No more dr Oz bloke, just me: December 2006

Monday, December 25, 2006

The customer is always right!

What do they teach you in the service sector?

The customer is always right! I totally agree to be frank.

This letter to the ST forum illustrates this very well.

And this reply from KKH reinforces my view.

I'll summarize the case in question. Customer goes to see the doctor and expects to have an ultrasound scan for her problem. The doctor says she doesn't need one. The customer insists she wants one. So the doctor reluctantly performs the scan and tells her beforehand that it would be normal anyway. But it turns out it is NOT normal. the customer is admitted to hospital and has an emergency operation that very night! Sounds scary eh?

Put it this way, an ultrasound scan is totally harmless. It has no side effects whatsoever. The customer wanted it. So why not serve the customer?

Ok so some doctors out there would say, most likely the scan would be normal. Well 9 times out of 10 you would be right, but then you can't be 100% correct all the time either. So why not just accede to the request, please the customer and make sure everything is alright? Or in this case, pick up something much less common but still nonetheless a dangerous pitfall?

The communication could have been indeed better. The customer SHOULD GET what they request for. But of course you are welcome as a professional to give an opinion of what the test is likely to show or not show. But nonetheless, why deny the patient?

I can only think of ONE reason. MONEY.

People don't realise that at the government hospital A&E's you pay a flat rate for all consults, test and medications given at that visit. Hence you don't earn more for ordering that scan or an extra test of any kind.

In the private sector, the customer is king. Whatever you want, we'll do it especially so if the procedure is totally harmless with no side effects! I am sure the guys at Mt E or Mt A or Gleneagles must be laughing when they read this letter!

In today's day and age....the customer is KING and IS always right. I pity the doctors working in the government sector though. They are schizophrenic.

One moment they are told that they have to keep costs low for the customers. Save on health care costs for the country. But at the same time, keep service standards world class. That's like saying you make sure customers don't buy those Bang & Oloufsen TVs but instead go for the Akira, Nachus or Prima brands? What kind of business is that? I can't imagine a professional TV expert telling his customer "You don't need a Bang & Oloufsen!"

Of course in this case it is a bit different. But then we are all taught in medical school the ICE of consults. The customer's Ideas, their Concerns, and their Expectations.

This can be applied to any service transaction don't you think?

When a customer wants something just give it to them.

On the other hand, customers should also be aware that SOMEONE has to PAY for what you want at the end of the day. It is better if it's you but if not then someone has to do it for you.

Wednesday, December 20, 2006

Doctor fined $2500? (Only?)

Read this in the papers today.

A doctor's delinquency

Mismanagement of Subutex prescriptions results in $2,500 fine

A DOCTOR in Woodlands has been found guilty of failing to properly administer Subutex — the first such case since the medicine was listed as a controlled drug in August.

It is believed that several other doctors are under investigation for the same reason by the Singapore Medical Council (SMC).

Dr John Heng Kuo Leng was fined $2,500 by the SMC and given a stern warning for mismanaging 19 of his patients.

Incidentally, this is not the first time the 47-year-old general practitioner from First Medical Clinic and Surgery has been censured.

In 2004, he was suspended by the SMC for 18 months for dispensing addictive cough mixtures and sleeping pills too freely at his clinic in Woodlands Street 11.

This time round, one of the charges levelled at the doctor is that he did not record and provide sufficient patient details and results of the diagnosis.

A council disciplinary inquiry last week found him guilty of mismanaging the 19 patients between December 2002 and February 2004.

It goes to show that the problem was really bad. No doubt about it but those doctors were doing very bad things. And it is no surprise that this doctor was not a 1st time offender. Same pool of patients, same nice market.

What surprises me though is the punishment meted out.

$2500 fine and a few stern words?

I think SMC is sending a signal out to young doctors like myself. Make your millions selling all kinds of sleeping pills, addictive medicines etc then get slapped with a bit of a pocket change fine +/- a short suspension for you to go on holiday and sabbatical then come back with the latest addictive drug and make a few million after 1-2 years and then go on holiday again.

Looks like a wonderful plan to me!

This topic was discussed before.

1 tablet of Subutex earned profit of $20. This doctor had 19 patients taking 1 tablet a day. 19 X $20 = $380. $380 profit a day. $380 x 365 = $138,700 $138,700 x 2 = $277,400. So that's how much he earned over 2 years with just 19 patients. And this is if he had totally been doing everything all well and proper. Who's to say he wasn't prescribing more than 19 tablets a day?

There were an estimated 8,000 Subutex abusers according to MOH. Let's say each of them take 1 tablet a day. That means 8,000 tablets are sold a day. Each tablet gives a profit of $20.

