“The bulk of medical research is funded by taxpayers, not patients. The same
goes for hospital overhead costs and a lot of capital expenditure items.”
Clearly, we have been “conned” by high medical charges simply because the
capital expenditure and overhead costs which are paid by taxpayer were
“double charge” into the medical bills we paid. Capital expenditure like
building, expensive equipment and other overhead costs on equipment are
“sunk costs” that were from govt capital fund received taxpayers taxes and
hence should be zero cost to the hospital. It seems the hospital recycles
the sunk costs many times and then recover from its patients all over again.
http://straitstimes.asia1.com.sg/storyprintfriendly/0,1887,214273-106…
,00.html?
OCT 12, 2003
Our Columnist
One man shakes up health care
By Chua Lee Hoong
SHAKING up Singapore? It’s not just the shake-up-your-Sunday Sunday Times
that’s been doing so; Mr Khaw Boon Wan has too.
Less than the proverbial 100 days into his new job, the Acting Health
Minister has already embarked on the promise he made on the day he took
office, to bring health-care costs down. Speed aside, what’s getting people
talking is also the way he’s set about doing this: Show them, don’t preach
at them.
Consider the chronology.
Aug 1: Taking over the helm of the ministry, he announces that his main aims
will be to promote health (quotable quote: ‘After all, we are a Ministry of
Health, not a Ministry of Illness’) and review health-care costs.
Sept 29: He holds a press conference announcing that his ministry has
collated and put on the Internet billing data for 28 common ailments that
public hospitals treat.
He leaves the media (and the public) to draw their own conclusions from the
data, which is arranged according to hospitals. ‘I only churn out data, no
comments. The public, GPs, and hospitals can examine for themselves,’ he
says.
It’s a deceptively laid-back line. The data has been collated in such a way
that the questions begging to be asked are obvious. He supplies them
himself: ‘Why am I more expensive?’ and ‘If we are outliers, why?’
Nowhere during the press conference does he point any finger at any
hospital. The data has spoken; he doesn’t need to.
Over the next few days, the medical community buzzes as it examines the data
tables in greater detail. It’s a time of intense financial soul-searching
for public hospitals charging the most for particular ailments.
Oct 4: With the message he wants to put out sunk deeply into the minds of
hospitals here, Mr Khaw now becomes explicit. Stop silly competition such as
fighting for patient share by engaging big names and splurging on the latest
equipment, he tells a medical gathering.
They’ve ‘gone a bit astray’ and there’s a danger of a ‘perverse outcome’ in
which hospital chiefs push for more patient days, more clinic visits, more
surgery and more prescriptions – which would add up to higher health-care
costs.
So hospitals are now feverishly reviewing how to cut their costs. A
gratified Mr Khaw said on Tuesday: ‘I think it’s coming along nicely. So
let’s keep it up.’
So how did Mr Khaw manage to get things moving so fast?
To be sure, he’s got incumbent advantage of a sort: he spent the first 14
years of his working life as an administrator in MOH. He helped formulate
Medisave; he restructured hospitals; and he even headed three of them. So he
knows the ins and outs of the hospitals, what’s really necessary and what’s
not.
Asked, for instance, by a journalist why he wouldn’t print flyers with the
billing data for the entire population to read and keep, he trotted out a
statistic I doubt many know: that at any one point in time, only 1 per cent
of the population will be sick and interested in data like this.
Why print something that’s going to be glanced at and thrown away by 99 per
cent of the people? (He was too gracious to add: ‘Far cheaper to get the
newspapers to print it – It’s a win-win outcome!’)
But it’s not just insider knowledge that’s enabling Mr Khaw to get things
moving. It’s also a canny political sense that shouldn’t be rare but
unfortunately is.
He had the astuteness to work with the Consumers Association of Singapore in
collating the data, and to harness public opinion by bringing the data
before the media. He could have simply disseminated the data within the
medical community, but he chose to go beyond.
In doing so, he showed he was unafraid to risk unpopularity by exercising
leadership. Leaders grasp nettles.
Mr Eddie Teo, permanent secretary in the Prime Minister’s Office and
responsible for developing public servants, wrote recently: ‘A leader is
someone who brings about adaptive, as opposed to technical, change.
‘He makes changes that challenge and upset the status quo and he must
convince the people who are upset that the changes are for their own good
and the good of the organisation.’
The verdict is still out, of course, on whether the changes that Mr Khaw is
introducing will be for the better.
There are those, such as my sister who is a frequent user of hospital
services, who believe that bringing hospital costs down will lead to
dangerous consequences – cutting corners, compromising care and losing the
cutting edge as a health-care hub. In her case, however, her employer –
Singapore Press Holdings – pays the bulk of her hospital expenses.
For those who have to pay for their health-care expenses themselves, it must
be reassuring to know that the minister in charge is someone who knows that
more expensive doesn’t necessarily mean better, and that regular price
increases need not be a fact of life.
Will Mr Khaw’s approach mean Singapore losing the cutting edge as a medical
centre? Hardly. The bulk of medical research is funded by taxpayers, not
patients. The same goes for hospital overhead costs and a lot of capital
expenditure items.
What the new minister’s approach does is highlight the fact that the people
who make up the bulk of hospitals’ clientele are the not-much-money-to-spare
heartlanders, not high-income earners or the regional rich who come to
Singapore for medical tourism.
Keep cutting-edge stuff for these groups – and charge them accordingly.