LETTER TO THE EDITOR
Time to temper focus on monetary rewards
I REFER to the report, 'Govt must close pay gap to retain talent: PM Lee - Pay for staff Grade 1 has slipped to 55% of benchmark' (BT, March 23).
While it is important to retain talent, we may need to temper the focus on monetary rewards. Otherwise, we may inadvertently be setting an unhealthy example for Singaporeans in general and sending an undesirable message to our children - that money is everything.
In this connection, Singapore has been ranked 130th out of 178 countries for happiness, 40th out of 41 countries for libido, 30th out of 35 countries for courtesy, fifth in the world for prisoners per capita and 105th in the world for income equality.
Has our over-emphasis on monetary rewards led to us being unhappy because we spend too much time and effort chasing more and more things and money - at a cost of having little time or energy to have sex, an uncaring attitude towards others and an inclination to commit illegal acts to get rich quick, resulting in many offenders?
Recent remarks by the Dean of the Lee Kuan Yew School of Public Policy - that 'Singapore should stop trying so hard to be world class, simply because it already is' - may be instructive. We may need to pay more attention to trying to improve those 'soft' areas in which we are far from world class - like happiness, libido and courtesy.
Singapore seems to be particularly good in the economic arena, but Third World in the non-economic arena.
Perpetuating the strategy of paying more and more to keep civil servants may be self-defeating. As a small country, we will find it increasingly difficult to compete with bigger, more developed countries that can offer higher pay, perks - and a better lifestyle to boot.
Perhaps we should shift some of the emphasis to the honour and duty of public service, contribution to our country and the pride and joy such service brings - which no amount of money can buy.
Our founding ministers, like our Minister Mentor, worked tirelessly for very little pay to take Singapore from Third World to First World status.
If the most senior civil servants who are now earning $1.21 million a year need to be paid $2.2 million to want to stay, I think there may be something wrong with the values we are teaching in our schools, our homes and our society at large.
Furthermore, benchmarking pay to the top echelons of private sector professions may not be appropriate, because civil servants do not have to face market competition, technological obsolescence, shareholders, investors, etc.
Finally, as long as our parents tell their children to aspire to be scholars and civil servants, entrepreneurship may never flourish in Singapore, no matter how hard we try to promote it.
Leong Sze Hian
Singapore
Copyright © 2005 Singapore Press Holdings Ltd. All rights reserved.
This story was printed from TODAYonline
Alliances may be safer bets
So, why do GLCs choose to acquire foreign assets?
Thursday • March 8, 2007
Letter from Leong Sze Hian
I refer to the articles, "iTV to be operated by Thai govt firm" (March 3) and "Temasek's Thai woes deepen" (Feb 28).
Nominated Member of Parliament Eunice Olsen raised a question in Parliament on the role of Temasek Holdings and asked if it could be more forthcoming in explaining its investment decisions and sharing its assessment.
As I read in the media about the unfolding saga of problems that our Government-Linked Companies (GLCs) are having with large-scale acquisitions in Thailand, Indonesia, Australia, and with countries such as Hong Kong and China in the past, I am compelled to ask searching questions, with the view that we must learn from the past in order to move forward into the future.
According to Professors Jeffrey H Dyer of Brigham Young University, Prashant Kale of the University of Michigan and Habir Singh of the Wharton School University of Pennsylvania, in Harvard Business Review (July-August 2004): "Alliances and acquisitions are alternative strategies — that is, the decision to do one usually implies not doing the other. If companies actually factored that into their decisions, they would make better deals."
This begs the question of what were the internal decision-making processes that our GLCs went through in deciding on acquisitions, instead of alliances, in the various countries concerned?
"Most acquisitions ... fail. A few may succeed, but acquisitions, on average, either destroy or don't add shareholder value," the professors wrote.
Our experience in Thailand is a case in point. "Acquisition deals are competitive and risky … Companies should consider exogenous factors like market uncertainty", and culture. Will it gain or lose the widespread acceptance of consumers, particularly in acquiring a major national asset of a foreign country?
According to Rita Gunther McGrath and Ian C MacMillan in Harvard Business Review (July-August 1995): "Business lore is full of stories about smart companies that incur huge losses when they enter unknown territory … new markets … By definition, new ventures call for a company to envision what is unknown, uncertain, and not yet obvious to the competition."
What management decision-making processes or other tools such as scenario planning, reverse income statement, pro forma operations specs, assumptions checklist, milestone planning, and so on, did the GLCs use?
Was "a keeper of the assumptions — someone whose formal task is to ensure that assumptions are checked and updated as each milestone is reached and that the revised assumptions are incorporated into successive iterations" designated?
How skilled are the GLCs in peripheral vision? Otherwise, we may end up being precisely wrong, rather than being about right.
A crucial question we may need to ask is whether the GLCs' present organisational capacity for strategic vision is more or less than their future needs? What risk-management techniques were used to weigh known, unknown and unknowable risks?
I write my comments and questions with the caveat that I know very little about the inner workings of the GLCs, because some, as private exempt companies, may not have much of their internal processes available as public information.
Copyright MediaCorp Press Ltd. All rights reserved.
Business Times - 02 Mar 2007
LETTER TO THE EDITOR
Fix income loss anomaly for lower-income self-employed
WHILE the Budget has generally given more cash and more CPF to lower-income people by way of lower CPF contributions by employees and the Workfare Income Supplement (WIS), on a relative basis, some self-employed lower-income people may actually end up with even less cash every month.
About a third of the self-employed do not contribute the Medisave they are supposed to. For example, a self-employed person above the age of 45, earning $1,000 a month, will have their current Medisave contribution of $80 reduced to $28, with the government topping up Medisave by $67. However, in view of the 1 to 2.5 ratio for WIS and two-thirds of WIS for self-employed people compared with employees, take-home pay after Medisave contribution is reduced by $28 for this group who cannot afford to contribute to Medisave.
In the 2004 Budget, only 47 per cent of self-employed CPF members paid their full Medisave contributions, 36 per cent made partial payments and 17 per cent did not contribute at all. What are the numbers now?
A 2.8 per cent reduction in disposable cash per month may appear to be little in absolute dollar terms. But to put things in perspective, consider the findings of the Department of Statistics' 'Key Household Income Trends, 2006'.
It shows that the first to 10th decile by income among employed households had the lowest number of working people at 1.28, supporting the highest average number of people in households of 3.92 people. This shows to some extent that the Budget discriminates against some lower-income Singaporeans relative to lower-income employees, because there is no cash component and the CPF component is only two-thirds of the WIS for employees.
I would, therefore, like to suggest that this anomaly be reviewed.
After all, how can we promote entrepreneurship when we give less benefits to the self-employed, compared to employees?
