Millionaire dollar ministers, yet only second in Asean?

Something is wrong, very wrong. Especially as the gap between us and Thailand is statistically significant.

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Diabolical: When healthtech and fintech combine

When my mum was hospitalised in Raffles (Bill: Private hospital treatment, public hospital fees ), the bill would have been about $15,000 for nine days’ stay and treatment. Thanks to the PAP govt, she paid “peanuts”: a few months earlier our dog’s hospital bill was more, more a lot more. I joked that the Gods saw how well we treated our mongrel that they gave my mum a treat when she was hospitalised. How she struck Toto: Private hospital treatment, public hospital fees.

But in future, need $ to pay private hospital bill?

Patients of India’s Apollo Hospitals can use an app to get drug refills, tele-consultations and remote diagnoses—and even secure a medical loan through Apollo’s partnership with HDFC Bank.

https://www.economist.com/business/2020/12/02/the-dawn-of-digital-medicine

Iran’s “Ownself shoot ownself” reminds me of SGH tragedy

When I read sometime back that Iran’s president Rouhani saying that the shooting down of an airliner should not be blamed on one individual, saying “It’s not only the person who pulled the trigger, but also others who are responsible”, it reminded of

What really went wrong at SGH?

And why the reluctance to do more than issue letters of warning?

a piece I wrote in 2016 about an incident at SGH where 25 people were infected and seven deaths were possibly caused by the cock-up

The piece went on:

A regular reader and commenter of this blog who seems to have been  a medical doctor and administrator has an explanation.

Note he had already raised the issue of the use of shared vials here before the internal report came out. He goes further below presumably having read the internal report.

This WAS a systems failure whereby the major gap was allowing same vial of insulin for multiple patients i.e. shared vials, although supposedly using fresh, sterile needles & syringes. By using shared vials, this created a single point of failure if any of the 1,001 aspects of infection control was not strictly adhered to. E.g. lack of hand disinfection — between patients, before drug preparation, before administering insulin, after administering insulin; not disinfecting the rubber bung of the shared vial adequately before use; not using new sterile needles/syringes; using new sterile needles/syringes but leaving them exposed for too long or mishandling them thus rendering them no longer sterile; etc etc. The possibilities are endless.

And then the pathogen being introduced into the shared vial and subsequently being re-transmitted, even though subsequent usage all followed 100% infection control — the bug is already in the insulin/vial, no matter how solid & how sterile you prepare the subsequent insulin administrations for other patients, you’re simply injecting them with already contaminated insulin.

Who’s responsible?!?! The senior doctors, medical directors who came up with this protocol in the 1st place??? The CEO or chief medical officer who approved & signed off on this protocol?!?!? The infection control team & educators who didn’t educate the ground staff enough, and weren’t vigilant enough in their audits & random spot checks?!?!?! The external audit teams who couldn’t detect any shortcomings & signed off that the staff are following protocol?!?!? The actual ground staff/staff nurses who got careless or bochap or simply burnt out to overlook 100% of the by-the-book steps?!??! How many of these staff nurses??? 1, 2 or the whole lot of them?!?!?

Going by what he says maybe the Health Minister must commit hari-kiti? No wonder only warning letters were issued? And ST is wayanging?

(Related post: GCT believes in Jap values. But not for the elites.)

Seems I was right to ask if ST’s call for a public cyber-lynching of “responsible” staff is a lot of wayang aimed at distracting attention away from those that must take responsibility: the CEO of SGH and the MoH senior officer that delayed reporting the matter to the minister.

“Where does a wise man hide a leaf? In the forest. But what does he do if there is no forest? He grows a forest to hide it in.”― G.K. Chesterton, The Innocence of Father Brown

In this story, Father Brown, an amateur detective, deducted that a commanding officer hid his murder of a fellow-officer by sending his soldiers into battle in the area where the body lay. The dead bodies of the soldiers “covered up” the murder.

Temasek’s US$800m investment in obscure Google unit

In 2017, Verily secured U$800m from Temasek in exchange for a “minority stake” (Que the usual KPKBing from TOC and other cybernuts). Funny, they very quiet when earlier this year, Silver Lake (tua kee private equity tech investor) and Ontario Teachers’ Pension Plan (tua kee savvy investor) invested US$1bn for “minority stakes” in Verily.

What is Verily?

Verily is Alphabet Inc.’s research organization devoted to the study of life sciences. The organization was formerly a division of Google X, until August 10, 2015, when Sergey Brin announced that the organization would become an independent subsidiary of Alphabet Inc.

Wikipedia

It made $ in 2016: https://www.vox.com/2016/4/13/11586102/verily-alphabet-profitable. Nothing heard since then.

It is, often through partnerships with healthcare companies or universities, using health data for clues that might predict and prevent diseases. Tools it uses include search, AI, cloud services and other such high tech stuff.

It has struck deals with large pharmaceutical companies (Examples GlaxoSmithKline, Dexcom, Sanofi and J&J) , device makers and research institutions (Think Duke University and Stanford Medicine), offering expertise in machine learning and user experience in exchange for deeper knowledge of medicine and regulation. Sounds a good trade.

Temasek has also been working with Google in this region: Indonesia: Temasek, Google & McKinsey singing from the same page.

Google joins Temasek in Go-Jek: Ho Ho Ho: Google agrees with Temasek.

Fyi, Temasek, GIC got this right in our backyard

 

Heathcare: PAP thinks its no longer a vote losing issue?

Taz the impression I get after PM didn’t seem to talk about healthcare (Am I right? Speeches like his make me brain dead after five minutes: now his pa could keep me interested) during his National Day Rally speech.

Maybe because he thinks, S’pore is not a bad spot to be in, despite concerns about old age healthcare (https://sg.news.yahoo.com/singaporeans-unprepared-on-rising-medical-costs-of-living-to-100-healthcare-survey-072434720.html) if one looks at medical inflation. But look at Korea, Taiwan and HK (But then the first two are democracies while HK is full of forceful and vocal people* albeit sometimes violent except when it comes to housing. They seem resigned to their expensive, rat holes.)

Seriously, he and PAP must think that the following measures have detoxified the issue

Pioneer Generation benefits: Are you better off now than you were in 2011?

Merdeka Generation: PAP cares for u, really they do

Reasons why our healthcare should be better, a lot better:

Access:

Access to healthcare here: Below average

Controlling costs:

Healthcare: user fees drives up costs

See who’s telling govt to control healthcare costs/ What we be should be KPKBing about

Cost of medicine could be cheaper:

Healthcare: Who is subsidising whom?

But we ain’t as bad as anti-PAP cybernuts make it out to be:

Foreigner praises S’pore’s healthcare

Healthcare: France 1st, S’pore 2nd

Pioneer Generation benefits: Are you better off now than you were in 2011?

Merdeka Generation: PAP cares for u, really they do

Finally, great idea to improve the system, while collecting more money: Healthcare: Gd lateral thinking in UK

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* “Tell everyone that we Hong Kong people are patient!We will get what we want, ”, shouted a protester at a 1.7m strong peaceful rally on Sunday at Victoria Park.

 

Merdeka Generation: PAP cares for u, really they do

(Part of an occasional series meant to burst the blood vessels of cybernuts like pork-eating, alcohol drinking “bapak” aka “Jihadist Joe”, and tax-dodging grave-dancer “Oxygen”).

Taxi driver Lim Ee Teh, 66, usually spends between S$10 and S$20 when he visits the polyclinic for his monthly diabetes check-up.

Mr Lim, who is eligible for the newly-announced Merdeka Generation Package, learnt on Sunday (March 24) that he could soon be paying less for this visit. This was after he attended a briefing organised by the Silver Generation Office (SGO) at the ComfortDelGro’s Cabbies’ Carnival.

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What’s expensive, what’s cheap in diabetes treatment

If Mr Lim is seeing the polyclinic doctor monthly, his must be terok case. As the consultation fee is $12+, he’s only paying $7 for the blood test and medicine. But the blood test is pretty expensive: $13+ each time. So the numbers don’t add up: unless he’s seeing a nurse, where the consultation fee might be lower.

My friends’ monthly medicine bill for diabetes average between $4-5, they tell me. They see the doctor once every three or four months. They pay $12+ for the consultation, and $13+ for the blood test. Assuming, they see the doctor once every three months, their monthly cost is around $12.

Seeing the doctor and blood tests are the expensive bits.

—————————–

Whatever, this is what he (and me) are getting

Under the Merdeka Generation Package, which is eligible to all Singaporeans born between 1950 and 1959, beneficiaries will be entitled to Chas subsidies from November regardless of their household monthly income per person or the annual value of their homes.

Beneficiaries of the package will also receive an annual topup of S$200 into their Medisave account under the Central Provident Fund (CPF) until 2023. They will also receive an extra 25 per cent discount on their bills at polyclinics and specialist outpatient clinics, on top of prevailing subsidies.

https://www.todayonline.com/singapore/more-medisave-top-ups-merdeka-generations-wishlist

Wow. How not to vote for the PAP? Still prefer BS from Mad Dog, Lim Tean and Meng Seng, Jihadist  Joe aka Pious Joe?

And taz not all, from NTUC Fairprice, there’s this

And for a one-year period from July onwards, customers who belong to the Merdeka Generation will enjoy a 3 per cent discount on all purchases every Wednesday.

Merdeka Generation individuals are those who were born from 1950 to 1959 and obtained citizenship in or before 1996, as well as seniors who were born in or before 1949, became citizens in or before 1996 and did not receive the Pioneer Generation Package.

Mr Ng Chee Meng, the secretary-general of NTUC, said that this was done because of feedback from workers that they needed more help to cope with the cost of living.

“So NTUC, as a social enterprise, we were trying to see how we could help in meaningful ways. Essentially, what we wanted to do was help people cope with the rising costs, in ways we could afford,” he said.

https://www.todayonline.com/singapore/prices-ntuc-fairprice-house-brands-cut-remain-same-for-15-months

PAP is really trying hard to get 65% of the popular vote: Why PAP aiming for 65% of the popular vote.

Vote wisely. Remember that a GST rise is coming: How to ensure no GST rise.

Vote tactically (I tell how soon) because at worse PAP will still form govt:

But the cybernuts like bapak should not be raising their hopes of their hero Mad Dog forming a coalition govt of spastics. At the very least, the PAP will get only 60% of the popular vote (a 10 point fall) and retain a two-thirds majority and not win back Aljunied. No GRC will fall even to Team TCB.

Another reason why ground is not sweet for the PAP

Merdeka Package shows how smart scholars are

It shows how the PAP’s millionaire ministers are killing five birds with one stone.

The Budget especially the Merdeka Generation Package has been condemned by all the usual suspects. Alt media and social media is full of criticism of said Budget. Nothing new here especially from the cybernuts who like Goh Meng Seng are prepared to misrepresent the facts (More on this another day). (Related post: 10- 20% of voters are anti-PAP cybernuts.)

Here’s an interesting angle from 99.co which has no known or even alleged links to the PAP IB or the constructive, nation building media.

THE MERDEKA GENERATION PACKAGE WILL INDIRECTLY HELP WITH AFFORDABLE HOUSING

The Merdeka Generation Package will benefit some 500,000 Singaporeans, mostly from ages 60 to 69. Over S$6 billion will be channelled into outpatient treatment subsidies, Medisave top-ups, and CHAS coverage of chronic illnesses.

But how does this affect Singapore’s housing? One of the biggest contributors to our rising cost of living is healthcare. Singapore’s healthcare inflation is now the highest in the region, and it will grow as our population ages. Anything that mitigates the rising cost of living will indirectly affect our ability to afford housing.

We feel that, while most Singaporeans can afford their HDB flats, taking the strain off healthcare costs will affect the housing considerations of retirees, or those near retirement. It may now be possible for some of them to finish off outstanding home loans instead of downgrading, for example, given CHAS coverage of chronic conditions and greater outpatient subsidies.

https://www.99.co/blog/singapore/how-budget-2019-could-impact-property/?utm_source=homepage&utm_medium=featured_stories

Hmm. Not tot about this. Did you?

What the Merdeka Generation Package does

— makes healthcare more affordable

— makes then housing more affordable

— also lessens pain of weaker HDB prices (Double confirm, ground not sweet for PAP) for resale buyers

— vote buying i.e. spending more of our money on ourselves

— shows the PAP govt cares

Vote wisely.

Maybe that’s why Terry’s Online Channel has been praising the PAP govt — TOC now part of constructive, nation-building media? and Wah lan! TOC praises PAP govt?

But to be fair: Cybernuts can relax: TOC resumes normal anti-PAP service.

TOC now part of constructive, nation-building media?

Wah lan! Who who would have tot this possible? TOC is now amplifying ST’s constructive, nation-building messages that “The PAP govt really cares S’poreans, really they do” and “Vote PAP”.

I kid u not. Further to Wah lan! TOC praises PAP govt there’s now this paean to the PAP on TOC’s FB page (Skip it if it churns yr stomach, I nearly vomited):

… Singaporeans from older folk and young people give thumbs-up to budget

“Retiree Karin Tan, 64, told ST that she is “very happy” with the package. “I am currently already retired, and do not draw any income. This will help subsidise my medical costs,” she said.

Another Merdeka Generation member, Ameerali Abdeali, praised the government, “I appreciate the recognition and validation that members of my generation are being given for our contributions to the country.”

ST said that the young people it spoke to, welcomed the announcement that the Government will invest in long-term plans to protect Singapore from the effects of global warming. Heng had announced a carbon tax on this year’s emissions and would later launch the Zero Waste Masterplan.

