class.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+MySingaporeNews+%28My+Singapore+News%29 and to http://www.tremeritus.com/2013/09/23/one-year-wait-to-see-specialist-at-sgh/

They are all very angry people because Ms Tay’s hubby has to wait for a year before he can see a kidney specialist.

I know someone who recently was told that he had to go to see a kidney specialist. He was then told by the girl responsible for making an appt that the waiting period was one yr if not longer. He juz shrugged his shoulders.

He was pretty relaxed abt waiting because

– He knew that there is a priority procedure for “siong’ cases. He had benefited from the priority list several yrs ago when a routine check had the doctor concerned about his eyes. He got an appt to see a specialist within weeks. I have had a similar experience.

– He also knew that the polyclinic doctors were monitoring the situation, via tests every time he renewed his medication. The doctor had told him that the dosage of one pill could be increased if necessary.

– The doctor had given him a copy of the results of his test. He was thinking of consulting a private-sector GP that he trusted to ask him what the results meant: is he in clear and imminent danger of dying, as Ms Tay seems to fear for her hubby? He could have also asked one of our mutual doctor friends, but felt piah seh.

– According to my friend, a doctor once told told him that polyclinic doctors knowing the length of the queue do put marginal cases on the waiting list juz to be kia-su: anticipative medicine that should be commended.

– If nec, he would consult a private sector specialist and then return to polyclinic with the results. The worse case would be if he got warded immediately as a private patient because things were that bad.

Be very clear, neither of us are defending the staus quo: one yr’s wait is not right, if one cannot afford to go “private’*. Especially, as there is the Toto element in the system. It is sometimes (very rarely to be fair) possible that if the polyclinic calls to make an appointment, it will be told that someone has juz cancelled and that there is a slot available say in two months. The polyclinic may grab the spot for the patient, and tell the patient that “die, die” got to go.  Conscientious staff do this even though there are consequences for the staff if the patient is daft not to take the lucky opportunity. I have heard that it does happen: daft patients who refuse to take the slot because got “other appointment” like going to beautician, or got golf game.

The system should be changed so that all such cancellations are offered to the next person in the queue. Only fair. Of course, this assumes that the IT system can cope with such changes. It may not be possible with legacy systems.

But, we are saying that she (and presumably hubby) are being too KS, and emotional. They also do not seem to trust the doctors, or the system. We don’t assume that the doctors or the system are out to fix us.

As to the comments of Redbean that a first world system shouldn’t have anyone waiting for one yr, juz google up the topic of waiting lists in the UK’s NHS system, one of the world’s finest. The issue is simple. In healthcare ,the demand is endless, resources are finite. There are two ways to handle the problem, rationing by

– wealth, the American way.

– queuing, the NHS way.

I wish Redbean, and all those TRE readers commenting on Ms Tay’s letter read what Jeremy Lim has to say http://theindependent.sg/what-singapore-did-right-and-wrong-in-health-care/, before they comment adversely on the healthcare system here. He also wrote shumething similar in ST https://www.evernote.com/shard/s1/sh/bfb5535d-4859-47f1-beb9-99270276e45f/4133391be0a8092e6d1ac8cdc39ef20b.

Read both articles. Jeremy Lim has his heart in the right place (unlike a certain sneering minister who was a doctor), but knows the practical problems of providing “affordable” healthcare.

Let’s be informed on the topic before opening our mouths. Don’t talk cock on this v. v. impt issue. Don’t use it to express cliched anti-govt or PAP cliches. Even the WP doesn’t.

*We are assuming Ms Tay’s hubbie has financial concerns but can afford to visit a private GP to ask what the test results mean. We are also assuming that they can know a gd GP, by reputation, at least. I hope they are not like a very rich neighbour who uses the public healthcare system but who is always complaining that she never sees the same specialist or GP again: always new one she complains.

It is acceptable if one is cheap-skate, or searching for “value’ person. My friend was an arbitrageur when he worked in the stockbroking industry. He believes that there are always free lunches but one mustn’t be choosy or picky. But he warns to be careful to avoid getting food poisoning. One bad case of food poisoning can wipe out the savings made, unless one goes to a polyclinic for treatment.

Cost effective ways of keeping us healthy?

In Infrastructure, Political economy on 17/10/2012 at 5:36 am

Yesterday, I read that the government is planning to do more to help the depressed and I remembered that I chanced across this (see below) response to an Economist blog piece on escalating medical costs in the developed world. It suggests (among other suggestions) adding various soluble drugs to the water Americans drink as a way of keeping healthcare costs down: one of the drugs is Prozac which is a drug that helps control mild clinical depression. Other drugs suggested are statins and aspirin.

Now that VivianB (a MD) is water minister, he may want to help out the Health minister. These measures seem to be in line with S’pore’s policy of spending as little as possible on health (around 4% of GDP) without upsetting economic efficiency or upsetting the masses compared say to Switzerland (around 8%).  And we already drink recycled water. LOL.