Leong Sze Hian
Singapore
>> Back to the article
Feb 23, 2007
More residents working for an income that has not changed for 10 years
I refer to the article, 'Singapore gearing up for 6.5m population' (ST, Feb 10).
National University Sociologist Associate Professor Pauline Straughn said that Singapore needs to assure its people that growing the population will not result in more competition for jobs, housing and places in school so that tension does not arise in the community.
The Manpower Ministry (MOM) said last year's figure for jobs creation was the largest number recorded and the highest ever at 88,200 for locals. In percentage terms, the percentage of jobs created to locals appears to be the lowest ever, having declined from 90 per cent for the period 1997-2002 to 70 per cent, 56 per cent in 2004 and 2005, and now 51 per cent last year.
According to the MOM Report on Labour Force in Singapore 2006, which covers the period 1991-2006, the number of unemployed for residents (Singaporeans and PRs) was 28,000 in 1991 and 69,600 last year. Against an increasing population, a more significant statistic is the Unemployment Rate (Non-Seasonally Adjusted) for residents, which increased from 2 to 3.6 per cent, from 1991 to 2006.
While the resident labour force increased by 27 per cent for the 15-year period from 1.373 million to 1.737 million, unemployed residents increased by 149 per cent from 28,000 to 69,600. This means that the resident labour force increased by 1.6 per cent per annum, while unemployed residents increased by 6.3 per cent per annum.
'Although the median gross monthly income of full-time employed residents has grown 2.9 per cent a year in the past decade to $2,040 as of June 2006', the number of part-timers has more than doubled over the decade from 51,400 to 112,300, expanding their share of employment from 3.5 per cent to 6.3 per cent.
The median monthly income for all employed residents (full-time and part-time) stagnated at $2,000 for the years 2001 to 2004.
This means that income grew by only $40 from 2001 to 2006, or 0.4 per cent per annum. Income growth may have been negative, after adjusting for inflation for the last five years.
The median monthly income for part-timers is still the same at $500 compared to 10 years ago.
In view of the 118 per cent increase in part-timers for the last decade, more residents are working for an income of $500 that has not changed for 10 years.
Leong Sze Hian
--------------------------------------------------------------------------------
Copyright © 2007 Singapore Press Holdings. All rights reserved. Privacy Statement & Condition of Access
Copyright © 2005 Singapore Press Holdings Ltd. All rights reserved.
Paper: Straits Times, The (Singapore)
Title: Have private patients seen at private hospitals
Author: Leong Sze Hian
Date: June 21, 2005
I REFER to the Ministry of Health (MOH)'s reply, 'Patients' needs based
on objective clinical appraisal' (ST, June 8), to my letter, 'Treat
patients based on needs, not ability to pay' (ST, June 3).
It states that 'the waiting time for clinic appointments is generally
shorter for private patients ... but there is no reason not to
accommodate the wishes of those patients who demand and want to pay more'.
This means that for every patient who is willing to pay the
non-subsidised fee, patients who cannot afford to pay the full fee are falling
further behind in the queue, and end up waiting even longer.
The wage gap means that there may be more people who are able and
willing to pay full, non-subsidised fees, and also more people who cannot
afford other than subsidised fees. This can only lead to a further
widening of the 'health-care waiting times' gap.
Those who can afford to pay the full rate should be directed to private
hospitals, instead of displacing needy patients from the queue.
In a way, this policy also enables public hospitals to compete unfairly
against private ones because some may go for subsidised fees, and are
less likely to switch to private hospitals when they realise that they
have to pay the full rate if they do not wish to wait.
In the letter, 'Public services are meant to serve people' (ST, June
8), Ms Catherine Lim Suat Hong said that using scarce resources as the
thrust of MOH's reply to a Forum letter does not help people who live
with this problem day to day, and that institutions in the health service
need to remember they serve the people - and if a policy is designed to
help needy patients, they should not let challenges they face in
implementing policy blind them from their goal.
As needy patients currently have to wait for up to nine months for
dental procedures, how much longer do they have to endure before policies
that perpetuate the 'health-care waiting times' gap are changed?
It is hard enough for some Singaporeans to be falling relatively
further behind on the economic ladder, so should they face discriminatory
policies like 'there is no reason not to accommodate the wishes of those
patients who demand and want to pay more'?
Prioritising the use of limited resources in health care according to
one's ability to pay, albeit only for non-emergency treatment, is
discriminatory.
I understand that in Britain, its National Health Service cannot
discriminate on this basis.
The disillusion and despair of those in the lower-income group may grow
because of health-care policies that saw the closing of all polyclinics
at night ('Resources finite, hence closure of night clinics'; ST, April
30), the stopping of doctors from advertising that they charge
polyclinic rates ('Why stop doctors from charging polyclinic rate?'; ST, April
5), declining spending on health care over the years ('Individuals
paying more for top-grade health care?'; ST, March 19), and increases in
premiums and deductibles, despite MediShield accumulating over $500
million of surplus ('MediShield's financial status must be protected'; ST,
Feb 16).
Author: Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Business Times, The (Singapore)
Title: Poor rewarded to have fewer children?
Author: Leong Sze Hian, Singapore
Date: June 15, 2005
THE Home Ownership Plus Education (HOPE) scheme provides assistance to
Singaporean households in which the wives are not over age 35, with no
more than two children, earn monthly household income of $1,500 or
lower, and where both husband and wife must have at most two GCE 'O' level
passes.
I understand that one form of the financial assistance offered is
monetary incentives for couples who undergo ligation.
This is contradictory to the national policy to encourage procreation.
Various incentives like the Procreation Tax Rebate encourage families
to have more children.
Why are the rich being given financial incentives to have more babies,
whereas the poor (under the HOPE scheme) are given monetary rewards to
have less children? In so doing, are we not procreating a 'class'
society?
I believe ligation is an irreversible procedure which means that one
can never conceive again.
I would like to ask how many people have taken up this 'ligation'
assistance under the HOPE scheme.
Perhaps a better way to help those who are now economically disadvan
taged, is to foster their understanding of the trade-off between money
and women's God-given right to bear offspring.
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Business Times, The (Singapore)
Title: More statistics on ambulance calls, please
Author: Leong Sze Hian, Singapore
Date: June 8, 2005
I REFER to media reports that the SCDF is considering charging for its
ambulance service. It will relook the 'no fee' charge for emergencies
as demand burgeons.
'Emergency calls have soared to nearly 74,000 last year, more than
double the 36,000 made in 1997. But it also received more non-emergency
calls. There were 6,233 last year, compared with 5,841 in 2003.'
Statistically, the reason given to charge $120 for each non-emergency
call is only valid if the percentage of non-emergency to total calls has
been increasing from 1997 to now.