Undergraduate Arjun Dhar told ST, “We are a city with the highest greenery density in the world, in which otters live in the middle of our central business district.”

“As we reflect on the Bicentennial, Singapore should also look to inculcate in all individuals a sense of care for the planet that nurtures us. This means replacing the idea that we are too small to make a difference with the idea that we each have a responsibility to try,” he said.

Ms Pamela Low, 24, a member of the Singapore Youth for Climate Action also told ST in the interview, “The Government eagerly investing in infrastructure to mitigate rising tides and sharing about it at the Budget shows the urgency of addressing the impact of climate change on the national agenda as it would become costlier in the future.”

https://www.theonlinecitizen.com/2019/02/19/st-singaporeans-from-older-folk-and-young-people-give-thumbs-up-to-budget/?fbclid=IwAR3JNp03HbQnnc9rqEU82-bfv1FXjOakB-uk_K4Dh06GXSNnWuBV3Lx4Efw

No it’s not as though Terry and the writer of this piece “Correspondent” have gone over to the Dark Side. Juz an “honest mistake” methinks because the piece ends on the an anti-PAP note, but who reads to the end? Only cybernuts, not most S’poreans.

And why did TOC highlight on FB the pro-PAP propaganda of ST? Some subversive working in TOC? Or juz a clueless intern? And Terry forgot to take his “PAP are wrong wrong” medicine before supervising his team?

Time to take writing and presentation lessons from me? I’ll give Terry and Correspondent a discount.

But I could be wrong. If Terry gets a light “sentence” over his persecution prosecution for criminal defamation and if Correspondent has move into a district 10 bungalow from his HDB flat, the two Jedi have been seduced to the Dark side by the Men In White.

Or maybe More evidence that being anti-PAP is bad for yr mental health?

6,400 senior citizens each get $312.50 hongpao from a TLC

(Part of an occasional series “PAP govt really cares for u, really they do” meant to burst the blood vessels of cybernuts like pork-eating, alcohol drinking “bapak”, and tax-dodging grave-dancer “Oxygen”).

A TLC gives 6,400 elderly S’poreans hongpaos each containing $312.5, whether they are Chinese or not.

A computer system error by NCS (owned by SingTel and ultimately by Temasek) caused about 7,700 individuals to receive inaccurate healthcare and intermediate- and long-term care subsidies, the Ministry of Health (MOH) said on Saturday (Feb 16).

But those who were overpaid will not have to refund. So that’s a lot of free lunches. Can buy a lot of restaurant or hawker food as each hongpao works out to an average of $312.5.

About 6,400 individuals received higher subsidies than what they are eligible for. The total amount is estimated to be about S$2 million. MOH intends to recover from NCS the costs and expenses incurred as a result of this incident, as allowed for under our contract.

And taz not all

“About 1,300 individuals received lower subsidies than what they are eligible for. The total amount is estimated to be about S$400,000. This will be reimbursed to the affected individuals,” MOH said.

Read more at https://www.channelnewsasia.com/news/singapore/7-700-singaporeans-received-inaccurate-chas-subsidies-due-to-11249848

PAP govt really cares, but could it be because a GE is coming?

Bill: Private hospital treatment, public hospital fees

My mum was discharged from atas hospital last Saturday. Nine nights 5-star stay and treatment cost slightly less than $2,500 (excluding Medisave deduction). After Medisave deduction (“our money”), amount I paid via credit card was “peanuts”. (I don’t carry more than $50 cash).

And that’s not all. If there’s a MediShield payout, I will get a refund via my credit card.

All in all, the amount we paid amounted to about 17% of the itemised, detailed bill. And that’s before any MediShield payout.

It was a great deal for her.

What the cybernuts and alt media are missing (Because they all living overseas or have private healthcare plans?) is that for many S’poreans, the public healthcare system (treatment and cost) is good and affordable. There are big, problematic gaps if specialised treatment is needed or if the family is struggling financially. But for the majority of patients, these problems do not arise.

It’s right to highlight and complain about these failings, but that’s different from saying that entire system is not fit for purpose. The condemning by alt media and cybernuts of the entire system based on individual failings only helps the PAP when ordinary people use the system and find out that it works pretty well. They’ll realise that alt media and the cybernuts are propogating fake news. And they’ll vote for the PAP.

Related posts:

Private hospital treatment, public hospital fees

No surplus B2 and C beds in govt hospitals

Will Gleneagles sandwich cost me a fortune?

No surplus B2 and C beds in govt hospitals

When Secret Squirrel visited my mum in hospital, he told me that we were really lucky that my mum had breathing problems during office hrs and that since there was a longish queue for B2 and C beds in the nearest govt hospital, the ambulance took her to an atas hospital: Private hospital treatment, public hospital fees.

He said the govt hospitals do not have spare C and B2 beds: they are juggling fluctuating demand with existing capacity. There are always patients going to be discharged and beds waiting to be made ready for new patients, and so while the supply and demand match over 24 hrs or as usual less, there’s always a waiting period for a bed: sometimes longer, sometimes shorter.

He told me that last weekend, a walk-in patient at the NUH A&E had to wait 10 hrs before getting a bed in a ward. Luckily, for him (Election yr?), there are now fully equipped rooms in govt hospital A&E departments that are effectively wards: transit wards. This helps give peace of mind to patients and their families, and avoids the bad PR of patients on stretchers in A&E corridors.

(Though I’m sure Alex Tan and other irresponsible anti-PAP people in alt media or social media will publish photos of patients on stretchers A&E corridors, saying that this is happening now. Doubtless Uncle Leong and friends will share such photos. And so there’ll be plenty to keep AG’s lawyers and ministers’ private lawyers busy.)

Contrary to what the cybernuts say, the PAP cares: at least to do enough to win 65% of the votes. The reason why: Why PAP aiming for 65% of the popular vote.

Vote wisely.

There are many things to be unhappy about the PAP govt

— no balls to sink M’sian ships

— MRT still screwed up

— Pay And Pay policies on water and GST

— SAF training deaths

— arrogance etc etc.

And there are good oppo people out there like Dr Tan Cheng Bock, Dr Paul and other SDP activists, the Chiams, and the Wankers.

But there are the likes of Mad Dog, Goh Meng Seng and Lim Tean.

Soon I’ll blog on how AMK voters voted wisely in 2006 (PM only had 66% of the popular vote) and got extra goodies by the next GE. In 2011, voters were happy, and PM was happy with the result (70% of the popular vote, in an otherwise bad yr for the PAP: only 60% of the popular vote).

 

 

 

Private hospital treatment, public hospital fees

In Will Gleneagles sandwich cost me a fortune?, I talked of my experience of going to Gleneagles for an eye op at SingHealth rates

Yesterday in the early afternoon, my ninety-something mother finally felt the results consequences of refusing for weeks to get her cold treated (She only very reluctantly agreed to go see a doctor before Christmas to treat her very persistent cold and cough and then got upset with the bill: “Subsidy? What subsidy” — she expected polyclinic rates) and of generally behaving like she was 50-something.

She suddenly had difficulty breathing and when the doctor saw her, she called for a ambulance, saying I should I have called from the ambulance from home.

Anyway, the ambulance came and took her to the nearest public hospital. Except It is no such thing.

It is a real atas place: marble and glass everywhere. When my mum recovered sufficiently, and heard from the nurse where she was and that she needed to be warded for observation, she asked me to get her into a “govt” hospital. I said I wasn’t going to move her, even if the doctors allowed it. The nurse told her “Pay public hospital rates Auntie”.

And it’s a great deal. Her ward is airconed and there are only three patients in a ward for eight. Only one ward was full. The rest, empty or half empty. A whole floor is available for patients like my mum.

And no I’m not naming the atas hospital lest I breach the Official Secrets Act and my mum loses her privileges if I name the hospital. My aunt’s doctor friend doesn’t know of this scheme. And I can’t find online the fact that this hospital is a “public hospital”  when it comes to ambulances operated by the govt.

Seriously, don’t believe Terry’s Indian goons and other alt media enemies of the PAP govt, and social media on why the S’pore public healthcare always sucks.

It works pretty well. Maybe Terry’s Indian goons etc are being paid to slime our public healthcare system by the enemy state that hacked our public health system?

What do u think?

Entitled, ugly S’porean

KPKBing about 6-month wait to see specialist in Changi General Hospital. He refuses to try to make an appt at some other public hospital because he lives in Tampines and wants convenience of CGH.

Well then sit down and shut up.

Dr Lam Pin Min, Senior Minister of State for Health, mentioned in Parliament last week that the median waiting time for new subsidised specialist appointments has improved from 28 days in 2013 to 22 days in the first half of this year.

My personal experience did not seem to show this. On Nov 20, I happened to call Changi General Hospital (CGH) for an appointment for my chronic neck pain as a new subsidised patient referred by a clinic under the Community Health Assist Scheme (Chas).

To my surprise, the earliest appointment is on May 23, 2019, exactly 180 days of waiting to see a specialist.

In disbelief, I asked the staff member to double-check because I thought it is impossible that the waiting time is so long.

She told me that the clinic for patients with spinal and neck problems is overwhelmed and suggested that I try another public hospital, but I declined because I live in Tampines and the nearest public hospital is CGH.

https://www.todayonline.com/voices/six-month-wait-subsidised-patients-get-appointment-specialist?fbclid=IwAR13bIYPcm0uR9rh1aCmk1XmDdwE7V5JRrAihc8U-McAnTmu5xGhGGfHsFM

(Emphasis mine.)

Francis Cheng Choon Fei must think he’s a white horse. Or a cybernut given his sense of entitlement. I mean S’pore’s a pretty small place but he die die wants to go to Changi General Hospital and KPKBs if he has to wait six months to get an appt there.

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Unhappy anti-PAP user of SingHealth

Reminds me of an anti-PAP heavy user of SingHealth. He says he does not expect to have to wait to see a specialist once he has registered. I asked him if he ever had to wait to see a private specialist: he kept quiet. I later upset him by telling him that I no longer had to wait to see the GP in Marine Parade Polyclinic. At the appointed time, I see the doctor. What I didn’t tell him is that I scheduled the appointment at 2 pm: first one to see doctor.

———————————————————————-

If he has to wait six months at all public hospitals, then he has a valid complaint. A FB comment on entitled Francis Cheng Choon Fei

Deliberately choosing a hospital due to proximity when there is no life threatening emergency, is it a patient problem or systematic shortage of treatment options?Apparently the most convenient.

Btw, a FB friend says that the reason why CGH clinic for patients with spinal and neck problems is overwhelmed is because it treats many injured NSmen. SAF refers neck and spinal injuries suffered by NSmen to this hospital. Any idea why?

 

Coming to a polyclinic near u

Video consultation for patients with chronic problems who need to see a doctor only because the prescriptions need to be renewed. At least that’s what Morocco Mole, Secret Squirrel’s side-kick, tells me. It’ll take a while though.

But based on this experience of a S’porean using video consultation, the wait will be worth it and give poor or cheap skate oldies with chronic diseases another reason to vote for the PAP.

Aisha Lin, a 25-year-old Singaporean … told the Nikkei Asian Review that video consultation had proved to be “an optimal experience” for her. “If I just have a minor condition and/or require prescribed medication, I really dislike being in the same enclosed space as other very sick people — those with a high fever, stomach flu, etc,” she said.

Nikkei Asian Review

Whatever telemedicine is already here. Ms Lin was using Singapore’s Doctor Anywhere. More on this app

Singapore’s Doctor Anywhere, launched in 2017, is one of the growing healthcare apps in the city-state, with some 50,000 users serviced by 50 doctors. The app offers video consultation, which is priced at 20 Singapore dollars ($14.50), as well as the delivery of medicines to a patient’s location.

[…]

There are also some benefits for doctors who work with tele-health apps. The apps can be a gateway to reach “more potential patients,” said Lim Wai Mun, founder of Doctor Anywhere. “Doctors can feel more connected with the patients by making themselves available and more accessible,” he added.

Akan datang: GE in late 2019

Singapore’s next parliamentary general election must be held by 15 January 2021. According to the Constitution, the Parliament of Singapore’s maximum term is five years from the date of the first sitting of Parliament following a general election, after which it is dissolved by operation of law.

Next Singaporean general election – Wikipedia

So far the PAP has signaled trice in recent months that an election will be held in late 2019 or early 2020, after the 200th anniversary of Raffles making S’pore British is co-opted by the PAP to propogandise the benefits of PAP rule, (like the 50th anniversary of getting kicked out of M’sia was co-opted in 2015).

First signal: the PAP govt ended the property cycle upswing early. If things had been allowed to run their usual course, we’d have rising property prices in 2019, if not 2020.

With less than a third of collective sale sites sold so far this year and no deal inked since property cooling measures took effect more than a month ago, one property analyst has declared the current cycle of en bloc fever to be over.

More than 30 collective sale sites have failed to secure a buyer since January, according to data from real estate agencies Huttons Asia, Savills and Colliers.

[…]

“This cycle has reached its end,” said International Property Advisor’s chief executive Ku Swee Yong.

If that is the case, the current cycle would have lasted about two years – If that is the case, the current cycle would have lasted about two years – beginning with the sale of former Housing and Urban Development Company (HUDC) estate Shunfu Ville – shorter than the three-year run that lasted between 2005 and 2007, he said.

https://www.todayonline.com/singapore/more-30-en-bloc-tenders-closed-without-buyer-year-none-successful-after-july-cooling

Rising property prices in 2019 would have been problematic for early elections.