Seriously I hope the SDP looks into these suggestions. SDP has a very gd team of doctors helping out. (BTW what do these MDs have to say about:

this plug for govt health policy;

the latent flaw in any public health insurance scheme; or

innovative ways of helping the elderly in ways that don’t cost too much money?)

(Note writer below is talking of the US, where fluoride is already added to the water they drink. Always wondered why this doesn’t happen here.)

America comes up short in international comparisons of health statistics principally because life expectancy lags despite the highest spending for healthcare. For less than one dollar per capita , I propose Ten Inexpensive Health Interventions WILL Improve Health Outcomes. These will lengthen life expectancy, improve health, increase happiness and decrease dysfunctional behaviors.

We already fluoridate the water to prevent dental caries. And chlorinate to reduce bacteria. We can use the water supply as a medication distribution network by introducing very tiny or trace amounts of medicines that have been known to reduce major diseases.

1.) Simple cheap ASPIRIN dramatically cuts rates of Strokes, Heart Disease and now recently proven in a longitudinal study, reduces Cancer death rates by 20%! Put ASA in the water supply–if would be cheaper than fluoride.

2.) Put STATIN drugs in the water supply. Heart disease and stokes are declining for the first time in history. And it is despite the epidemics in Diabetes and Obesity. It is due to widespread use of effective anticholesterol drugs known as ‘statins.’ ie. Lipitor. High cholesterol is endemic and contributes to strokes and heart attacks. Just about everyone benefits from lower cholesterol.

3.) Water Born Oral VACCINES. Up to 30% of parents do NOT believe in the value of vaccinations and many act on this belief. Utilize water borne vaccinations in the water supply, such as the oral polio Sabin Vaccine. Put Folate in H20 to prevent neural tube defects in fetuses.

4.) PROZAC to decrease Dysfunctional Behaviors and improve Mental Health. Far more common than crime is non-criminal personal dysfunctions. Up to 40% of Americans will experience a diagnosable mental illness in their lifetime including Depression, Alcohol abuse, illicit Drug abuse, Anxiety disorder, PTSD, Obsession-Compulsion, Eating disorders. Half of these will remain undiagnosed. And love ones suffer by enduring the mental ill relative like an affliction. Virtually all these maladies would benefit from Prozac type drugs which increase brain serotonin neurotransmitter. It is a vital tool in psychiatry: ‘Vitamin P’. Put Prozac in the water supply and we will be less sad, less depressed and less dysfunctional. It will shrink dysfunctional behaviors, criminal behaviors, afflictions and addictions. It would save BILLIONS in the Criminal Justice System. Lead to more productive fulfilled citizens who are happier. Less alcohol and drug addictions. Less DUI, trauma and killing sprees.

5.) Perhaps an effective future drug to treat or prevent Diabetes or Obesity–put it in the water. We have a new Epidemic of Obesity never before seen in the history of civilization. All interventions have been stymied to reverse the epidemic. We have to be creative about how to address this problem. The water supply is a simple and effective vector that treats the entire population. Observe the effectiveness of fluoridation on cavities for pennies per capita per year.

6.) Ban Tobacco Products, the leading Preventable cause cancer deaths, heart attacks and strokes. It would cost nothing in health care but would literally overnight vault the US life expectancy over the #1. Japan.

7.) Restrict television broadcasts to 2 hours a night of quality programming from 8 pm to 10 pm. We get 24 hours of 1000 channels–98% is garbage programming. It would force Americans to find other more healthy forms of recreation like walking, exercising, reading and even talking with each other. We undersleep and spend 4-6 hours of waking hours watching TV.

8.) Make Supermarkets reflect a Vegetarian Diet. 80% of floor space for Produce. 10% for dairy. 10% for the meat department. Vegetarians live longer and are more active. We have to make it easier and more desirable to enjoy vegetables Likewise encourage walking, exercise, and activity.

9.) Tax Alcohol extremely regressively to the point that consumers have to hurt to make a purchase. They will value that little sip of brandy or Chardonnay even more. Make bottles much smaller at around 100 ml. Like a Coca Cola at the turn of the century: medical tonic amounts. Yes people can drink, but moderation(less than two drinks) is best.

10.) Milk-Based Nutrition/ Beverages. To increase calcium in young persons, make all flavored beverages and hydration drinks MILK BASED. A milk based Coca Cola. We will see taller, more active, healthier citizens. Perhaps the best way to combat osteoporosis in the elderly is fortifying bones in teen age girls. And using high impact sports like simple rope jumping. This will make a difference in the wide spread osteoporosis of the elderly. Your skeleton will thank you decades later.

This is a radically different way of thinking about Public Health, Medicine and Wellness.

Desperate Times Call For Desperate Measures.

Make Public Health medication an automatic feature by incorporating it into normal plumbing.

Let people OPT-OUT by buying their own water and we will have 95% participation.

We now have an OPT-IN system for medicine that is not working.

Healthcare delivery is a complex problem requiring smart solutions, but sometimes solutions can be as simple as fluoridating water. We need a Fluoridation System for the 21st Century.

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