Since we are only given the data that non-emergency calls have
increased by about 7 per cent over the previous year, it is not possible to
determine whether the ratio of non-emergency to total calls has increased,
unless we know what the previous year's total number of calls was.
Similarly, although we are told that the total number of calls has
increased by about 106 per cent from 1997 to now, one cannot conclude that
the ratio has been increasing over the last seven years, in the absence
of statistics for yearly non-emergency to total calls.
Therefore, I would like to ask what this statistic is on a year-to-year
basis, with an adjustment for the yearly increase in population and
more elderly people. Has the number of ambulances increased in proportion
to the increase in population and foreign visitors over the last seven
years?
Are 30 ambulances for a population of 4 million enough, as it
translates to one ambulance per 133,333 persons?
How does this figure compare with other countries?
For example, in the United States, according to the American Ambulance
Association, there are 23,575 ground ambulance vehicles for the US
population of about 296 million. This is one ambulance for every 12,556
persons, which is about 10 times more than Singapore's SCDF on a per
capita basis.
A percentage of non-emergency calls is inevitable given that the lay
person may not be sure in an emergency whether it is a genuine emergency
as defined by the SCDF. I would like to suggest that the SCDF continue
to educate the public on what the typical non-emergency cases they
receive are, and to warn first-time non-emergency callers, instead of
imposing a $120 levy.
My fear is that while those who can afford will call in any case
because it is natural to not take chances and err on the side of caution,
those who are poor may be deterred from calling even in real emergency
cases. This may result in an unnecessary loss of life or aggravated injury
due to the delay.
If the half dozen or so private ambulance services are charging
'between $40 and $95 for transport to A&E departments during office hours,
and from $50 to $125 at night', the $120 charge is 200 to 26 per cent
more and 140 more to 4 per cent less, respectively, for day and night
charges compared with the private services that presumably are operating
profitably.
With 6,233 non-emergency calls, the additional annual revenue to the
SCDF would be about three quarter million dollars.
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Straits Times, The (Singapore))
Title: Patients' needs based on objective clinical appraisal
Author: Bey Mui Leng (Ms) Assistant Director, Corporate
Communicationsfor Permanent Secretary, Ministry of Health
Date: June 8, 2005
WE AGREE with Mr Leong Sze Hian that public hospitals should 'treat
patients based on needs, not ability to pay' (ST, June 3). This is indeed
our approach.
A patient's needs are based on objective clinical assessment, not a
layman's individual preference.
Hence, in the emergency department, all patients requiring urgent
medical treatment are attended to immediately, regardless of their paying
status. Others will have to wait their turn.
In non-emergencies, the waiting time for clinic appointments is
generally shorter for private patients. But treatment for subsidised patients
is not compromised as these are non-acute conditions.
Even where needs are indicated, treatment options are not identical.
There is a wide range of drugs, implants and devices, from generic to
branded products.
We ensure that all patients receive an adequate level of care. But
there is no reason not to accommodate the wishes of those patients who
demand and want to pay more for branded drugs or devices.
Author: Bey Mui Leng (Ms) Assistant Director, Corporate
Communicationsfor Permanent Secretary, Ministry of Health
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Straits Times, The (Singapore)
Title: Treat patients based on needs, not ability to pay
Date: June 3, 2005
I REFER to the article, 'Going paperless slashes waiting time at skin
centre' (ST, May 30).
It was reported that keeping medical records electronically saved the
National Skin Centre $237,000 in labour costs at the end of the year,
and cut patients' waiting time.
I also refer to media reports that said two hospitals here retrenched
108 workers, presumably to cut costs.
When you go to a hospital to seek treatment for a dental problem, you
may be told that as it is not something which warrants immediate
attention, you may have to wait for up to nine months if you pay subsidised
fees.
However, if you opt to pay the non-subsidised rate, you can be treated
immediately.
The same goes for eye operations.
As the question of whether an ailment is serious enough to require
treatment sooner rather than later is sometimes subjective, patients who do
not want to take a chance may opt to pay the full rate.
Those who cannot afford or do not wish to pay the full rate may risk a
deterioration in their condition.
As a matter of principle, should the priority of treatment not be based
on one's health condition, rather than ability to pay more?
Is this fair to the poor and less economically well-off?
What if the rest of the health-care system, such as specialists,
polyclinics and general practitioners, follows the example of the dental and
eye centres?
Hypothetically, if one's health condition worsens and irreversible
damage is done because of the delay in treatment, can the medical facility
and medical practitioner be held liable?
The Health Ministry should examine the ways in which hospitals manage
their financial objectives and resources.
Which is a bigger problem that should be given priority: cutting
waiting time by 30 minutes, or letting those who cannot pay wait for months?
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: Elections Dept unaware of case of fraud cited
Date: May 21, 2005
I REFER to Mr Leong Sze Hian's letter, 'Election fraud: Why wasn't
action taken?' (ST, May 19).
What the Home Affairs Minister said in the House was that 'he had heard
a story told by his colleague where in one election, one of the PAP
supporters turned up at the nomination centre and saw his name on the
opposition candidate's list of assentors'. He was told of this story only
recently.
The Elections Department is unaware of any occurrence of such fraud and
did not receive any such complaint in past elections. If the incident
had been reported to the Elections Department at the time when it was
said to have taken place, we would have investigated the matter then.
There is no way we can verify the facts now as the nomination papers
and all related documents have been destroyed, as required by law at the
end of six months after every election.
The recent amendment to the Parliamentary Elections Act requiring the
proposer, seconder and at least four assentors of every candidate or
group of candidates to be present at the nomination for verification of
their intent, will eliminate the possibility of such an election fraud
occurring in future.
Lee Seng LupHeadElections Department
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: Election fraud: Why wasn't action taken?
Author: Leong Sze Hian
Date: May 19, 2005
I REFER to the articles, 'Election process simplified' and '2 different
views from 3 MPs in opposition' (ST, May 17).
The Home Affairs Minister said that the main concern of the amendment
was to prevent fraud.
He told the House that a People's Action Party supporter had found his
name on an opposition candidate's paper - and his signature forged on
it - during one election, even though he had not given approval.
I am somewhat puzzled by this revelation, and would like to ask whether
there was an investigation into this instance of election fraud.
Why is it that the perpetrators of this election fraud were not charged
or taken to task?
As I understand that there has been no instance of election fraud in
Singapore for the last 40 years, is it not pertinent for this incident to
be disclosed earlier? Why are Singaporeans told only now?
As the fraud was allegedly committed by the opposition on a
ruling-party supporter, the opposition members may be wondering why they were let
off.
Why was the obvious not done, which is to gain political mileage in the
election by exposing the opposition party concerned?