Second signal: goodies for my generation

Just as Singaporeans born in 1949 or earlier received the Pioneer Generation Package to cope with healthcare and other expenses, baby boomers born in the 1950s will receive help from the Government.

Called the Merdeka Generation Package, it will cover areas such as outpatient subsidies, Medisave account top-ups, MediShield Life premium subsidies and payouts for long-term care, announced Prime Minister Lee Hsien at the National Day Rally on Sunday (Aug 19).

Third signal: kicking problem of expiring HDB leases (Why 30-year old HDB flats difficult to sell/ Why PAP rule will end in 2029) into the long grass while details will be worked out in the next 20 yrs or so (Taz how confident PAP is of ruling S’pore)

With Prime Minister Lee Hsien Loong’s speech, the Government has laid out a “visible” programme for Housing and Development Board (HDB) flat owners for the future of their homes, said CIMB economist Song Seng Wun, who added that public housing has been the backbone of Singapore’s wealth creation.

Vers, which Mr Lee said would start about 20 years from now, will see residents of precincts that are about 70 years into their 99-year leases voting on whether they would like the Government to buy back the flats. The Government will compensate them — at terms less generous than the Selective Enbloc Redevelopment Scheme (Sers), which is compulsory — and help them get another flat to live in.

https://www.todayonline.com/singapore/devils-details-flat-owners-should-not-expect-windfall-new-hdb-scheme-analysts

I hope that the Oppo is better prepared this time to handle the PAP’s handouts of goodies. This was written in Sept 2012: Time for Opposition to rethink assumptions, lest it repents after next GE. But the Oppo fought GE 2015 as though it was GE 2006 and 2011 again. The result PAP got 70% of the popular vote. Of course LKY’s death and the 50th anniversary of independence celebrations helped.

One thing is sure, talk cock sing song Lim Tean is sure to make another video. Which reminds me: if he can make videos of himself talking cock, why can’t he produce the video on how to avoid getting sued for defamation he promised for Sept, then Nov 2017 after raising the money for it? Remind Lim Tean, it’s December

 

Why I not KPKBing about MediShield Life

… while he feels that MediShield Life is inadequate in terms of making healthcare affordable to the masses, he acknowledges that it is “a huge advance in that it took in people with pre-existing conditions”.

https://www.channelnewsasia.com/news/singapore/paul-tambyah-chairman-singapore-democratic-party-on-the-record-10527550

It’s really a big step from Hard Truths that it took in people with pre-existing conditions. The PAP is slowly but surely adapting itself to the realities of a modern, developed society.

Declaration of interest: I paid “peanuts” for my second cataract operation (first one was $1000 ++) because it was heavily covered under Medishield because it was the second eye operation within a yr.

Related post: Will Gleneagles sandwich cost me a fortune?

Healthcare: user fees drives up costs

To show S’poreans that saying that they want to earn the right to lead is more than BS, the coming generation of leaders should start looking at Hard Truths that have become irrelevant or were wrong in the first place. They can do no worse than look at user fees in healthcare.

The PAP administration swears by user fees in healthcare because it says that not to have fees means that there’s a buffett syndrome: Welfare for insurers (cont’d)

It would argue

In the 1980s and 1990s many health economists were relaxed about out-of-pocket payments, also known as user fees. The World Bank saw them as a way of making sure money was not wasted, and of helping health-care consumers hold providers to account. There is merit to this argument. Research by Jishnu Das of the World Bank found that when Indian health workers saw patients in their private clinics, they spent more time with them and asked more questions than when the same health workers saw patients in public clinics.

Economist

———————-

I’ve blogged before that the PAP doesn’t need that many smart people as it follows most of the Economist’s prescriptions (except on hanging, drug legalisation, free media and a liberal democracy): PAP’s bible challenges “market-based solution”)

—————————————————–

Well its bible now says that it’s not a

good idea to rely mostly on user fees to fund a health system. They stop those who need care from seeking it. Concerns that users will consume too much health care unless they have to pay are overblown. And when people are not getting vaccinated to save a few cents, others suffer, too.

Worse

Out-of-pocket payments are also “cannonballs of inefficiency”, says Timothy Evans of the World Bank, which is now sceptical about user fees. If spending is pooled, it can insure more people against the risk of ill health and put pressure on providers to cut prices. Of the $500bn generated globally by user fees every year, the World Bank estimates that 40% is wasted.

https://www.economist.com/news/special-report/21740870-if-universal-health-care-become-ubiquitous-politicians-will-have-act-more

Re the issue that user fees

are also “cannonballs of inefficiency”

seems to apply here as DBS says govt should control costs of households esp in healthcare: See who’s telling govt to control healthcare costs/ What we be should be KPKBing about

Welfare for insurers (cont’d)

Here in Welfarism the PAP way I gave an example (share of taxes paid) that the PAP did welfare: corporates get welfare, not the people

Here’s another: the new requirement that Integrated Shield Plans (IPs) with riders have a co-payment portion of at least 5%.

When the PAP introduced this welfare scheme for insurers, a minister talked about “buffet syndrome” of policyholders.

Well the insurers should have allowed to wallow in their own urine and shit.

The problem was self-created. The “free” riders were created to increase their profits, or so they tot. Now that it was not working for them, the PAPpies should not be riding to their rescue. They should simply stop marketing the products. And start increasing the premiums for existing holders to reflect previous pricing mistakes.

But to be fair to the corporate loving PAP govt: the change has not mandated any change for the 1.1m people who already have full riders for their Integrated Shield Plans (IPs) – which means they still will pay nothing for hospital bills.

But the freeloaders and scroungers that are the insurance industry will not stop lobbying for this to change. They had wanted the co-sharing to apply to the existing contract, or so Secret Squirrel and Morroco Mole tell me.

But the PAP govt didn’t want another public row what with its plans to raise GST after the next GE.

 

Apple wants to replace yr doctor

From NYT Dealbook

Tim Cook talked up Apple’s health care ambitions, hinting at a move beyond wellness apps and devices. (CNBC) Amazon has invited hospital executives to Seattle to discuss expanding its business-to-business marketplace. (WSJ)

Need Paracetamol? Ask SingHealth

Getting Paracetamol from SingHealth, like Using yr CPF OA as a savings account, is one of few ways S’poreans who are not millionaire ministers or senior bureucrats can get a “free” lunch.

Recently when I went to Marine Parade Polyclinic for  my usual blood pressure pills, I asked the doctor for a big pack of Paracetamol. I was given a packet of 90 which should last me for months.

This reminded me that a SPP member and wannabe MP posted on FB a few months back:

Now I find this fascinating. In Singapore, a box of Panadol 12 x 500mg tablets costs $6.85 ie 57 cents per tablet. Here in London I saw Tesco selling a box of paracetamol 16 x 500mg tablets at 57 cents (32 pence) ie 3.56 cents per tablet. Panadol is just paracetamol. So the same product is 16 times (!!) more expensive when sold under a brand name. Come to think of it, can we buy generic (unbranded) paracetamol from shops in Singapore? I haven’t seen …

Jeannette Chong-Aruldoss on FB

Many of her FB “friends” pointed out that Paracetamol is widely available here and some tot that it could be cheaper here than in the UK. Everyone said it was even cheaper in JB but they couldn’t give a price. I couldn’t comment as I’ve not bought Paracetamol from my Chinese medicine shop for yrs because I get mine from SingHealth, though I did think 3 cents was a good deal.

Well I can inform readers that my Paracetamol cost me less than 2 cents a pill. To be exact $o. o15555 a pill.

Yes, I do find it strange that Ms Chong doesn’t know Paracetamol is widely available here. But I’ll give her the benefit of the doubt and assume she and her family use analgesics that don’t contain Paracetamol. After all, I prefer Aspirin, but was told when I was in my 50s, given my age, I should not take it unless a doctor prescribed it or OKed its use. Seems that many doctors hold the view that if Aspirin were invented today, it would not never ever get regulatory approval to be sold over the counter.

Still it doesn’t look good for her and the Oppo that she’s clueless about a basic medical item. I’m sure our millionaire ministers know that Paracetamol is sold here.

 

Yikes? Even US health system better than ours?

The extract on S’pore

U.S. vs. Singapore: A Mix of Ideas

The United States has a mix of clashing ideas: private insurance through employment; single-payer Medicare mainly for those 65 and older; state-managed Medicaid for many low-income people; private insurance through exchanges set up by the Affordable Care Act; as well as about 28 million people without any insurance at all. Hospitals are private, except for those run by the Veterans Health Administration.

Singapore has a unique approach. Basic care in government-run hospital wards is cheap, sometimes free, with more deluxe care in private rooms available for those paying extra. Singapore’s workers contribute around 36 percent of their wages to mandated savings accounts that may be spent on health care, housing, insurance, investment or education. The government, which helps control costs, is involved in decisions about investing in new technology. It also uses bulk purchasing power to spend less on drugs, controls the number of medical students and physicians in the country, and helps decide how much they can earn.

Singapore’s system costs far less than America’s (4.9 percent of G.D.P. versus 17.2 percent). Singapore doesn’t release the same data as most other advanced nations, although it’s widely thought that it provides pretty good care for a small amount of spending. Others counter that access and quality vary, with wide disparities between those at the top and bottom of the socioeconomic ladder.

Our pick: United States, 4-1

AARON: United States. Singapore is intriguing, because it’s so different from other systems. But its huge mandatory savings requirement would be a nonstarter for many in the United States.

CRAIG: United States. Singapore, a scrappy underdog, has become a fan favorite of conservatives. But its reliance on health savings accounts is problematic: When people are spending more of their own money on health care, they tend to forgo both effective and ineffective care in equal measure.

AUSTIN: United States. It’s hard for me to overlook Singapore’s lack of openness with data.

ASHISH: United States. The lack of data in Singapore is a problem, and it had higher rates of unnecessary hospitalizations and far higher heart attack and stroke mortality rates than the United States. Plus, the U.S. has a highly dynamic and innovative health care system. It is the engine for new diagnostics and treatments from which Singapore and other nations benefit.

UWE: Singapore. It’s hard to defend the messy American health system, with its mixture of unbridled compassion and unbridled cruelty.

 

 

Free prescriptions for chronic illness

The PAP has sewn up the Pioneer Generation vote by using our money to pay the medical bills of the PG.

For the next GE, the PAP should give free prescriptions for those aged 45 and above for those suffering from diabetes or high blood pressure. That will make another group of elderly S’poreans prone to support the PAP.

And if the PAP is feeling the need for more votes, here’s a more comprehensive list courtesy of the NHS in England:

Which conditions qualify for free prescriptions?

• diabetes mellitus, except where treatment is by diet alone
• hypothyroidism that needs thyroid hormone replacement
• epilepsy that needs continuous anticonvulsive therapy
• a continuing physical disability that means you cannot go out without the help of another person
• cancer, the effects of cancer and the effects of cancer treatment
• disorders such as Addison’s disease, a rare hormone disorder of the adrenal glands, for which specific therapy is essential
• diabetes insipidus and other disorders where the pituitary gland is not functioning well
• hypoparathyroidism, where the parathyroid glands are not making enough hormones
• myasthenia gravis, a disease that affects the nervous system and leads to muscle weakness
• a permanent fistula (for example colostomy) that needs continuous surgical dressing for example

http://www.bbc.com/news/health-40431800

HoHoHo: Did u know?

Standard Chartered is the only western bank left in Zimbabwe.

Yup the country ruled by Mugabe the guy who gives glowing references to our Gleneagles Hospital to his fellow dictators.He’s a regular customer. And his wife loves shopping here.

Healthcare: Gd lateral thinking in UK

Our A&E departments don’t have the problems faced by A&E departments in the UK, but here’s an interesting suggestion from the UK in this area: have GPs and support staff on duty to deal with patients who do not need emergency treatment. And charge and charge those who use this facility. Still would be cheaper than getting doctor to make house call at midnight.

BBC reports

The Times reports on a survey of doctors that suggests most believe GP surgeries should be placed in A&E departments to deal with patients who do not need emergency treatment.

The study of more than 500 doctors by the Press Association found most believed such a move was necessary to relieve the pressure on A&E.

Medishield: Expert on whether to buy integrated plans

 

Younger S’poreans who can’t afford to misspend money on useless, unnecessary stuff should heed the wise words of Tan Kin Lian the ex-CEO of NTUC Income who was sadly persuaded by the likes of Goh Meng Seng to stand for president.

The message basically is “Don’t buy Integrated Plans. Juz rely on Medishield for all its flaws”:

When you buy an integrated plan, or go to a non-subsidized ward*, you are helping the government to reduce its subsidy. You get a ward with 4 patients** instead of 6 patients*** and have the chance to choose your doctor. In most cases, these differences do not really matter to the quality of the care. But you are paying a much bigger bill (due to lower government subsidy) and you have to pay a much higher premium (maybe 2 or 3 times) to cover this difference. Is this really necessary?

http://tankinlian.blogspot.sg/2016/10/bad-design-for-medishield-life.html

(Emphasis mine.)

Someone who realised the folly of an integrated plan and wanted to revert was told

It is easy for you to convert back to Medishield Life. Call the insurance company and ask them if they will give you a pro-rata refund for the premium that you have paid for the integrated plan. If they can, you can convert immediately. If no, you can convert to Medishield Life at the next renewal date.

http://tankinlian.blogspot.sg/2016/10/move-back-to-medishield-life.html

———————————————

Healthcare for cheapskates

Older S’poreans who are well-off but cheapskates (otherwise known as “value for money” folks of which I’m one) use SingHealth, go to B2 wards and only have Medishield. The really hard-core try for C class but get found out and are whipped publicly.