Subutex has been around for 4 years?

So in total the profits over the past 6 years = 8000 x $20 x 365 x 4 = $233,600,000!

$233.6 million over the past 4 years! And if you divide it by the 35 GPs registered to sell Subutex, each GP made $6.67 million over the past 4 years!

That's an incredible amount of money! Maybe I've been doing the wrong sort of work all these years!

Thursday, December 14, 2006

This is why Singapore's service standards are so screwed!

I was pretty shocked after I read Tabitha Wang's latest "Budget Tai Tai" column.

Bad service can drive you Nuts

Some days, it's apathetic service at every turn

Budget Tai Tai • By Tabitha Wang

The other morning, I tried to get something sent overseas at a convenience shop. An international courier company had signed on the shop as one of their drop-off points.

What an innovative idea — or so I thought, until I went to the counter.

"Cannot," the shop assistant said. "We don't do such things."

"But your shop is on the courier company's website," I protested.

"No, don't have. Never heard before."

When I insisted, she gave a theatrical sigh, then said she'd phone her supervisor when she had finished serving all her "legitimate" customers (who wanted nothing more mentally taxing than a can of soft drink or a packet of crisps).

After giving me a few hard stares to will me to leave, she finally called her supervisor, reluctance written all over her. Thirty seconds later, she turned to me and then said: "Ya, got such thing. Give me your parcel."

I wish I could say that this was an isolated incident but I've encountered many sales people just like her.

Their motto: If in doubt, just say no.

Is it possible to get free alteration? No.

Can I have mashed potato instead of fries? No.

It's as if they've been programmed with a set script — greet customer, give product, get money. Heaven forbid if there's a deviation because their brains just shut down.

Now I understand what Creative boss Sim Wong Hoo meant when he said in his book, Chaotic Thoughts from the Old Millennium, that Singaporeans are Nuts. He coined the phrase, No U-Turn Syndrome, to describe how we need someone in authority to tell us what to do before we can proceed. To describe this, he compared local traffic rules to those found overseas.

Here, drivers can't U-turn unless a sign allows them to do so, while in other countries, drivers can U-turn unless a sign forbids them to.

"When there is no rule, we cannot do anything. We become paralysed," he noted.

You see this problem most with service staff here, mainly because they're lowest in the pecking order in any shop or restaurant. They don't dare to deviate from the rule book because they know it might incur the wrath of someone higher up in the organisation.

And in most hierarchical Singapore companies, that's not an exception, it's a given.

If there are no rules specifically allowing them to do something (for example, offer rice instead of baked potato), they will err on the side of caution and say no.

This apathy may serve them well but it sure doesn't serve me, as a customer, at all. While I may sympathise with them, that doesn't stop me from feeling irritated just the same.

Given the Nuts around, it will be impossible to ask them to change by themselves. If we want better service all round, sales managers should be trained to give their underlings more control.

A good example of this was in a restaurant I recently visited. Because they were having an a la carte buffet promotion, the place was packed and the two waitresses there had their hands full trying to get the orders right. Inevitably, orders went missing and tempers were frayed. What I expected to be a quiet half-hour meal turned into a long-drawn two-hour affair.

At the end of the meal, I told a waitress that it was the worst dining experience I'd ever had. I was prepared never to step foot in the place again. But she totally disarmed me by apologising and, without applying to her manager, gave me a $10 voucher.

"Please come again. I promise we'll do better," she encouraged.

I was impressed. By trusting her with the vouchers, her bosses had allowed her to use her initiative, wow customers with good service — and drum up more business.

There's no prizes for guessing which place I'd be going to again. I'm never going into that (in)convenience store again, not even for a pack of crisps.

The shopaholic writer has no qualms dealing with shop assistants, as long as the first word that comes out of their mouth is not "no".

Hello? But will somebody please tell the Budget Tai Tai that this IS exactly why Singapore's service standard are so screwed up!

A restaurant hires 2 waitresses for a busy packed restaurant offering a buffet! Vastly understaffed if you ask me. Service has to be atrocious and Tabitha herself said it was the "worst dining experience I'd ever had"

And all of a sudden it becomes no prizes for guessing which place I'd be going to again?

All because of what? A $10 voucher!

So you see. The restaurants and service staff know what is it that Singaporeans want. It's not good service. It's cheap food and good prices with freebie vouchers to give away. Your service can be the worst in the world, but just give a $10 voucher and you become a place they'd go back to!