Author: Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: PM and Cabinet decide who gets state funeral
Date: May 14, 2005
SINGAPOREANS who have made 'truly exceptional contributions' will
receive a state funeral.
But it is not feasible to have a set formula on who gets one, based on
a person's previous rank or appointment, Prime Minister Lee Hsien
Loong's press secretary said yesterday.
'The decision to hold one is made by the Prime Minister and the
Cabinet,' Mr Chen Hwai Liang said in his letter to the Today newspaper and
Chinese-language daily Lianhe Zaobao.
'If they decide to offer a state funeral, they will of course consult
the family members and take into account their wishes.'
The letter, released yesterday, came in the wake of views expressed in
both papers on the different funeral arrangements for former presidents
Ong Teng Cheong and Wee Kim Wee.
Mr Ong received a state-assisted funeral in 2002. Mr Wee, who died last
week, had a state funeral.
In a May 10 letter published in Today, reader Leong Sze Hian asked why,
citing Mr Ong's 27 years of public service. He also suggested that, in
future, all ex-presidents be given state funerals.
Writing in Lianhe Zaobao on May 12, former People's Action Party MP Goh
Choon Kang suggested that Singapore have definite rules on who would be
entitled to a state funeral.
Mr Goh is now head of news research at the Chinese newspapers division
of Singapore Press Holdings.
In his letter, Mr Chen said when Singaporeans who have made major
contributions to the country die, it is right and fitting that they be
honoured and mourned by the nation.
They may or may not be former presidents, he noted. 'The appropriate
way to do so will vary with each individual. It is not feasible to have a
set formula as to who should receive a state funeral, based simply on
the person's rank or the appointment that he or she had held.
'It depends on the person's services to the nation, as well as other
special circumstances.'
As a young country, Singapore's practices and customs for public
ceremonies and observances are still evolving, added Mr Chen. 'As the years
pass, we will gradually establish norms and traditions that will reflect
the Singapore way of honouring our best sons and daughters who have
passed away, that is dignified, restrained and expresses the gratitude and
sense of loss of the nation.'
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Straits Times, The (Singapore)
Title: No reason for SBS to raise fares
Date: May 14, 2005
THE article, 'SBS Transit reports net earnings of $13m' (ST, May 12),
states that pre-tax profit was 3 per cent higher at $16.3 million for
the first quarter ended March 31, compared to the corresponding quarter
last year.
Rail losses in the first three months were merely $1.6 million, 67.3
per cent lower than in the same period last year, and if things continue
to improve at the same rate, losses for the full year are expected to
be less than half that of last year.
At this rate, the rail business could start turning a profit next year.
Non-transport income rose by 8.8 per cent to $5.3 million, total assets
rose by 2 per cent to $542.1 million, while total liabilities shrank by
2.7 per cent to $245.7 million, and net asset value per share is 99
cents, up from 94 cents previously.
In view of the above statistics indicating rising overall profits,
declining rail operations losses, increasing non-transport income, higher
assets and lower liabilities, and an increase in net asset value, how
can SBS Transit apply for a fare increase from July 1?
By almost any financial measure, the fare-increase application should
not stand on the merits of its application based on financial data prior
to the release of its March 31 first-quarter results.
Why is it that the deadline for a fare-increase application is just
before the release of the first-quarter results?
I would suggest that future fare-increase deadlines be adjusted to
ensure that the most current financial results are reported, and also that
the Public Transport Council evaluate the current application using the
latest results.
SBS Transit should be asked to re-submit its application to incorporate
the latest results.
Putting aside the one-off effect of Sars in 2003, SBS Transit's net
profit rose 158 per cent last year.
SMRT's full-year net profit jumped 42 per cent to $127 million,
compared with $89.5 million a year ago.
In 2002, when SMRT raised fares, its profit increased 27 per cent. In
2003, its profit increased 24 per cent.
If the new formula and criteria were applied in 2002, would the quantum
of the last fare hike be justified?
As profits seem to keep rising every year since the last fare increase,
does it make you wonder whether the fare increase was justified in the
first place?
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: Night clinics closed, GPs not an option for poor
Date: April 23, 2005
I REFER to the articles, 'Polyclinics to close at night' and 'Many
upset with night polyclinics closing' (ST, April 21).
A spokesman for Sing- Health was quoted as saying the closure would
allow it to channel resources used in the night clinics into prevention
programmes, such as screening for diseases.
A spokesman for the National Healthcare Group (NHG) said patients who
want to see a doctor at night for immediate health care can turn to
general practitioners (GPs), who provide services 'very adequately'.
The reason given for the closures does not seem to make much sense,
because providing night consultation and prevention programmes are
entirely separate issues.
If we go along with this line of reasoning, we may next be told that
health-screening services would be reduced to allow the health cluster to
channel resources to health-education programmes.
GPs may provide services 'very adequately' but at what cost to the
lower-income, as the Singapore Medical Association (SMA)'s fee guidelines
for consultation start at $18, which is 125 per cent more than the $8
fee at polyclinics?
Twenty-two doctors that were willing to offer the same $8 fee as
polyclinics on a health services website no longer do so because the scheme
has been withdrawn due to the SMA's objection to how it was being
advertised on the Internet.
Where else can the lower-income go at night?
There are several clinics offering Traditional Chinese Medicine (TCM)
free. GPs may lose even more business as people might be driven to TCM
because of lower costs.
Are there any free Western clinics in Singapore, other than the one at
a Catholic church in Serangoon Gardens which operates on Wednesday
nights and Sunday afternoons?
Many Singaporeans may not be able to visit polyclinics in the day
because they are at work or will lose their earnings because they are
self-employed.
The other reason is that the day-time queues at polyclinics are already
very long. The closure at night may lead to even larger crowds and
increased workload in the day.
The lower-income may now be deterred from seeking immediate
consultation at night because they cannot afford the higher fees at GPs' clinics.
This may lead to medical complications because of the delay.
This may, on balance, offset any benefits that may be derived from
'channelling resources into prevention programmes'.
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Business Times, The (Singapore)
Title: Drug, testing mark-ups justified: SMA
Author: Dr Raymond Chua Swee Boon, Honorary secretary 46th SMA Council
Singapore Medical Association
Date: April 22, 2005
I REFER to Mr Leong Sze Hian's letter 'Give breakdown in medical bill'
(BT, April 13). Mr Leong quoted the article '12 Wishes of a GP for the
New Year' in the February 2005 issue of the Singapore Medical
Association's (SMA) newsletter to support his arguments. However, he had omitted
some salient points.
The SMA wishes to point out that the obviously satirical article was
written by a columnist, and opinions expressed do not represent the
official position of the Association unless so specified. This is clearly
stated on the cover page of every issue of the SMA News. Our newsletter
provides an avenue for medical professionals to express their opinions
and alternative stands on any issue. It is unfortunate that Mr Leong has
obviously overlooked these facts in his letter.