Now their secrets on B2 and Medishield is public knowledge.

For those who voted against the PAP using SingHealth, B2 and only Medishield has another advantage. U can give the PAP the finger and have your cake and eat it. Eat yr heart out Queen Jos: us peasants (plebs) can be like millionaire ministers too. Have cake and eat it. And give the PAP the finger.

---

More on TKL

He lost his deposit in the PE, and thus indirectly helped the PAP’s prefered candidate to win. Bad advice and personal quirks made him look like a clown. He’s eccentric but no clown. I should know. I helped him help the mini-bonders (though sadly we didn’t help them that much) so I should know. But I fell out with him when he listened to “bad” advice. But to be fair, I’m not an easy person to work with.

Since the PE, he’s focused on his core competency of dishing out financial advice, Example

Financial Services Consumer Association

I have updated a few articles on financial planning and insurance in the FISCA website. They answered questions that were sent to me by ordinary people. You may find these articles to be useful and relevant.

Click here to view these articles. 

I have also produced about 10 videos covering different topics on financial planning and insurance. Each video is about 5 to 10 minutes. One video is longer.

Click here to view these videos.

I invite you to view to vote on the issues listed here. You will win a book prize – Financial Planning for Young People.

If you are tired of receiving my messages, you can click on the link below to unsubscribe from all future mailings. 

Click here to unsubscribe from all future mailings.

Tan Kin Lian
——————————

*The real challenge is in dealing with treatment in a non-subsidized ward, i.e. B1 and A ward. The term “non-subsidized” is not a proper description. There is a small subsidy in B1 wards. TKL

**B1 has four patients to a room and has aircon.

***B2 has six patients to a room and has no aircon. C (“Cattle”?) class has nine to a room.

An expert comments on Andrew Loh’s bill

Here’s the view of a regular commenter who has given valuable insights into our medical and healtcare complex, for example into Woodbridge and the SGH tragedy. He says he was a doctor, turned mecical administrator, turned fat cat. He’s anti-PAP but no nut.

Singapore’s high medical costs are mainly due to expensive medical equipment and staff costs (even with 80% foreigner nurses & 50% foreigner doctors in restructured hospitals). If we use 90% Sinkie nurses & doctors, govt budget for healthcare will be 15%-20% like in UK, US, Oz.
C and B2 bills cannot even cover the salaries of foreign nurses, let alone the doctors’ salaries, medical equipment, consumables, drugs, imputed rent, etc.

Total hospital bill for CABG (coronary bypass surgery) at 75th percentile:-
Natl Heart Ctr (SGH) C-class — $5,200
Natl Heart Ctr (SGH) A-class — $41,500
For private hospital like Mt E it will be at least $80,000.

Andrew’s bill for his CABG of $4,900 is about ballpark for C-class.

What I find can be improved is Andrew’s billing for angiography. Even with overnight stay, it should be about $2,500 in total, and not $4000.

It became expensive for Andrew becoz SGH is charging him the procedure for PTCA (artery ballooning). But becoz it was a failed procedure, SGH could have waived more of its charges on good faith, particularly since Andrew was to follow up with his CABG operation in-lieu of the PTCA failure. [CI’s note: Err maybe he anti-PAP, so no pang chance? Maybe he realises this and now brown-nosing the system to get the benefit of the doubt in future?]

As for the comments by N.Jungne* extracted from TRE above:
1. Andrew didn’t show the actual billing for his CABG, only the Medisave deduction notice which of course doesn’t show all the details about daily claimable limits and deductibles and co-payments etc. You’ll need Andrew to show the actual bill AND the Medishield statement for all that.

2. Btw it wasn’t all 7 days in C-class ward — it was 4 days in C-class ward, and another 3 days in ICU & high dependency (HD) ward. Andrew didn’t breakdown how many days in ICU and HD ward. Both ICU & HD ward are single class (same ward & facilities whether you’re A-class patient or C-class patient). But C-class patient gets the subsidies while A-class patient doesn’t. However consultants & registrars tend to push C-class patients quickly out of ICU & HD ward as long they won’t die immediately. Unspoken hard truth in Singapore’s hospitals.

Of course daily claimable for ICU and HD are higher than for general ward.

———————————-

*N.Jungne:

October 16, 2016 at 10:25 am  (Quote)

What was in the Bill is true, the devil is in the detail. It (the bill) does not reflect the detail of how they come about (summarized).
1). The maximum daily deduction per day in “C-class” X 7 days
2). The deductible for “C-class.
3). The half of 15% co-payment.
Now there is another NEW category (I can’t remember), even a few $$$ can be deducted from our Medisave.
Andrew is not WRONG, they change and change until we are confused.
The QUESTION is WHY (they change).

From Andrew Loh’s bill dissected

Are PAPpies and cybernuts related?/ Andrew Loh’s bill dissected

Maybe the u/m from FT will explain why Queen Jos and Andrew Loh sound so alike in their whackiness? The former appears to believe that sex is meant for procreation only and the other seems to swallow, hook ‘line and sinker the PAP spin that public healthcare is cheap*. On the latter as I’ve wriiteh here

Going by what Andrew Loh has written, anti-PAPpies repent and say “Vote PAP” when they see that their medical bills are peanuts? LOL

David Dunning and Justin Kruger received an Ig Nobel prize in psychology for their discovery that incompetent people rarely realise they are incompetent; the Dunning-Kruger effect is now widely cited. FT

(More on this effect.)

*When TRE republished this, a cybernut asked a rational question: was there over-priced billing in the first instance.

oxygen:

October 16, 2016 at 12:38 pm  (Quote)

ANDREW LOH IS DEFINITELY NOT WRONG OF HIS FINANCIAL STATISTICS – it is his actual billing. But what he didn’t ask of obvious is this – was there over-priced billing in the first instance.

I saw a scanned copy of SGH’s colonoscopy bill of another – there was TWO facilities charges for one surgical procedure done – that is, there is a facilities charge for waiting area and another facilities charge for procedural surgery. The latter is comprehensible but the former (facilities charges sitting in the waiting room waiting to be call in for actual procedures) is mind-boggling. Why not also charge “facilities charge” for the patient’s relative sitting there waiting as well?

So the issue is the total billing and its details – the discount is rubbery fantasy of illusion -and of course the final billing. If Andrew Loh has expired all his Medisave account, HE WOULD STILL HAVE TO PAY THE AMOUNT OUTSTANDING OUT OF HIS POCKET.

Draining the balances of his CPF Medisave account must mean he has to top that up soon or sometime in the future. IT IS SEMANTIC OF ADVANTAGE ILLUSION – a bill is a bill and needs to be settled – one way or another unless it is free of universal health care like Medicare in Down Under.

Rating: 0 (from 0 votes)

There was another nut who also had a fit of sanity:

N.Jungne:

October 16, 2016 at 10:25 am  (Quote)

What was in the Bill is true, the devil is in the detail. It (the bill) does not reflect the detail of how they come about (summarized).
1). The maximum daily deduction per day in “C-class” X 7 days
2). The deductible for “C-class.
3). The half of 15% co-payment.
Now there is another NEW category (I can’t remember), even a few $$$ can be deducted from our Medisave.
Andrew is not WRONG, they change and change until we are confused.
The QUESTION is WHY (they change).

 Rating: +8 (from 8 votes)

Tua kee anti-PAP blogger has repented?

They say there are no atheists in foxholes.

Going by what Andrew Loh has written, anti-PAPpies repent and say “Vote PAP” when they see that their medical bills are peanuts? LOL

I would have to pay S$2,348.71 in cash.

So, that’s for the angiography.

And

In the end, I pay $0 in cash. [He’s talking about his very complicated bypass]

As an aside, I would just like to add this: some people have criticised Medishield Life as a rip-off scheme. I don’t think it is. I do know that it is a lifesaver for many poor and elderly folks who worry themselves sick whenever they contemplate going to the doctor’s.

Medishield Life, which is not without flaws, does help, and remember that it is aimed at helping the less well-off with the bigger medical bills.

It is a basic insurance plan, not meant to be a comprehensive one.

For those who can afford it, go get the Integrated Shield Plans offered by insurance companies. They complement Medishield Life.

If you are unable to foot out a one lump sum to pay the bills, you can go to the hospital (mine is SGH) and apply to pay by installments, which is what I intend to do.

http://singaporedaily.net/2016/10/12/went-two-major-medical-operations-much-really-paid/

Fatties and smokers should not be demonised

They are demonised by govts round the world because of the costs they impose on society.

It is the long-living healthy (non-smoking, non-obese) who ultimately generate the highest lifetime medical costs says a letter writer to the Economist.

Something to chew on

“Counting calories” (August 13th) takes it for granted that obesity costs the National Health Service “billions of pounds each year”. According to a widely cited study from 2008 by Pieter van Baal, a Dutch economist, it is the long-living healthy (non-smoking, non-obese) who ultimately generate the highest lifetime medical costs. Because obese people die younger on average, they require fewer years of medical care and are less likely to fall victim to the expensive morbidities associated with old age. Obesity prevention is important to improving public health and should not be seen purely as a way of saving money.

TAMAY BESIROGLU
London

The Lion roars

On 21 March. Leon the Lion reported on his Facebook page Today I filed this Parliamentary Question for oral answer at the next available sitting:

“To ask the Minister for Health (a) what are the names of the SGH and Ministry staff who have been disciplined in connection with the Hepatitis C hospital infection cluster in 2015; (b) what are the penalties and/or warnings that they individually received; and (c) for what reasons have these penalties and/or warnings been given in each case.”

[Readers will know I have problems with the naming of so many people, but I agree with his two other points about the details of their “honest mistakes”. Related post.

The Hepatitis C infection cluster in 2015 was a tragedy that led to seven lives being lost. With confidence in our healthcare system at stake, Singaporeans deserve to know who was held to account and in what way. After all, when doctors are sanctioned by the Singapore Medical Council, they are publicly named. I hope that Parliament will be able to debate this matter of grave public concern. 

[Looks like the beast in him wants blood via a cyberspace lynching. I think a deep bow and apology from the CEO of SGH is sufficient.]

Leon the Lion is no duckweed. Neither is he a highly paid social worker like the elected WP MPs. And he like the rest of the WP East Coast team (bar Gerald Giam, I hear) is walking the ground there. After GE2011 GG went AWOL, though to be fair that team broke up after GE 2011.

I’ll end with a question a reader asked about how infection is controlled in public hospitals

What I really like to know is what actions have been taken to control infection/cross-infection in every conceivable medical situation or protocol. It is the renal ward today. It can be another specialty/ward tomorrow. Granted that this is highly specialised and technical work requiring a very keen sense of awareness and detailed knowledge of procedures, (and detective work, perhaps?) etc. The best and onerous way about it is to embark on a very thorough and detailed audit of every pertinent and relevant medical/clinical/ward area/activity. Is this now being done?

As an example, MRSA infection, nowadays a rather common infection acquired by patients as a result of hospital stay. What is actively and effectively being done to monitor and control it? Are patients aware of the steps he/she has to take to protect himself/herself and for those who have been infected/acquired MRSA, how can they protect themselves and their family members, relatives and friends whom they come into contact with during hospital visits and upon discharge from hospital? What medical procedure and control measures have been formalized and implemented by the MOH across the board not only for SGH, but ALL private/public/restructured Singapore hospitals? At the moment, it seems very much like a ‘see no evil, say no evil and hear no evil’ situation of pretense and hoping that nothing worse would/can happen even when it can be a very serious infection for one who had contacted it and there is no available more powerful antibiotic to fight it.

Can someone who knows any good PAP MP (think Lily Neo or Puthu son of Coldstore detainee) or any of the three WP NMPs pass this on to them and ask them to raise this issue. Don’t bother with any of elected MPs of the Wankers’ WP: they are Tin Pei Lin clones. Highly paid social workers who only “Talk cock, sing song” in Parly when they are not silent.

 

What really went wrong at SGH?

And why the reluctance to do more than issue letters of warning?

A regular reader and commenter of this blog who seems to have been  a medical doctor and administrator has an explanation.

Note he had already raised the issue of the use of shared vials here before the internal report came out. He goes further below presumably having read the internal report.

This WAS a systems failure whereby the major gap was allowing same vial of insulin for multiple patients i.e. shared vials, although supposedly using fresh, sterile needles & syringes. By using shared vials, this created a single point of failure if any of the 1,001 aspects of infection control was not strictly adhered to. E.g. lack of hand disinfection — between patients, before drug preparation, before administering insulin, after administering insulin; not disinfecting the rubber bung of the shared vial adequately before use; not using new sterile needles/syringes; using new sterile needles/syringes but leaving them exposed for too long or mishandling them thus rendering them no longer sterile; etc etc. The possibilities are endless.

And then the pathogen being introduced into the shared vial and subsequently being re-transmitted, even though subsequent usage all followed 100% infection control — the bug is already in the insulin/vial, no matter how solid & how sterile you prepare the subsequent insulin administrations for other patients, you’re simply injecting them with already contaminated insulin.

Who’s responsible?!?! The senior doctors, medical directors who came up with this protocol in the 1st place??? The CEO or chief medical officer who approved & signed off on this protocol?!?!? The infection control team & educators who didn’t educate the ground staff enough, and weren’t vigilant enough in their audits & random spot checks?!?!?! The external audit teams who couldn’t detect any shortcomings & signed off that the staff are following protocol?!?!? The actual ground staff/staff nurses who got careless or bochap or simply burnt out to overlook 100% of the by-the-book steps?!??! How many of these staff nurses??? 1, 2 or the whole lot of them?!?!?