The SMA would like to reiterate that the main issue in the $8
consultation fee is not how much a doctor charges for consultation. The SMA is
also not against all publicity of healthcare services. Rather, it is the
mode of advertising that the website clinicsingapore.com was trying to
engineer among healthcare providers, which could be unethical and
infringe on the new Publicity Regulations of the Private Hospitals and
Medical Clinics Act released last year.
In a circular issued by the Ministry of Health (MOH) to explain the
rationale behind the regulations, it was stated that 'discounts' and
'coupons' are clearly disallowed for the promotion for healthcare services.
MOH was also quoted in the Lianhe Zaobao report of April 11 that the
ministry is consulting the Attorney-General's Chambers on this issue. As
such, it would be prudent to wait for the regulatory body's response.
The SMA believes that professional services to the public must be
offered in the spirit of professionalism, and in the healthcare sector,
professionalism demands some degree of decorum.
Mr Leong further claims that doctors may make excessive profits by
marking up the cost of medicines and investigations, and receiving a
typical referral fee. The Singapore Medical Council's (SMC) Ethical Code
strictly prohibits fee-sharing and obtaining commissions from referrals,
and the SMC has previously disciplined doctors for doing so. This is a
serious allegation and SMA would like to invite Mr Leong to inform us if
he has any concrete evidence of this happening. SMA will investigate
and take the necessary action. Alternatively, Mr Leong can inform SMC
directly.
The drug mark-up percentages that Mr Leong mentioned do not tell the
whole story. Cost of drugs does not include dispensing costs, which are
substantial. These include costs for re-packaging, storage and wastage,
as well as the dispensing time and service.
Medication mark-ups are generally recommended at about 20 to 25 per
cent of costs for patented original drugs. This applies to clinics and
pharmacies alike. The extreme percentages quoted by Mr Leong may only
apply to the very cheap and much older generics.
This principle is similar to that for tests. Significant resources such
as knowledge, time, disposable items and so on, are consumed on-site in
the clinic for tests performed at laboratories elsewhere. These include
organising of tests, making of appointments, simple procedures (for
example, blood sampling and PAP smear) and so on. A mark-up is thus
justified for the administration and service rendered.
GP clinics provide an accessible 'one-stop' station for the patient.
There is no need, for instance, to make separate trips to the clinic to
see the doctor, the pharmacy to obtain medications, and the laboratory
to give blood or urine for analysis. The patient also benefits from the
convenience provided by the GP service.
The SMA appreciates and supports Mr Leong's call for transparency in
medical bills. The SMA also believes that clinics will readily oblige in
providing a breakdown of fees when requested by their patients.
However, the move by the website clinicsingapore.com to get doctors to promote
their services by charging $8 consultation fees does nothing to promote
the transparency that Mr Leong advocated in his letter. In fact, it may
have the opposite effect.
Author: Dr Raymond Chua Swee Boon, Honorary secretary 46th SMA Council
Singapore Medical Association
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Business Times, The (Singapore)
Title: Give breakdown in medical bill
Author: Leong Sze Hian, Singapore
Date: April 13, 2005
I REFER to media reports about the issue of doctors charging the same
$8 fee as polyclinics.
The Singapore Medical Association (SMA) spokesman said that 'the issue
was not the lower fee, but the way it was publicised'. If the 22
clinics that are willing to charge the same $8 fee as polyclinics are not
allowed to list the information on a health services website, then how
would the public know about it?
In its February 2005 newsletter, the association states: 'The SMA has
guidelines for the pricing of drugs and consultation fees. However,
these guidelines have been vitiated by clowns out there who continually
quote $1 or $2 consultation fees to their corporate clients. Of course,
this act of deception is also well received by fools on the other side of
the fence who feel that $1 or $2 consultation is still possible unless
accompanied by overcharging in other areas, usually in the medicines
part of the bill. There is REALLY no free lunch, dude. Ipsa loquitur, if
the polyclinic charges $8 consultation with subsidies, how can any GP
practice quote less than $8?'
I understand that the mark-up for medicines may be up to 400 per cent
of the cost, up to 60 per cent for tests, and the typical referral fee
received by doctors for referring additional tests like X-rays,
laboratory tests, etc, is 25 per cent.
I would like to suggest that a breakdown be given in medical bills so
that the patient knows how much one is being charged for consultation
and medicine.
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Docs' ads allowed, so why not discount scheme?
Author: Danny Tseng
Date: April 13, 2005
I REFER to Mr Leong Sze Hian's letter, 'Why stop doctors from charging
polyclinic rate?' (ST, April 5), and Ms Arti Mulchand's article, 'Doc
discount scheme suspended' (ST, April 9).
According to the article, the Singapore Medical Association (SMA) was
concerned that the scheme might breach a soliciting clause in the
Private Hospitals and Medical Clinics (Publicity) Regulations.
SMA spokesman Tan Sze Wee was quoted as saying that the association
welcomed a quick ruling from the Singapore Medical Council (SMC) and
Ministry of Health, so that 'everyone has a level playing field'.
Doctors in Singapore, especially general practitioners, are already not
practising on a level playing field because of the existence of group
clinics, which offer special rates to corporations.
I understand that the SMC has relaxed its ruling on advertising by
doctors, and I have seen advertisements promoting their services in
newspapers and magazines such as Mind Your Body.
Why then the concern by SMA over the discount scheme, which offers
affordable medical services to the public?
If the scheme constitutes solicitation for more business, then should
the SMC stop group clinics from offering corporate discounts?
And for that matter, isn't the purpose of advertising to get more
business?
Why allow advertising and yet stop doctors from soliciting for more
business?
The use of a third party's website to promote doctors' services is just
one method of outsourcing the advertising service.
I am sure doctors are busy enough and do not have time to worry about
advertising and promoting their services to the public.
I think it is time for the SMA and SMC to focus on what should matter
most to them - that they regulate doctors for misconduct rather than
stop them from offering affordable medical care to the public.
Author: Danny Tseng
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Quality care by GPs? It comes at a price
Author: Dr Hia Kwee Yang
Date: April 7, 2005
I REFER to Mr Leong Sze Hian's letter, 'Why stop doctors from charging
polyclinic rate?' (ST, April 5).
I agree that doctors should be allowed to charge $8 or less for a
consultation, notwithstanding the Singapore Medical Association's
recommended rate of $18 to $55.
Much as I wish I can charge $1 or $2 for a consultation while
maintaining good professional service, circumstances dictate otherwise.
I am a general practitioner working in a rented HDB shop. My monthly
fixed overheads are about $10,000. I work a 5 1/2-day week, which
translates to about $400 a day in fixed expenses, or $50 an hour based on an
eight-hour day.