Going by what he says maybe the Health Minister must commit hari-kiti? No wonder only warning letters were issued? And ST is wayanging?

(Related post: GCT believes in Jap values. But not for the elites.)

Seems I was right to ask if ST’s call for a public cyber-lynching of “responsible” staff is a lot of wayang aimed at distracting attention away from those that must take responsibility: the CEO of SGH and athe MoH senior officer that delayed reporting the matter to the minister.

“Where does a wise man hide a leaf? In the forest. But what does he do if there is no forest? He grows a forest to hide it in.”― G.K. Chesterton, The Innocence of Father Brown

ST wants cyberspace lynching? Waz its agenda?

Name those responsible for Hep C infections at SGH

Staff confidentiality has no part to play when there is a serious breach of patient care

 

No the above did not appear in TRE or TOC or any other anti-PAP blog. It appeared in the constructive, nation-building ST and was written by its long-time health reporter, a usually reliable ally of MoH. She was ranting like any cybernut rat from TRELand, The findings should have gone a long way towards restoring the badly dented reputation of SGH, which describes itself on its website as “Singapore’s flagship tertiary hospital with a history and tradition of medical excellence spanning two centuries”.

Instead, all we were told this week was that disciplinary action has been taken against 16 (unidentified) senior-level people, and that the action included “warnings, stern warnings and financial penalties”.

The public had expected transparency and accountability*.

Well the TRE rats would agree with her.

What she’s missing is that where there is a systems failure where no-one person or group persons are primarily responsible, in management or organisation theory, it’s wrong to name and shame all of them publicly. This is especially true in  the age of social media. The cybermob can bully and intimidate. Is this what a responsible reporter and the nation-building ST want? Cybermobs running riot in cyberspace, bullying and intimidating.

Coming back to mgt theory, the CEO of SGH is the one that has to accept public responsibility for the failure of procedures that resulted deaths and someone at MoH has to accept the responsibility of not informing the minister earlier.

The reporter and ST should have asked for a Japanese style apology from the CEO of SGH and the senior MoH officer responsible for the delay in reporting the problem. GCT was keen to stress Jap values so long as they didn’t apply to the PAP administration; Khaw when it applied to the WP.

Where’s GCT’s and Khaw’s Jap style of responsibility from the head of SGH and the senior official in MoH**?

Actually is this the kind of Jap behaviour the PAP administration prefers? CEO takes cover.

Coming back to the ST article, could the call for the naming and shaming of staff be a smoke screen to avoid the real issue of who should take responsibility for the deaths, and the late reporting of the problem? Is it to avoid the CEO of SGH being made to accept public responsibility for the failure of procedures that resulted deaths? Is it to protect someone at MoH who would have otherwise had to accept the responsibility of not informing the minister earlier?

What do you think?

“Where does a wise man hide a leaf? In the forest. But what does he do if there is no forest? He grows a forest to hide it in.”― G.K. Chesterton, The Innocence of Father Brown

In this story, Father Brown, an amateur detective, deducted that a commanding officer hid his murder of a fellow-officer by sending his soldiers into battle in the area where the body lay. The dead bodies of the soldiers “covered up” the murder.

Is ST and the reporter growing a forest to help their ally, the PAP administration, avoid the issue of mgt responsibility for the deaths and the late reporting?

What do you think?

——–

*But it does not tell us who these people were, how they were at fault, and what disciplinary action has been taken against each of them.

When asked for details, the MOH spokesman said: “Adhering to staff and patient confidentiality norms, we would like to assure the public that the staff who were involved in the incident have been disciplined accordingly.

“The disciplinary actions were decided based on the specific roles, responsibilities and job nature of the officers, as well as the nature of the incident and the impact of their actions in this episode.”

Sounding like one of those anti_PAP warriors she cont’d

Patient confidentiality, one can understand. But staff confidentiality?

The public had expected transparency and accountability.

Instead, what it got was roughly: “We’ve looked into it and taken action. You don’t need to know anything more. Just trust us to do the right thing.”

Staff confidentiality has no place when people have died because of something those 16 people did or failed to do.

Patients go to a hospital to be cured, not to get an avoidable infection because staff were cavalier, or negligent, or inept.

Yes, hospital-acquired infections are unfortunately common, and people do catch them and die as a result. But this was not a case of an airborne bug which spreads easily.

This, according to the Independent Review Committee set up by the MOH, was likely due to “gaps in infection prevention and control practices”.

Doesn’the above sound like something from an anti-PAP blogger, not from a responsible reporter from the nation-building, constructive ST?

**She pointed out:

It bears repeating: 25 people were infected and seven deaths were possibly caused by the outbreak.

Tell us, was it caused by laziness, negligence or ineptitude – or something else altogether. Tell us also that this incident is viewed seriously by spelling out the actions taken.

If people are left with the impression that doctors and ministry officials get special protection no matter what they do, then confidence in the system will be badly eroded.

Can’t argue with her and her cyber-rat fans cheering her on.

 

 

 

Treatment of Roy and MoH, SGH staff

 

The above has been making the rounds in cyberspace. And even some usual rational people say that it has a point.

A super troll points out that it’s comparing rambutans to durians: Big difference. The latter made “honest mistakes” in the cause of their duties that sadly resulted in deaths. Roy was skivving while at work.

Update at 7.10am

Lest one forgets, being given a”warning” letter are usually career-damaging in the public sector. The anti-PAP waeeiors don’t point out/.

Update at 10,15am: PAPpy pointed out in a FB post: Prior to his dismissal, two warnings were served and all these were in black and white and communicated professionally in the best relationship between an employer and employee.

And

He was caught red handed because the PC n mailbox are the property of the company. He was caught red handed. Prior to this, the whole company knows that he was not using the working hours constructively liao. Not only that, he was consulted by his superior many times until TTSH had to serve him warning letters to communicate the process leading to his termination officially. So in which way u don’t understand, please feel free to check with TTSH.

Hospitals make sick more sick

hospital systems have developed to serve the people who work there, not the clients. Err this could describe the PAP administration.

Seriously better try to avoid getting admitted unless absolutely nec. Patients once in there are more vulnerable to disease and accidents.

Krumholz learned that only about a third of patient readmissions were related to the original cause of hospitalisation. Patients’ reasons for returning to hospital were diverse and linked to their immune systems, balance, cognitive functioning, strength, metabolism and respiratory systems. It was as though they were mentally and physically below par, off-kilter, out of whack.

Could it be, Krumholz wondered, that the very experience of going to hospital had made patients more vulnerable to disease and accidents?

In a series of opinion pieces in top medical journals, he has developed the concept of “post-hospital syndrome” (PHS), which he defines as “an acquired, transient period of generalised risk”.

“My premise is it’s the cumulative effect of a lot of insults to the body, of all the stress coming from all different directions,” he says.

“What do we do to them? We sleep-deprive them, we malnourish them, we stress them, we disturb their circadian [sleep] rhythms, we put them at bed rest and de-condition them, we confuse them with lots of different people and new routines – we don’t give them any control.”

A recent, yet-to-be-published study lends support to Krumholz’s theory.

Dr Paul Kuo, chairman of surgery at Loyola University Medical Center in Illinois, supervised research in which records from about 58,000 patients who had gone in for a hernia operation in California were carefully analysed. The research team identified a sub-group of 1,332 patients who had been in hospital in the 90 days leading up to the operation.

They found that in the 30 days following the hernia operation, this subgroup was roughly twice as likely to visit the emergency department, and five times as likely to have to be admitted to the hospital as an in-patient. It seemed their previous stay in hospital had “de-tuned” them, making them more vulnerable to complications arising from the hernia operation, even though it is a very straightforward, same-day procedure.

http://www.bbc.com/news/magazine-35131678

Health care: Model for S’pore

The country is Cuba which like S’pore is a one-party state (albeit only de-facto here) but which is really poor but has a free-health-care service and

To serve its population of 11 million, the country has 90,000 of them. That’s eight for every 1,000 citizens – more than double the rate in the US and in the UK (the US has 2.5 doctors per 1,000, the UK 2.7 per 1,000 according to the World Bank).

S’pore has 2.1 per 1,000 in 2o14 acording MoH data.

Seriously given the Big Brother mentality here by both the pigs and the sheep aristocrats and the peasants, surely we can have this here

Compulsory health checks

“My nurse knows where they live,” Dr Quevas Hill jokes. “They can run, but they can’t hide!”

The data from this check-up allows the family doctor to put her patients into categories according their “risk”. If they’re healthy, the annual check-up is enough. But if they’re showing signs of ill-health, if they drink too much, smoke or have a continuing health condition, they’re seen much more regularly.

It’s an integrated, whole-person approach to healthcare, perhaps too intrusive for some, but widely accepted within Cuba.

The aim is to stop people getting ill in the first place.

http://www.bbc.com/news/health-35073966

If you’re wondering if the SGH tragedy could happen there, rest assured it won’t. If it happens the head of the unit responsible will be executed by firing squad. Our Harry would juz have humiliated the head and sacked him. But Jnr ….

 

“Resilient”/ “Unresilient” stocks : MayBank Kim Eng

Under the worst test scenario – this assumes that a 10 per cent cut in revenue, 10 per cent foreign exchange depreciation and 100 basis-point hike in interest rates happen all at once next year – three sectors emerged as the most resilient: China water-utility stocks, healthcare and manufacturing. So says MayBank Kin Eng in a report in mid Sept.

Don’t know about the Chinese utlities but the rest of list (see below)l ooks about right.

Healthcare stocks such as Q&M and Raffles Medical: “buffered by the largely non-elective procedures they offer”: “Under (the worst scenario), their earnings could drop 12 to 16 per cent when revenue declines, while foreign exchange and interest rate changes do not really move the needle,” said the report.

It added that manufacturers such as Innovalues, Valuetronics Holdings and Venture Corporation – which earn the bulk of their revenues in US dollars – should benefit from the strengthening greenback as they reap cheaper production costs.

Unsafe 

Offshore and marine, property and banking sectors – already under pressure – which could be “severely tested” by falling oil prices, rising interest rates and depreciating currencies, noted the report.

In the event of a market shock, highly geared offshore and marine asset owners like Vard Holdings, Pacific Radiance and Swiber Holdings may need to “recapitalise their equity, restructure their debt or face consolidation”, it said.

Developers CapitaLand and OUE would also be at risk of cash-flow constraints as their earnings before interest, tax, depreciation and amortisation (Ebitda) fall to “dangerous levels”, while the local banks could well see profits slump by up to 80 per cent.

S’pore along with Thailand and India, appears to be more resilient compared with others in the region, said Maybank Kim Eng.

China and Indonesia stood out as the most vulnerable, with China the only country to log a negative free cash flow in the stress test.

“This could be a consequence of excess capacity in China, meaning a shock has a greater impact on cash flows,” noted the report.

Are you better off now than you were in 2011?

I tot of the above when I was reading this piece about

Hundreds of aging leftists gather in a restaurant tucked away in an obscure corner of an old shopping complex. They talk, shout, argue, and rant about the government. One of them goes onstage and demands political change in the next elections; he is greeted with raucous applause and loud cheers.

The attendees are mostly in their seventies or eighties. Several lean on spouses, children, or canes as they hobble to and from their seats …

Given that they are of the Pioneer Generation, the answer to “Are you better off now than you were in 2011?”* should be a resounding “Yes” because of the healthcare and medical provisions for Poneers. Yes, even those locked up in Coldstore etc are entitled to them. The PAP administration is saying, “Let bygones be bygones”? (Which brings me to the tot that if the leftists had won, would they be so magnanimous to Lee Kuan Yew and gang? For a start, LKY and gang and many others may not have been allowed to grow old and bitter. Think Cuba, Nicaragua, Vietnam, Cambodia, Laos and Red China, and I think you will get the drift of what I’m thinking: opponents and intellectuals not sympathetic to the leftists cause were, imprisoned, exiled or killed.

Much good it would do the PM and his PAP administration that these leftists benefit from their policies. These aging leftists would never say anything good about LKY and his legacy. (Related article: http://www.latimes.com/world/asia/la-fg-singapore-change-20150319-story.html#page=1).

———————————————————————–

Real life examples of what Pioneer Benefits mean:

— A mother and her autistic son are Pioneers. The son has been in a nursing home for over ten years, ever since his mother became too frail to look after him. The monthly bill was about S$4,000 a month and was borne by his siblings. Now this bill is “only” a few hundred dollars a month. The mother’s medical bills (she’s in her 90s and suffers from various chronic conditions) are now minuscule.

The extended family is happy.

— Another Pioneer used to pay $30 when she visited a polyclinic every three months for her medicine etc. She now pays $7.

— Another lady lives in a home because of Alzheimers. The cash from the sale of her flat was paying the bills. Now there is no worry of the cash running out before she dies. Her monthly bills have been slashed. Her working daughter (with children and an unemployed PMET husband) is breathing a sigh of relief.

Will they vote PAP? I didn’t ask.

Btw1, I’m sure Dr Goh Keng Swee would approve of these measures. As His daughter-in-law and biographer said

During his time as a tax collector in the War Tax Department, Ms Tan said, “He was a bad tax collector. His boss didn’t like him,” to much laughter. Later, after joining the Social Welfare Department, Dr Goh helped to set up ‘People’s Restaurants’, which were canteens where people could buy cheap meals during the working day.