At $8 a consultation, I need to see 6.25 patients an hour (or 9.6
minutes a patient) to earn that $50 to pay for my fixed overheads. I may
make a little money from the drugs I dispense, but I do not depend on this
service as it rightly belongs to the pharmacist.
If I see eight patients an hour, this will translate to 7.5 minutes per
patient and $64 an hour. After deducting $50 an hour for fixed
expenses, I am left with just $14 an hour.
Remember the $1 chicken rice price war? You end up with smaller
portions and less ingredients, a product of much poorer quality.
Allowing the standard of care of GPs to fall because of 'market forces'
forcing down consultation fees to unsustainably low rates is not an
option, and it behoves the profession to intervene.
Good primary medical care is the most cost-effective way to deliver
health care. A drop in standards leads to disease complications resulting
in hospital admissions and unnecessary referrals to specialists, not to
mention the unnecessary suffering of patients.
This will increase costs tremendously and overwhelm the already
overstretched government hospital specialists. It makes sense, therefore, to
keep GP standards high, and this comes at a price.
The SMA fee guidelines are fair and equitable. There is no such thing
as good and cheap.
But government polyclinics are good and cheap, right? Good, yes. Cheap,
no. Will the Health Ministry kindly enlighten Mr Leong as to how much
it forks out to subsidise each polyclinic patient, and how much it costs
taxpayers a month in polyclinic subsidies?
If the Government cannot deliver good and cheap health services, how
can Mr Leong expect GPs to do so?
Well, we can, if the likes of Mr Leong are prepared to subsidise our
patients. Then I can charge $1 per consultation, and I promise good care.
I can then develop my practice into the mother of all polyclinics,
duplicate this in every neighbourhood, and cause the government polyclinics
to close.
The Government will be only too happy to redeploy polyclinic staff to
hospitals to ease the staff shortage there. A win-win situation, Mr
Leong?
Otherwise, GPs can deliver only good, cost-effective and affordable -
not cheap - health care.
Author: Dr Hia Kwee Yang
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Why stop doctors from charging polyclinic rate?
Date: April 5, 2005
I PRINTED an e-coupon 'Visit your doctor at polyclinic rates' from
www.clinicsingapore.com, which allows one to pay the same $8 that
polyclinics charge, for medical consultations at any of the listed 20 or so
clinics.
I understand that some of the clinics had withdrawn from the scheme
because they received a letter from the Singapore Medical Association
(SMA), informing them that participation may be an infringement of its
regulations. This is because the SMA's recommended consultation fee is $18.
Polyclinics are already charging $8 and some clinics with company
contracts charge employees even less. So why is it that doctors are not
allowed to charge a fee that is 55 per cent lower than the SMA recommended
fee? Will such anti-competitive behaviour be covered by the competition
law?
From my experience, various doctors have charged less as well as more
than the SMA recommended fee. So if they already have the discretion to
charge their own fees, why disallow the $8 scheme? Is it because the
difference from the recommended fee is too large?
As a consumer, I think the issue is why a professional body should not
allow its members to charge the general public the same fee that
polyclinics charge.
Unlike in the past, doctors can now advertise their services. So why
the restriction on price?
With the long queues at polyclinics, especially during peak hours, the
$8 consultation fee scheme may lighten the Government's health-care
burden.
It may also be more convenient for some patients because of the wider
choice of locations, saving them time and transport costs.
Perhaps the best rate to charge - and the best way for the medical
profession to serve the public - is the one that ensues from free market
competition and unfettered choice for patients and doctors.
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Business Times, The (Singapore)
Title: Passports will not be cheaper
Author: Leong Sze Hian, Singapore
Date: March 31, 2005
I REFER to media reports that the Immigration and Checkpoints Authority
(ICA) will lower the passport fee from $70 to $60 or $50 (for
applications online or by post), for passports that are issued on or
after April 1.
However, passports will have their validity slashed from 10 years to
five. The reason given was 'to incorporate new technologies into the
Singapore passport more rapidly and deter errant persons or syndicates
from forging or abusing our passports'.
If the 10-year passport fee was $70, then logically the five-year fee
should be half, which is $35.
The new fees are proportional increases of 71 and 43 per cent
respectively.
If three million Singaporeans apply or renew their passports, the
additional revenue to the ICA is $45 million (3 million x $15), that is
assuming everyone does so online or by post.
I would like to ask whether the ICA operates at a profit, and if so,
what were its profits for previous years?
If every time a public agency decides to increase fees by such a large
margin, 'to incorporate new technologies more rapidly', then the cost
of
living and inflation in Singapore may go up even more.
Is there a process or panel to scrutinise how the quantum of public fee
increases are determined and whether they are justified?
Perhaps the headline for this report should read as 'More expensive
passports' rather than 'Cheaper passports'.
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
Paper: Business Times, The (Singapore)
Title: Passports will not be cheaper
Author: Leong Sze Hian, Singapore
Date: March 31, 2005
I REFER to media reports that the Immigration and Checkpoints Authority
(ICA) will lower the passport fee from $70 to $60 or $50 (for
applications online or by post), for passports that are issued on or after April
1.
However, passports will have their validity slashed from 10 years to
five. The reason given was 'to incorporate new technologies into the
Singapore passport more rapidly and deter errant persons or syndicates from
forging or abusing our passports'.
If the 10-year passport fee was $70, then logically the five-year fee
should be half, which is $35.
The new fees are proportional increases of 71 and 43 per cent
respectively.
If three million Singaporeans apply or renew their passports, the
additional revenue to the ICA is $45 million (3 million x $15), that is
assuming everyone does so online or by post.
I would like to ask whether the ICA operates at a profit, and if so,
what were its profits for previous years?
If every time a public agency decides to increase fees by such a large
margin, 'to incorporate new technologies more rapidly', then the cost
of living and inflation in Singapore may go up even more.
Is there a process or panel to scrutinise how the quantum of public fee
increases are determined and whether they are justified?
Perhaps the headline for this report should read as 'More expensive
passports' rather than 'Cheaper passports'.
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: Health-care subsidies have risen over time
Author: Karen Tan (Ms) Director, Corporate Communications, Ministry of
Health
Date: March 26, 2005
IN 'INDIVIDUALS paying more for top grade health care?' (ST, March 19),
Mr Leong Sze Hian wrongly inferred from the World Health Organisation
(WHO) report that the 'burden of rising health-care costs has gradually
been shifting from the public sector to individual Singaporeans'.
The WHO defines government health-care expenditure broadly to include
capital spending on environmental-health projects. The lumpiness of such
capital projects (eg, incinerator plants) results in volatile spending
patterns that distort the underlying trends in the data. In this case,
it skewed the WHO figures downwards due to the completion of projects
at the end of the reporting period.