“He was always involved in social work,” she added.

http://www.pweefoundation.com/pwee-foundation-holds-talk-on-dr-goh-keng-swee/

Btw2, As would Lim Kim San, Toh Chin Chye and the other members of the Old Guard, including one LKY.

Btw3, Wonder if one VivianB voted against these measures when they were presented to the cabinet?

—————————————————————–

A group that will certainly say they were better off in 2011: PM and his ministers. Somehow I don’t think they would vote Oppo.

—————-

*In a televised debate with Jimmy Carter during the 1980 Presidential election, Ronald Reagan asked viewers a simple question: “Are you better off now than you were four years ago?”

Voters realised they were not and Reagan romped to the White House.

That Reagan line has since become a cliché of political campaigning, second to “the economy, stupid” – the mantra drummed into Bill Clinton’s campaign team in 1992. BBC Online

 

Healthcare: France 1st, S’pore 2nd

‘High-quality’ healthcare

So is it possible to say which country has the best healthcare system?

Prof William Haseltine, president of ACCESS Health International and a former professor at Harvard Medical School, thinks the answer is France – which provides universal health coverage through social health insurance contributions from employers and employees.

Patients pay their medical bills and are reimbursed by sickness insurance funds.

“A uniform, high-quality medical service is available throughout the country and medical care is available to all, so no distinctions are made between rich and poor,” says Prof Haseltine.

What about a close second? He thinks Singapore.

“It has a unique approach to finance healthcare through government subsidies, insurance, as well as a mandatory saving system,” he says.

The compulsory saving programme is called Medisave, into which employers and employees contribute a certain percentages of their salaries every month.

“As a result, the government has managed to control national healthcare costs remarkably well by keeping it below 5% of GDP (gross domestic product),” says Prof Haseltine, who is also the author of Affordable Excellence: The Singapore Healthcare Story.

It also means that Singapore is better situated to handle an ageing population, which has resulted in ballooning healthcare costs in other developed economies.

There are still out-of-pocket payments to be made, however, which critics says are too high and make it difficult for low-income families.

Whatever the merits of Singapore’s system, though, what works for a city-state of 5.5 million people may be difficult to replicate elsewhere.

http://www.bbc.com/news/business-31052665

What say you SDP and yr cybernut groupies?

Marine Parade Polyclinic sees consequences of Pioneer ‘benefits’

My friend (a retiree but not a pioneer) who has diabetes, high blood pressure and high cholesterol (Yup, he lived off the hog) told me of a recent visit (I’ve had to do a lot of editing, even if I report it as if he were talking):

Every four months, I go to the Marine Parade Polyclinic for my blood test, checkup and medicine.

I usually go around 11 am on a Tuesday, Wednesday, Thurday or Friday because there is no crowd at the blood testing laboratory at this time. There is no waiting time at the lab at that time unlike at between 8-10 am.Also the waiting period to see a doctor is usually only about an hour.

On Tuesday I was there at about 10.45 am and the crowd at the lab was big, as was the crowd waiting to see the doctors. It was like 8 am on Tuedays to Fridays.

There were 20 people ahead of me at the lab. So I went to register to see a doctor (within the usual ten minutes) and then waited to take the test. I waited for about 40 minutes before I could be tested.

I then waited to see the doctor and after waiting an hour (the average waiting time), I was examined by the doctor. I told her that the size of the crowd at 11 am surprised me. She said it was the pioneers coming forward to use SingHealth. I asked if it was less crowded in the aftrenoon. She said no.

I said, “Looks as though before the ‘benefits’, many of the Pioneer Generation found it too expensive* to use the SingHealth system: only using it when they die-die needed medical care.” The doctor didn’t saying anything. She just smiled.

If the Marine Parade Polyclinic can be so crowded, places at Sengkang must be just about coping. A doctor who is usually based at Sengkang once told me that comingto work at Marine Parade is a bit of a holiday for her: less people. A doctor in private practice told me that the Marine Parade Polyclinic is a gd one to use because many in the catchment area prefer to visit the private doctors. in the area.

—

*Actually it could be juz stinginess. My mum has always talked of making a new set of dentures. But never got round to do so because it was ‘so expensive” even though she has plenty of $ in the bank. But now, she is planning to make a set.

Integrated Shield Plans? Waste of money? Cont’d

When TRE republished my piece on S’pore overinsuring their healthcare that pointed out, But seven in 10 armed with IPs that target Class A wards in public hospitals chose to stay in lower ward classes when hospitalised. Only one in 10 from the same group chose private hospitals.Echoing a similar trend were those with IPs that target private hospitals – six in 10 chose lower ward classes in public hospitals. The committee noted twice in its report that many Singaporeans want medical treatment beyond that provided in Class B2/C wards but have “over-stretched themselves to buy the most expensive product for higher protection”.,

two responses stood out, one rubbishy (but which I suspect explains why many gold plate and gem encrust their Medishield plans) and the other sensible.

But both imply that because the money’s there in the Medisave a/c so spend it leh (a major point of my piece was that the ltd uses of Medisave “encouraged” gold plating and gem encrusting medical insurance. Btw, an actuary tells me that insurers don’t really make much money from such plans, but admits that it could be because they are inefficient.):

Ace:

August 11, 2014 at 8:31 pm  (Quote)

This analysis by Cynical Investor is too simplistic. There are many consideration for buying a medical insurance.

In an emergency, for example if you faint at Tanglin Shopping Centre, the nearest hospital is Gleneagles Hospital which is a private hospital. If you are NOT covered under the highest plan and you go to Gleneagles Hospital, you will need to pay much higher out of pocket. You can of course go to SGH where you can be fully reimburse for the charges but it is further away and you may not have the luxury of time in an emergency.

For non-emergency cases, you can plan which hospital to be admitted but the fact is that the waiting time for admission to B2 or C wards for such cases can be as long as up to 9 months. Can you take the pain for so long and do you want to wait?

Hence most people would opt to buy the most expensive plan when they are young since the full premium can be paid by Medisave. When you are older, you can still downgrade to a lower plan if premium is an issue.

Singaporeans are not as stupid as the report make us up to be. We may be Kiasu but we are definitely not DAFT.

 

spiny dogfish:

August 11, 2014 at 10:06 pm  (Quote)

One reason why people buy the most expensive plans is because of the very rapid escalation of hospitalization costs. That and the fact that the insurer has an obligation to renew your plan but is NOT obligated to allow you to upgrade.
When i bought my first shield plan the benefits were enough for a private hospital. When i got hospitalized this year the benefits had not changed as i had naively not upgraded my plan for years. The benefits were only marginally enough for B1 ward. The benefits do not change but the costs keep rising.
And i was told that had my conditon been a chronic one like say cancer or heart disease, it was possible that should i wish to upgrade my plan i would either suffer loading or that very condition would be excluded. BUT i could renew my plan, no problem.

After that you bet i’ll take the highest plan i can afford. In 5 years who knows what this plan will be good for. Just take it as front loading. The real issue is rising medical costs. Dealing with the insurance is treating the symptoms not the disease.

Setting straight SPH’s tale on WP “discontent”

I refer to this “Discontent among WP’s old guard” in the New Paper. Typical of “constructive, nation-building” media. When the PAP changes members of the management team, the media praise it  for” self renewal”, “New blood”. when an Oppo party does the same thing the emphasis is on “discontent”, splits of the losers, malcontents.

I was going to deconstruct the article, given that I’m not too well-informed on the WP’s internal workings (My Morocco Mole has his agenda when telling me stuff. And he had a howler ). But my FB avatar came across a detailed analysis (deconstruction and factual) on FB by a WP member. As we didn’t ask permission, I will not name the person. But if she wants to be named, I will amend this piece to give credit where credit is due.

The New Paper published a report masquerading as a factual analysis of the dynamics at this year’s Organising Members Conference held at the Workers’ Party HQ on 27 July 2014. The article was mischievous and misleading. But more importantly, errors were aplenty. The following are my brief comments.

1. A binary between veterans and younger members who hold degrees was constructed. Supposed “facts” were thrown into this binary framework to create a seamless understanding of what has transpired and to provide analysis of and/ or an account of the situation.

In the article, John Yam and Somasundaram are conveniently labelled as part of the “old guard”. In that case, it appears that both of them were labelled as such due to their physical age in relative to the previous council members who were voted out, such as Ng Swee Bee and Koh Choong Yong who are in their 30s and early 40s respectively, rather than their experience in the Party. If the journalist had done his research, he would have realised that John Yam and Somasundaram joined the Party in 2009 and 2006 respectively. They are in no way “veterans” alluded to by the journalist as being “around for more than 15 years.” In fact, Swee Bee has been in the Party for the last 10 years, longer than John Yam and Somasundaram.

In listing down the reasons for the unhappiness of the “veterans”, he cited that “newer and younger members who hold degrees are preferred over veterans. In that case, the two “older members” who were elected does not in any way fit this caricature. Dr. John Yam holds a PhD and Mr. Somasundaram holds a Masters degree. Swee Bee on the other hand, for the longest time since she joined the Party in 2004 did not have a university degree, but she has been holding the position of Organising Secretary for many years.

The journalist also pointed out that former members, “Mr. Mohamed Fazli Talip and Sajeev Kamalasanan” were veterans of the Party. They were not. Fazli joined the Party in and around 2009/ 2010 and Sajeev joined the Party in 2006. To put it into perspective, Swee Bee and Choong Yong joined the Party in 2004 and 2006 respectively. This binary of “veterans”/ “old guard” vis-a-vis the younger and educated members is clearly misleading and in his attempts to construct a “Other” in the Party, does more harm than good in helping readers of The New Paper understand what had transpired at 216G, Syed Alwi Road on 27 July 2014 and more importantly, the implications/ significance of the new Council in the lead up to the next General Election.

The fundamental point is this. The journalist contradicted himself with the use of the terms “old guard” and “veterans” to mean the same group of people or to construct a faction within the Party from thin air. As he writes on, even he became confused.

2. The journalist displays his lack of understanding of the operations and functions of the Workers’ Party. He did not bother to do his research and check his facts.

The Workers’ Party do not and would not parachute in their candidates. In the article, it was pointed out “candidates are parachuted in, despite not having walked the ground.” Anyone with a basic understanding of the Workers’ Party knows that this is not true at all. The journalist would also be interested to note that the Workers’ Party fielded an ITE graduate at the 2006 elections.

The reasons for Dr. Poh Lee Guan’s sacking, Mr. Eric Tan’s resignation (why Mr. Gerald Giam was made NCMP ahead of Mr. Eric Tan) and the earlier resignations of Mr. Fazli Talip and Mr. Sajeev were made clear to members, cadres and non-cadres at the annual members seminar of the Party. In particular, Mr. Low had explained to the entire membership the reasons as to why candidates were not guaranteed a cadreship. This point was consistently explained to the membership whenever it was brought at internal meetings. For the case of Dr. Poh Lee Guan, Mr. Low had made the reasons clear in his interview with the press after the nomination of Mr. Png Eng Huat during the 2012 Hougang by-elections.

Thus, the journalist was simply mischievous in attempting to illustrate a lineage of discontent and dissatisfaction in the Party. He accepted the comments of these former members at face-value, without trying to better understand the respective motivations/ intentions of these former members. Not too sure whether this is journalism or gossip.

3. “How bad was it?” / “Is there a split?”

In situating his piece in the context of an election drama and an internal party split, the journalist tried his utmost to fit his analysis with the gossip and rumours he picked up with members at the coffeeshop under the party’s headquarters. He had no intention to put up a accurate report.

4. The journalist do not understand the historical context behind Sylvia Lim’s statement.

Sylvia Lim told the cadres that the “WP could not afford to have internal problems or disunity.” Any responsible political party with an understanding of the period in Singapore’s political history (1991 – 1997, Singapore Democratic Party) would make a similar appeal to its members. A quick search would also find Lee Hsien Loong emphasising party unity to his members.

—
If a political party was nothing but a monolith, with the entire membership parroting the leadership, then I guess something is really wrong. It probably would be inherently broken. As a member of the Party, I am glad to say that this is not the case. The Workers’ Party is growing, its membership is growing and with that will come more competitive internal party elections. Different individuals with different views, ideological inclinations and backgrounds and experiences join the Party at different junctures in their lives. This can only be good for the long term development of a Party. As the case of Mr. Yaw Shin Leong and Dr. Poh Lee Guan had clearly shown, no one is above the institutions and standing orders laid down in the Workers’ Party. WP is a professional organisation and a well-oiled political machinery.

By the way, I attended the conference last Sunday. There were more cadres than the physical space at HQ would allow. It was packed, very packed. No wonder WP needs a new HQ for its continued growth and development. I like to think that this is not very newsworthy for The New Paper.

BTW, I’m sure that TRE ranters who call me a PAP mole, ISD person will say this post confirms what they have been saying, ’cause it sides with the WP. For the record, I think the SDP has the best policies for S’pore, 10-15 yrs into the future. It’s the only party that talks about

De-couple housing and healthcare from CPF.

The major reason why Singaporeans are left with insufficient retirement funds is because the PAP gives Singaporeans no choice but to use what is their retirement money to pay for their HDB flats and hospital expenses.

The SDP plan ensures that HDB flats are sold without the inclusion of land cost (see here) and that the Government stops profiting from healthcare (see here) In this way, our CPF savings are left unmolested for retirement.

Solving the problems around retirement, public housing and healthcare require solving all three issues together.

Yes, yed, I know that in the long term, the SDP’s retirement and healthcare policies will be very expensive for S’poreans but

The long run is a misleading guide to current affairs. In the long run we are all dead. Economists set themselves too easy, too useless a task if in tempestuous seasons they can only tell us that when the storm is past the ocean is flat again.

Here’s an explanation of what Keynes meant:by Simon Taylor

Keynes wrote this in one of his earlier works, The Tract on Monetary Reform, in 1923. It should be clear that he is not arguing that we should recklessly enjoy the present and let the future go hang. He is exasperated with the view of mainstream economists that the economy is an equilibrium system which will eventually return to a point of balance, so long as the government doesn’t interfere and if we are only willing to wait. He later challenged that view in his most important work The General Theory of Employment, Interest and Money (1935). arguing that the economy can slip into a long term underemployment equilibrium from which only government policy can rescue it.

 

 

 

Medishield: Totful tots on loss ratio to determine premiums

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.

Daft Sinkies? Dishonest insc agents? Or Medisave sucks?

I was shocked to read in BT on Saturday that the MediShield Life Review Committee highlighted something that should never have been allowed to happen by a truly nanny govt or a govt that cares for its people:

 [O]ne issue has stuck out like a sore thumb: the overbuying of Integrated Shield Plans (IPs).

In the clearest indication that something is amiss, the committee’s report released last Friday stated that about three in five Singaporeans covered under MediShield purchased IPs.

…

But seven in 10 armed with IPs that target Class A wards in public hospitals chose to stay in lower ward classes when hospitalised. Only one in 10 from the same group chose private hospitals.

Echoing a similar trend were those with IPs that target private hospitals – six in 10 chose lower ward classes in public hospitals. The committee noted twice in its report that many Singaporeans want medical treatment beyond that provided in Class B2/C wards but have “over-stretched themselves to buy the most expensive product for higher protection”. (Emphasis mine)

So S’poreans fork out premiums to stay in the best (OK most expensive) wards, but then don’t use them ’cause no money? Presumably the insurers are laughing when they see their bank statements.They pay out less than what they are prepared to pay for.

Shumething is clearly wrong.

BT as part of the constructive, nation-building media tries to avoid blaming S’poreans. insurers and their agents, or Medisave.

Having said that, it qualified that this typically happens during the working years, when premiums can be paid entirely or mostly through Medisave, the national medical savings scheme used to foot hospital bills, among other things.

A quick comparison of the IPs offered by the five insurers – AIA, Prudential, Aviva, NTUC Income and Great Eastern – showed that premiums for the first 40 years of an individual’s life were priced suitably low to gain market share.

For example, existing private IPs for Class B1 in public hospitals range between $78 and $207 annually, according to the comparison provided by the Ministry of Health’s website. The amount payable doubles to about $297 to $410 when the consumer is between the age of 41 and 50. It rises to between $425 and $921 for those aged 51 to 65, and for those who are 66 to 90, the yearly costs go up to between $888 and $4,245.

It calls for more education rather than pointing out that Medisave nudges S’poreans towards over-insuring despite describing the process of nudging (for the daft: the last three preceding paras).

While information is relatively accessible and most people understand that they have to pay more as they get older, only a small number of people truly realise the exponential spike in IP premiums from age 60 onwards, not to mention the accumulated lifetime costs.

All these point towards a poor comprehension of the workings of IPs – a point that the committee also made sure to reiterate throughout its report. This is why there is a pressing need for the government to educate the wider public of its entire healthcare financing system, as well as the things to look out for in choosing an IP if required, so that the individual can make an informed decision.

But it ignores the T Rex in the ward, Medisave: this typically happens during the working years, when premiums can be paid entirely or mostly through Medisave, the national medical savings scheme used to foot hospital bills,

The answer to the title of this rant?

All three with Medisave the catalyst. It worsens the stupidity (or financial incompetency) of many S’poreans and the dishonesty of agents, by nudging via skewed incentives money in Medisave cannot be touched except for illnesses and medical insc premiums, so might as well buy the more expensive coverage)). It’s our money in MediSave, but we can only spend it in the right ways, one of which leads to bigger profits for insurers..

Update: Follow-up https://atans1.wordpress.com/2014/08/19/integrated-shield-plans-waste-of-money-contd/

 

One ranking PAP govt and media will never publicise

One ranking PAP govt will not be proud of: see where we stand in diabetes ranjing 11in world. But S’poreans have to take responsibility for diabetes, can’t rely on govt. Govt has never explained why basic diabetes medication can be bot in JB at close to polyclinic charges. Subsidy? What subsidy? It’s a subsidy only to what the private sector charges.

Graphic truncated for those above us. For full pix http://www.economist.com/blogs/graphicdetail/2014/04/daily-chart-15

No $ needed: Three fixes to show the PAP really cares

Prime Minister Lee Hsien Loong said Singapore has to strike a balance between maintaining its competitiveness and caring about the less well-off as it strives to reduce the income gap. (CNA report a few weeks ago: More extracts at end oif article).

And the Budget statement and the spin that the conastructive, nation-building media has been putting on it esp the Pioneer package is along the same lines.

We all know that an election is coming round the corner and we know the PM (remember the 2011 “Sorry”, followed after the GE with massive tpt breakdowns and the population white paper, the latter issued juz before NatCon?)

So PM and the PAP has to walk the walk, not juz talking the talk.

The benefits for the pioneer generation are a gd, if a belatedly and niggardly start. Still got to start sometime and somewhere. It helps the pioneers and their children.and grandchildren who are caring for them**. Here are some things that PM can do to show the govt cares. They cost nothing going by what ministers said when defending these rules.

–Scrap the MediShield limit. It doesn’t cost anything as a minister has admitted but will give S’poreans peace of mind.

Since the inception of Medisave-approved Integrated Shield Plans (IPs) in 2005, no IP policyholder has reached his lifetime claim limit.

Health Minister Gan Kim Yong said this in a written reply to a Parliamentary question from Hougang Single-Member Constituency MP Png Eng Huat about the number of Singaporeans who are no longer insurable under MediShield or Medisave-approved Integrated Shield Plans.

This could be due to exhausted benefits and claim limits upon diagnosis of major illnesses.

Mr Gan said that the MediShield lifetime limit was increased in 2005, and more recently in March last year from S$200,000 to S$300,000. (CNA sometime back)

— Fix the flaw in CPF Life Plans

There is a provision in the law governing the CPF Life Plans which states that payouts are contingent on the Plans being solvent. This is because premiums that are paid in to get the annuities are pooled and collectively invested. If the plan you chose doesn’t have enough money to pay out, you die. This is unlike the [Minimum Sum] scheme, where account holders are legally entitled to the monies in their CPF accounts … (https://atans1.wordpress.com/2011/12/03/best-cpf-life-plan/). Even if the rules to access these monies make a mockery of the ownership, at least (so far) the beneficiaries can inherit the monies. (Remember that when Roy Ngerng again asserts (as he regularly does) that CPF contributions should be classified as a social security tax. He would wouldn’t he? He thinks the PAP is oppressing us, even though as a critic and  self-outed gay, ISD is ignoring him.)

The government has said the provision on solvency is only a precaution unlikely ever  to be used. If so, why have it? Again, this is a peace of mind issue. It was again Gan who made this assurance when he was MoM.

Finally,  the PM should apologise for VivianB’s sneer at the elderly poor all those yrs ago

Or make him make a fulsome apology. Even ex-Red Guards are apologising for their actions in the Cultural Revolution.

Even if … made amends for selfish or political reasons, their words and gestures are still important, says [a historian]. “It is still better than those who refuse to repent until they die. The conflict and hatred should be solved. The nation must move forward.”

(http://www.economist.com/blogs/analects/2014/02/apologising-cultural-revolution)

Why, I am I not asking him to be sacked? He is actually a gd environment minister. For starters, there are no more 50-yr floods***. Secondly, in my area (Marine Parade, East Coast), there are now regular cutting of shrubs and grass at empty plots of land and along pathways. There is also an attempt to ensure that in spots where ponding regularly occurs after the rain: attempts are made to fill in the spots and re vegetate them. Yaacob and his French cook of a chef never bothered.

And Vivian did get the Indons to do something about the haze by practicising megaphone diplomacy https://atans1.wordpress.com/2013/07/05/haze-pm-silence-is-not-a-solution/. Yaacob was sensitive to Indonesians’ attitude to S’pore and kept quiet: he always liddat. Took PM to rebuke his dad on Malay integration. Yaacob muttered, “Worse case scenario”.

—

*He made the comment in an interview with China’s New Century — a magazine by Beijing-based media group Caixin — which was published a few Mondays ago.

Mr Lee said there is a need to keep a balance between the yin, which he described as caring for one another, and the yang, which is the “competitive element that drives the society forward”.

“If you go too much towards competitiveness, you lose that cohesion and sense of being Singaporeans together,” Mr Lee said.

“If we go… the other way and say, well, we don’t compete… I think we will all be losers.”

He acknowledged that the competitive environment in Singapore is getting fiercer and conditions are getting more challenging for middle and lower-income groups in many societies.

Alluding to the concept of yin and yang, he said Singapore needs to do more to “tilt the balance towards the yin side” — the element of care and concern for others.

This means greater help for the low-income groups as well as keeping society more open, so that the people who have talent can move up and will not be daunted by the gaps in incomes between the rich and poor, which is what Singapore has been doing, he added.

In reply to a question, Mr Lee acknowledged that while the income gap in Singapore is wider than most other countries, it was not as wide when compared to other cities.

But rather than bringing those in the higher income bracket down, he said it is important to focus on levelling-up the wider population.

He also said Singaporeans have to stay connected to the rest of the world, particularly the Asian region as it offers many opportunities.

Describing Singaporeans as hardworking and talented, he said: “I think the best way to make use of their talents and their abilities is not just to confine (them) within Singapore, but to connect to what’s happening around us.

“So if a company sets up an operation in Singapore, it’s not just for our market, but for the region.

“And if our people have abilities as managers and leaders, they can be managers and leaders not just in Singapore, but they can go out and there are many operations, many companies all over the region which will find a good Asian executive a very considerable asset.”

Prime Minister Lee believes as society changes, so too will Singapore’s political structure, as he cited how it has evolved over the years.

He said: “I think as we go forward, we will probably have to make further adjustments, surely, because our society will change.

“I believe that there will be a greater degree of competition, there will be a greater desire of Singaporeans to participate in the political process. And we ought to accommodate that, because it’s good that Singaporeans care about the affairs of the country and which way Singapore is going.

“But whatever we change, we still want a system where you encourage good people to come forward — you encourage voters to elect people who will represent their interests well, and you encourage the government to act in a way which will take the long-term interests of the country at heart.

“And that’s not easy to do.”

**A constructive suggestion: “Will eldercare be as common as childcare?” (BBC Online)

***OK it hasn’t been raining.

PAP listening to SDP?

Err didn’t the govt rubbish the SDP’s idea of lowering the cost of HDB flats by making it a condition of getting cheaper flats that they be resold to HDB?

And didn’t Khaw just say that this idea will be studied? But didn’t credit the SDP for suggesting it?

As an oldie using SingHealth, here’s hoping the SDP’s healthcare ideas be adopted* and that Paul A** gets co-opted to become Health minister.

——

*Never mind if it bankrupts S’pore as healthcare costs in the US and UK are bankrupting these nations, I’ll be dead.

**He was a possible SDP candidate for Punggol-East. Gd that he didn’t stand because he couldn’t claim to be born poor: even s/o JBJ claimed that although born in a pram made of gold, silver and ivory, he became poor when his dad took on the PAP. He dared make this claim even though he went to very expensive ang moh schools. JBJ became so poor that he could send his son to expensive schools? Come on, man who doesn’t know the Pledge, pull the other leg, it’s got bells on it.

 

Typical S’porean way

In a 2010 paper in the journal Tobacco Control, a group of Singapore-based cancer specialists proposed phasing-out tobacco by denying access to tobacco for anyone born from the year 2000 onwards. The researchers said their idea introduced the concept of tobacco-free generations that would “never legally be able to take up the harmful habit of smoking, at any age”

So very S’porean.

I came across the above when I read Should you need a licence to smoke?  This is something experts in the West are now thinking of recommending.

S’pore’s juz the place to introduce it, less draconian than banning youngsters from smoking.  We got licences to own cars (COEs) , licences to drive into the city (ERP charges),  licences to buy “subsidised” public housing (got to have marriage licences first), and local media journalists need licence to think (juz kidding).

And the govt could introduce the mandatory death penalty for smoking without licences. Shan could justify it on the grounds that smokers are all going to die one day, anyway.

Bearish news for First Reit?

Background info

Lippo Karawacial is First Reit’s financial sponsor: “On 11 December 2006, Lippo Karawaci became the first company in South East Asia to list a Healthcare REIT on the Singapore Stock Exchange with Indonesian assets. Assets in the First REIT includes the Siloam Hospitals Lippo Village, Siloam Hospitals Kebon Jeruk, Siloam Hospitals Surabaya, Siloam Hospital Cikarang, Mochtar Riady Comperhensive Center and The Aryaduta Hotel and Country Club Karawaci, and four Singapore based properties.”

https://atans1.wordpress.com/2012/07/20/first-reit-nav-revision-bonus/

Now the bearish news

One of the sources told Reuters that first-round bids were below expectations, but the sale process will continue to give the buyers an opportunity to bid higher. It wasn’t clear how much the bidders had offered for the stake in the first round.