A more accurate measure of the Government's share of medical cost is
what we provide in health-care subsidies. This has been increasing
steadily, from $560 million in FY1997, to $850 million in FY2000, and $1.3
billion in FY2004.
Over the same period, government health-care subsidies increased from
13 per cent of total health expenditure to around 20 per cent.
Mr Leong also commented on Singapore's 101st (out of 191) ranking for
'fairness of financing' in health care, as reported by the WHO. Not
surprisingly, Singapore was ranked lower than countries with extensive
welfare systems, which promise cheap or free health care to all citizens.
For example, the top-ranked country is Colombia, where health-care fees
range from US$1 (S$1.65) to US$8 per year.
But is this sustainable? Besides, at such low fees, what standards of
medical care can patients expect to receive?
Finally, Mr Leong thought that ElderShield's opt-out rate was lower
than that of MediShield. This is not so. On an overall basis, the opt-out
rate of ElderShield is about one third for all eligible Singaporeans.
For MediShield, it is only 10 per cent.
Author: Karen Tan (Ms) Director, Corporate Communications, Ministry of
Health
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Individuals paying more for top grade health care?
Author: Leong Sze Hian
Date: March 19, 2005
ACCORDING to the 2004 report of the World Health Organisation (WHO),
Singapore's per capita government expenditure on health at average
exchange rates has been falling gradually, from US$365 in 1997 to US$274 in
2001.
Government expenditure on health also fell from 39 per cent in 1997 to
33.5 per cent in 2001.
It is in a way somewhat puzzling that on the one hand rising
health-care costs necessitated various measures, such as the need to increase
MediShield premiums from July 1, on the other hand the WHO report seems to
indicate that the burden of rising health-care costs has gradually been
shifting from the public sector to individual Singaporeans.
Since the WHO has ranked Singapore sixth out of 119 countries and the
top in Asia for overall health-system performance, how do we reconcile
and explain Singapore's relatively low 101st out of 191 ranking for
'fairness of financing' in health care?
The ElderShield opt-out rate for the recent cohorts has declined to
less than 20 per cent. Does 'recent cohorts' refer to those who became
eligible when they reached the initial entry age for ElderShield?
When ElderShield was first launched, about a third opted out, and the
last time the ElderShield opt-out rate was reported in the media, it was
more than 40 per cent. I would like to ask what is the opt-out rate for
all eligible Singaporeans since the scheme started.
If the opt-out rate has been reduced to 'less than 20 per cent', then I
would like to suggest that we learn from the successful experience of
ElderShield to try and get the 440,000 Singaporeans who do not have any
form of medical insurance to opt back into MediShield.
Author: Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Business Times, The (Singapore)
Title: Let firms link their names to MRT stations
Author: Leong Sze Hian Singapore
Date: March 16, 2005
I REFER to the articles 'SMRT looking to expand into retail sector'
(BT, Feb 24) and 'SMRT Q3 profits boosted by lower taxes and costs' (BT,
Jan 29-30).
In Kuala Lumpur, the Monorail stations have names like Bukit Bintang
Coca Cola and Titiwangsa Telecom because companies pay a lot of money,
which I believe is in the millions, to have their names associated with a
station.
I would like to suggest that we explore the possibility of having a
similar scheme in Singapore, allowing companies to bid on an annual or
periodic basis for their names to be announced whenever a train stops at a
station.
With tens of thousands of commuters seeing daily the station's name
with the company's name, it may generate revenue which may be used as a
cushion against future MRT fare increases, or may even reduce current
fares.
In this connection, SMRT has indicated since the fare increases in 2002
that it may have to raise fares again in the future. Its profits for
2002 and 2003 rose 27 and 24 per cent respectively, and for Q3 2004, it
climbed 25 per cent.
I think the sky is the limit in view of the novelty and impact of the
advertising value potential.
For example, I understand that a company is paying the Land Transport
Authority (LTA) more than $200 million over 15 years or so for the right
to build and manage the advertising panels at some bus and taxi
shelters.
If some of this money is given back to bus operations, it may also act
as a cushion against future bus fare increases, or even lead to a
reduction in current fares. After all, in a sense, this money is derived
from bus operations in Singapore.
Author: Leong Sze Hian Singapore
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: Current practice adheres to global best practices
Date: February 24, 2005
WE REFER to the articles, 'Wanted: More transparency in
investment-linked policies'; 'Insurance 'time bomb' set to explode'; 'Elderly and the
sick face highest risk of hidden costs in policies'; 'Insurers need to
be more upfront about 'hidden' costs'; and 'Investment-linked plans
'meet MAS disclosure standards', by Ms Lorna Tan (ST, Feb 12,15,16 and
17).
The issue may not be so much one of 'transparency' as one of the
balance between clarity and understanding of ILPs on the part of the
consumer, vis-a-vis the complexity of breaking down further the components of
ILPs.
ILP benefit illustrations already disclose all charges and their effect
in total on the gross returns, with the net-returns projection on a
year-to-year basis; a mortality table is typically included in the policy
contract.
An ILP benefit illustration and product summary can run to 27 pages;
there is sufficient information and disclosure given to the consumer. The
challenge lies in understanding complex technical information.
A better approach would be for the consumer to seek clarity from his
adviser.
Ultimately, the consumer is the best judge in the determination and
evolvement of the appropriate balance between 'transparency' and
complexity.
Meanwhile, we want to assure Singaporeans that the current practice
adheres to best practices globally.
Jonathan Low Vice-President, PR & Marketing Insurance and Financial
Practitioners Association of Singapore
Leong Sze Hian Chairman, Practice Standards Committee Society of
Financial Service Professionals
Copyright, 2005, Singapore Press Holdings Limited
Paper: Straits Times, The (Singapore)
Title: MediShield's financial status must be protected
Date: February 16, 2005
IN HIS letter, 'Cap co-insurance so Class C patients pay less' (ST, Feb
11), Mr Leong Sze Hian offered several suggestions for MediShield
reform: (i) cap the co-insurance, (ii) use MediShield Plus to
cross-subsidise MediShield Basic, and (iii) focus on cutting health-care costs.
We share his concerns about the financial burden of large hospital
bills on Class C patients. That is why the Government subsidises 80 per
cent of the costs of treatment in such wards.
While capping the co-insurance will further ease the financial burden,
this must be funded by higher premiums. The necessary premium
adjustment will then exceed the current maximum monthly increase of $11.25.
Elderly Singaporeans may find such premium increases unaffordable.
Mr Leong is mistaken in thinking that MediShield Plus has made huge
surpluses to be able to cross-subsidise the additional benefits for
MediShield Basic.
As a long-term medical insurance plan, MediShield Plus must set aside
reserves from its operating surpluses to cover future obligations and
contingencies.
The tender of MediShield Plus will not free up these reserves. After
the tender, MediShield will remain the basic tier of insurance for all
MediShield Plus policyholders. MediShield will continue to provide basic
medical coverage at the Class B2/C level. These long-term obligations
have to be backed by adequate reserves.
Mr Leong is also mistaken in noting that 'most countries' national
health insurance schemes operate at a deficit'.
No insurance scheme can function with sustained losses. Either premiums
have to be raised or the scheme will eventually go bankrupt, to the
detriment of all policyholders as they risk losing their medical coverage.
As an example, Taiwan's National Heath Insurance had to raise premiums
in 2003 after its initial years of operating surpluses turned into
deficits. Since then, its finances have continued to worsen. Further
premium hikes are now being considered to save the programme from financial
collapse.
Therefore, even as we seek to maximise benefits for policyholders, we
must not compromise MediShield's financial position.
For long-term viability, MediShield premiums must be sufficient to fund
payouts and the cost of running the scheme, with adequate reserves set
aside for future obligations.
Mr Leong also questioned the need for the deductible increase, as he
felt that it would make private insurers less 'competitive and
innovative'. In drawing this conclusion, he has somehow linked the deductible
level with the degree of competition and innovation in the industry. But
the two are not related.
MediShield and the Medisave-approved private medical insurance schemes
are catastrophic medical insurance plans. Their deductibles must be
adjusted periodically with changes in medical cost, so that the policies
kick in only for large bills.
Market competition will come about not through lower deductibles but
through a proper industry structure, where new players can enter the
market and compete with existing ones for the benefit of all policyholders.
That is why we are restructuring the industry to allow all private
insurers to compete in the provision of enhancement plans on top of the
basic MediShield tier.
Such competition among the insurers will then drive the industry
towards a wider range of innovative and competitively priced insurance
products.
In parallel with these changes, the ministry will continue to manage
medical costs without compromising patient care.
We have published bill sizes and quality indicators to allow
Singaporeans to make informed choices on where to seek treatment, and provide
health-care providers with comparative benchmarks.
As for drug purchases, these are consolidated to exploit bulk
discounts, with selection based on price and other factors such as safety,
quality and efficacy.
Patients, too, must play their part and moderate their expectations of
the public health-care system.
If we succeed on both fronts, then we can avoid frequent and major
adjustments in deductibles and premiums.
Karen Tan (Ms) Director,Corporate Communicationsfor Permanent
SecretaryMinistry of Health
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Cap co-insurance so Class C patients pay less
Date: February 11, 2005
I REFER to the articles, 'Patients to pay higher initial amount from
July' by Ms Salma Khalik, 'Don't leave the uninsured out in the rain' by
Ms Chua Mui Hoong (ST, Feb 4); and 'To go or not to go over the
counter' by Dr Andy Ho (ST, Jan 27).
The deductibles for MediShield will go up by $500. Monthly premiums
will also increase by up to $11.25, so that the payout for large bills can
be around 70 per cent compared to the current 40 per cent.
The increase in the deductibles and graduated reduction in co-insurance
mean that while the minority of people with higher bills will pay less,
the majority with lower bills who opt for Class C wards will have to
pay more or not be able to make a claim because their bills do not exceed
the higher deductible.
I would like to suggest a cap on co-insurance instead, as increasing
the bill payout to 70 per cent does not really relieve the Class C
patient's burden very much if, say, the medical bill is $20,000.
In this example, the patient will still have to fork out $3,200. By
capping the co-insurance to, say, $1,500 for Class C, patients will never
have to pay more than $1,500 plus the deductible. This co-insurance cap
may be higher for Class B2 and B1 wards, with no cap for Class A.
Instead of the current system of separating the funding, payout and
accumulation of surplus premiums for the MediShield and MediShield Plus
schemes, they should be taken in totality.
In this way, the general principle of pooled sharing of risks is such
that those who choose to and can afford to pay more in Class A and B
wards can provide some subsidy to Class C patients.
The outcome may then be that those with lower bills in Class C may not
need to pay more compared to under the current MediShield scheme.
The fact that MediShield has accumulated profits of more than half a
billion dollars may also be a contributory factor to the low payout
ratio.
I understand that most countries' national health insurance schemes
operate at a deficit, so why does MediShield operate at a profit?
Although the basic MediShield was in operational deficit for the last
two years, when combined with the MediShield Plus schemes, was the total
in deficit too since MediShield Plus is operating at a surplus?
Now that MediShield Plus will be hived off to a private insurer, will
the surplus accumulated be transferred to MediShield and, if so, what is
the estimated amount?
Instead of subjecting the 440,000 Singaporeans without health insurance
to underwriting if they want to get into MediShield, I propose that
with the MediShield Plus surplus and the increased pool of those insured
under MediShield, it may be actuarially viable to 'let the uninsured opt
in and charge premiums based on the community rating of the total 2.7
million pool, and not discriminate against the old and sick'.
The higher minimum deductibles of $2,000 for Class B1 and $3,000 for
Class A may mean more patients not being able to claim or having to pay
out-of-pocket for higher sums because of the higher deductible.
The change is to promote a 'more competitive and innovative private
insurers' market'. But is it not in a sense self-contradictory because
private insurers are being mandated to increase deductibles, instead of
lowering them to become 'more competitive and innovative', as was the
case when MediShield Plus was opened up to private insurers who managed to
reduce the deductible from $2,500 to $1,500?
How much of the current under-coverage may be due to the high prices of
drugs and pharmaceuticals here?
I understand that in the award of drug tenders, medicines that can cost
as much as 10 times more than generic drugs may be selected for use.
If there are generic drugs that are already approved and available
here, we may need to give greater scrutiny to the award of tenders that are
vastly more expensive.
Dr Ho said that in Britain, going over-the-counter would slash the
National Health Service's annual bill of £700 million (S$2 billion)
for statins alone, and 'that is why it is imperative that the Health
Sciences Authority must make its own decisions fully aware of the economic
and political pressures under which switches come about abroad'.
Health-care costs rose 11.1 per cent in the last five years, much
higher than the 2.5 per cent increase in the consumer price index ('Why
S'poreans complain about the cost of living'; ST, Feb 4).
According to The Straits Times Interactive Poll (Jan 31), 24 per cent
voted 'I'm not likely to consider signing up (for MediShield) even with
the changes', and 19 per cent voted 'I'm in the scheme but will get out
of it'.
This is perhaps indicative of the public's sentiment and
dissatisfaction.
Accordingly, I think we need to try to cut costs too, instead of just
raising premiums and deductibles, and accumulating surpluses.
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
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