 Blackstone, Bain Capital, KKR & Co and Dubai’s Abraaj Capital have been shortlisted for the second phase of an auction of a fifth of private Indonesian healthcare operator Siloam in a deal that could fetch as much as $300 million, sources said.

Seller PT Lippo Karawaci is seeking a valuation of more than 20 times Siloam’s forward core earnings for the stake, they said, declining to be named as the discussions were private. Siloam is the country’s biggest private hospital firm.

“Lippo may be back in the market next year if the valuation disparity is too big,” said one of the sources.

…

Lippo plans to sell a minimum 20 percent of unit Siloam Hospitals for between $200 million and $300 million, but could increase the stake to 49 percent if the price is right. It hired Bank of America Merrill Lynch to run the auction, sources have told Reuters earlier.

http://www.nytimes.com/reuters/2012/08/27/business/27reuters-lippo-privateequity.html?_r=1&src=busln&nl=business&emc=edit_dlbkam_20120827

So there may be no revision of First Reit’s NAV https://atans1.wordpress.com/2012/07/20/first-reit-nav-revision-bonus/

Might even be revised downwards. But Global buyout firms are keen on Indonesia’s consumer and healthcare sectors despite steep valuations, as they are betting on the country’s fast-growing economy.

Indonesia has one of the world’s lowest healthcare spending-to-GDP ratios, but its rising middle class – which represents more than half of its population of 240 million – is expected to sharply increase its medical spending and drive growth in the sector over the coming years.

“The healthcare sector still continues to remain the darling of private equity. Even with rich valuations it is easy to find bidders for this sector,” said Krishna Ramachandra, head of corporate finance and investment funds at law firm Duane Morris & Selvam LLP.

But a growing number of investment banks are advising clients that south-east Asian rivals such as Malaysia and Thailand now look more enticing than Indonesia. Morgan Stanley and Credit Suisse say the Indon economy is overheating. Barclays is relaxed abt the “problems”.

First Reit: NAV revision bonus?

Indonesia’s PT Lippo Karawaci may sell as much as 49 percent of its unit Siloam Hospitals in a deal that would value the firm at more than $1 billion, drawing a slew of private equity firms to the sale as they bet on growth in healthcare spending in Southeast Asia’s biggest economy, sources said. Reuters

There is plenty of US private equity market sloshing around the region as article explains. And the IHH IPO and the coming one by Fortis (Religare Heath Trust) will ensure that the animal spirits of these investors remain bullish.

The Indon co is First Reit’s financial sponsor: “On 11 December 2006, Lippo Karawaci became the first company in South East Asia to list a Healthcare REIT on the Singapore Stock Exchange with Indonesian assets. Assets in the First REIT includes the Siloam Hospitals Lippo Village, Siloam Hospitals Kebon Jeruk, Siloam Hospitals Surabaya, Siloam Hospital Cikarang, Mochtar Riady Comperhensive Center and The Aryaduta Hotel and Country Club Karawaci, and four Singapore based properties.”

Kinda painful for me as I didn’t buy this Reit. Really dumb as I kept waiting price to correct. I aim to buy a Reit that is trading at a big discount to published NAV. The discount was smallish and now has disappeared. Big premium in fact.

See healthcare productivity from patient’s perspective

So the SDP says healthcare should be a “right not a commodity” while the WP’s Chairman (and a MP) points out, “Singapore’s total expenditure on healthcare as a % of GDP was far lower than international standards. More importantly, the government or public expenditure on healthcare is also far lower than elsewhere. Singapore’s government expenditure on healthcare is about 1.6% of GDP; nearly 4 times lower than the 6.1% global average in 2009”.

Here’s an interesting perspective from Jeremy Lim, a private sector healthcare manager, that appeared in BT sometime ago. The headlines sums up what I as a 50-something “new poor” but financially responsible voter want from a public healthcare system: not money being thrown at the system but

See healthcare productivity from patient’s perspective

Does their health improve in the shortest possible time at the lowest possible charges?

BUDGET 2012 reaffirms the government’s commitment to raising productivity and signals in no uncertain terms the stance that some short-term pain faced by companies is necessary for the longer-term good. However, even as we re-examine processes and traditional practices, it is timely also, especially in very tightly regulated sectors such as healthcare, to explore whether our rules and regulations encourage and reward productivity efforts.

In some instances, in the name of safety, do we actually stifle productivity and ‘kill’ innovation?

Funding is another key driver of behaviour – does the way we reimburse healthcare paradoxically reinforce inefficiency?

Healthcare trade-off

Healthcare is often characterised as ‘finite resources, infinite demand’. There is never enough to satisfy everyone and difficult choices balancing cost and effectiveness have to be made.

This necessitates that at the system level, clinical quality and patient safety are relative concepts.

Imagine a graph plotting ‘Cost’ on one axis and ‘Effectiveness’ on the other. The resulting 2 x 2 matrix conveniently categorises all healthcare interventions into one of four possibilities: ‘Less Expensive and More Effective’, ‘More Expensive and Less Effective’, ‘More Expensive and More Effective’, and ‘Less Expensive and Less Effective’.

The first two are easily dealt with: Do the first; it is a no-brainer, don’t do the second; another no-brainer.

If ‘More Expensive and More Effective’, then the pivotal question is ‘Is it worth the extra costs?’

For the ‘Less Expensive and Less Effective’ category, which we will focus on, the key question to ask is ‘Is it good enough?’

Over-specified standards

Singaporean readers old enough will remember the dental hygienists of yesteryear scaling and polishing teeth, especially of children. These hygienists were, compared to dentists, less well educated ‘technical staff’ and trained specifically in scaling and polishing, leaving diagnostics and more complicated dental procedures to properly qualified dentists.

As Singapore advanced up the economic ladder, the dental hygienist faded away and dentists dominated the landscape.

In recent years, the hygienist has made a comeback. With increasing recognition of the desperate shortage of dentists, dental hygienists are now resurgent. Of course a dentist should be more skilful in polishing and scaling teeth, but is a hygienist good enough?

Think about the MinuteClinic in the United States. Starting with a modest single clinic in 2000, the chain now has 600 locations across the US proudly proclaiming: ‘Our practitioners have seen more than 11 million patient visits, with a 95 per cent customer satisfaction rating’.

These practitioners are supported by sophisticated computer algorithms, treating only specific symptoms and conditions, and are priced much lower than traditional practices. Oh, retail clinics are run by nurses and physician assistants. Is that good enough?

Prescribed nurse-to-bed ratios are entrenched in healthcare regulations in many countries and a cheap and easy regulatory instrument. However, these may be an over-specification and penalise innovative organisations which embrace technologies to increase an individual nurse’s efficiency. Tele-health initiatives may permit offsite and even out-of-country monitoring, thus enabling fewer nurses to care for more patients.

But hospitals have little incentive to invest or even think about such possibilities if the ratios are rigid and allow for no cost savings from reduced manpower.

Dollars and sense

Years ago, some patients would be admitted to hospital overnight for an MRI. These otherwise well patients occupied a bed for one night so as to be eligible to use Medisave dollars to pay for the MRI! Today, while such blatant examples of ‘abuse’ are less common, Medisave, by design, is still biased towards hospitalisation payments. Choosing between a day surgery and an inpatient option for a minor surgery, say, a laparoscopic gall bladder removal, the sharp patient would note that Medisave claims for hospitalisation go up to $450 a day but only $300 for day surgery coverage.

Between two nights in a hospital with room rate claims of $900 and an outpatient procedure followed by hiring a day nurse for post-operative home care for which only a total of $300 is claimable, which would patients choose?

Are we inadvertently fostering prolonged admissions at a time when Singapore is furiously playing catch-up to the tune of 1,900 hospital beds?

Patients today resist moving from subsidised wards in public hospitals to community hospitals as the subsidy schemes are more generous in the public hospitals. Furthermore, half the patients would not qualify for government subsidies.

Finance Minister Tharman Shanmugaratnam announced in this year’s Budget that ‘all patients in community hospitals will now qualify for government subsidies . . . The middle-income group will receive the largest increase in subsidy rates, getting a subsidy of 20 to 50 per cent when they previously did not receive any’.

This is a step in the right direction to ensure a coherent financial gradient and, hopefully, will result in better use of very scarce hospital beds.

Productivity in healthcare needs to be reframed as value creation from the perspective of the patient and not simplistically as output for a given input, which is a common technical definition.

The hospital which has its doctors seeing a hundred patients a day may not be better than the hospital whose doctors treat on its premises only 30 patients a day. What matters to patients is whether their health improves in the shortest possible time with the least possible inconvenience at the lowest possible charges.

This engagement with the healthcare system may be in an institution, like a hospital, or in the home setting, offered by a doctor with over a decade of intense specialisation or a technician with two years of vocational training – it doesn’t matter.

What matters is the outcome and it is not simply a matter of productivity.

Governments have a role to play not just in doling out incentives to spur productivity and innovation, but in fostering an eco-system where smart regulations drive genuine value creation, and reversing payment perversions that result in inefficiency and wastage.

The writer is CEO, Fortis Healthcare Singapore

DBS: HR costs of private healthcare sector to rise substantially

Last week DBS Securities came out to say that costs in the private healthcare sector will go up as a result of the government’s plans to spend more on the public healthcare system. What FTs and foreign medical tourists have to pay more to get treated here? Can’t be right can it? This is not PAP policy which is FTs and foreigners first. Juz kidding.

Seriously this increased spending has implications for Parkway’s pending IPO. And for Raffles (see DBS report below) and the micro healthcare counters listed on SGX.

DBS VICKERS SECURITIES, March 7

The Singapore health minister unveiled a healthcare roadmap in Parliament yesterday, focusing on three goals: 1) Singaporeans to receive health care when needed; 2) healthcare services will be of good quality and effective; and 3) such services will be affordable to Singaporeans.

To achieve the above objectives, the government will be increasing hospital beds and manpower. These are: a) addition of 3,700 hospital beds by 2020; b) addition of 20,000 healthcare workers (+50 per cent) by 2020 and; c) lease capacity from private healthcare operators, namely Parkway East Hospital and Raffles Hospital, to treat subsidised patients, to ease the tight capacity in the short term.

Raising healthcare workers remuneration by 20 per cent. A new salary framework will be introduced to retain manpower in the public sector. On average, healthcare workers’ total compensation will increase by about 20 per cent by 2014*, with the first adjustments by April 2012. The measures to lease beds/capacity from private hospital operators will be positive in terms of operational utilisation, and could create some initial euphoria in share prices of private healthcare operators.

However, the financial metrics of how this will be done are still being ironed out. For example, patient charges, level of subsidies to be provided by the government, and the level of take-up rates (if based on patients’ preference), etc.

Furthermore, we believe there is a limit to the number of beds each operator is able to lease to the public sector given that this could compromise its service level if the public partnership saps too much resources.

Fight for manpower issues a longer term challenge: With the increase in public sector remuneration, the bar by private operators to attract healthcare workers is likely to be raised. This comes at a time when capacity is increasing in the private sector. These are Parkway’s Mt Elizabeth Novena Hospital, Singapore Health Partners’ Connexion One (at Farrer Park), Adam Road Hospital by Fortis Healthcare, and Raffles Medical Specialist Medical Centre at Bideford Road and 30 per cent increase in GFA at its hospital.

Essentially, both public and private healthcare sector will need additional manpower resources. Staff cost accounts for about 49 per cent of revenue at Raffles Medical.

Maintain hold on Raffles Medical. Despite some near-term boost from the public partnership to lease beds, the details are yet to be finalised and the financial impact is uncertain. Over the medium term, the challenge lies in managing costs, namely manpower.

As Raffles Medical is trading at about 22.2 times FY12F price-to- earnings (P/E), above its mean of 21 times and 60 per cent premium to the overall market, we believe the valuations have already factored in the positive outlook. Our target price stays at $2.48, based on 24 times FY12F P/E, a +0.5 standard deviation above mean.

*Bet you SingHealth charges will go up. PAP caught in vicious circle. Improve healthcare but have to charge more, and lose votes; or don’t recover costs and make a profit and become like West.

Healthcare: Who is subsidising whom?

So, we the people, are going to get more help from the government; and in particular the Health Ministry will do more to help those suffering from chronic illnesses. My friend who suffers from a chronic illness will be hoping the government walks the talk.

He tells me that the cost of buying “unsubsidised” medicine in Johor Bahru is more or less the same as the same “subsidised” medicine bought from SingHealth via a polyclinic. As the price of the medicine bought from SingHealth is roughly half that charged by a private clinic here, he thinks that is why the govmin claims it is “subsidising” the medicine bought from SingHealth.

He thinks maybe the government’s medicine procurement policies are inefficient. How come a profit-making M’sian pharmist chain can match SingHealth’s prices? Or maybe that the government is paying the drug makers more so that they will make pills here and invest in R&D facilities here.

In other words, are polyclinic patients subsidising rich MNCs so that the government can boast of its success in attracting drug companies to set up pill-making plants and R&D facilities here? Their presence here, incidentally, boosts GDP growth and, indirectly, the bonuses of ministers and senior civil servants.

S’poreans have long asked where’s the subsidy in public housing? The government ties itself in knots, trying to explain where is the subsidy. So much so that many S’poreans don’t believe that there is such a subsidy.

So here’s another “subsidy” that should be queried by the public.

On a wider point, ordinary S’poreans should join the Opposition and activists in querying how the government defines any “subsidy”. We are unlikely to get straight answers, but the questioning ensures that they know that we are not daft.