Actually I'm not surprised by this fact, because it is true about Singapore and Singaporeans. Tabitha Wang proves she is a typical Singaporean. No problems with that.

However the tone of this article seemed to be an attempt to "fix" Singapore's problem with bad service. Hardly a solution. In fact it's a stab at perpetuating or worsening the problem!

Shocking. Absolutely shocking.

Thursday, December 07, 2006

Appropriate use of my money? I think not!

This was the headline news in the Today paper this morning.

The long arm of ethics
Why holding Shorvon accountable is important to the S'pore Medical Council

Tor Ching Li
chingli@mediacorp.com.sg

WHEN he came to Singapore in 2000 as chief of the National Neuroscience Institute (NNI), Professor Simon Shorvon was acknowledged as one of the world's leading authorities on epilepsy.

Today, his reputation is in tatters, his research is on hold and the 58-year-old is talking of "early retirement" as the Singapore Medical Council (SMC) and its team of lawyers has followed him all the way to Britain to make sure he answers for his actions.

The vigour with which SMC has pursued the Shorvon case — even beyond Singapore's borders — has surprised legal circles, but the council says it had no choice.

What's more, as Singapore becomes a biomedical hub, the SMC says that if any foreign doctor breaches ethics here, he won't get away merely by fleeing Singapore. It will pursue him wherever he goes, taking up the matter through its foreign counterparts.

The Shorvon case shows how determined it is to make this point.

Given a $10-million grant here to conduct research on Parkinson's Disease and other conditions, he used some patients as unwitting guinea pigs. Their medication was changed without their knowledge. In some cases, they were told to ignore the regular prescriptions from their neurologists.

The NNI sacked him in 2003. He was struck off the Singapore medical register and made to pay a $10,000 fine and foot the SMC's $175,000 legal costs. As Prof Shorvon moved back to England, the SMC informed its counterpart, Britain's General Medical Council (GMC), of its findings.

If this was routine, the SMC's resoluteness to hold the former NNI chief accountable became clear after this point.

As GMC prepared for a public inquiry into Prof Shorvon's conduct here, the SMC and its solicitors made two trips to London to assist them.

It discussed options including video-conferencing or sending doctors and patients from Singapore to London for the inquiry.

In September last year, the GMC decided to drop the inquiry as its independent expert, Prof A C Williams, felt that Prof Shorvon's offences here were "of a relatively minor nature".

Far from letting matters rest, the SMC appealed against GMC's move in the British High Courts.

It has hired Queen's Counsel David Pannick to present its case there. And apart from pointing out inaccuracies in Prof Williams' report presented in a two-day hearing this week, Mr Pannick has spelt out the SMC's stand: It feels that Prof Shorvon has a strong case to answer, and he should answer it.

Dr Lau Hong Choon, SMC's executive secretary, told Today that GMC's cancellation called into question the "integrity and independence of the SMC's findings against Prof Shorvon".

SMC president Prof R Nambiar said that Prof Shorvon's ethical lapses were "serious", and the standards to be upheld as "internationally established principles of medical practice and research and must be strictly complied with in all research projects".

Prof Shorvon has said that the SMC has no right to contest the decision of Britain's GMC, and told The Straits Times that his reputation, career and salary progression would be seriously compromised if the GMC continued to inquire into his conduct in Singapore.

Between 1997 and 2003, he received grants worth $21.5 million. He has received no grants since 2003.

But Dr Lau said there was a bigger issue involved.

"The SMC has an interest in upholding Singapore's reputation as a place where foreign doctors can practice medicine and conduct biomedical research, in a framework of internationally well-accepted ethical standards," he said.

"Foreign doctors may practise medicine or conduct medical research in Singapore. However, if medical ethics are breached and patients are harmed, they should expect to face disciplinary proceedings before the SMC.

"If these doctors leave Singapore in a bid to avoid such disciplinary proceedings, the SMC will pursue the matter through its foreign counterparts," he added.

Still, criminal lawyer Bajwa Singh commented that the SMC's move was unusual.

"It is unusual for the SMC, or for any other professional body in Singapore, to pursue a matter outside the jurisdiction of Singapore," said Mr Singh.

"One reason for not pursuing is that our bodies usually have no standing to take action in a foreign jurisdiction — though in this case they do seem to, or they would not have filed for action. On the other hand, the obvious rationale for taking action is for a matter of public interest and duty."

The British High Court will come to a decision before Dec 22. The legal costs will then be decided between the SMC — which is funded by registration fees of doctors in Singapore — and the GMC depending on outcome. Should the SMC fail in this appeal, there are two other tiers of appeal — to the Court of Appeal and subsequently the House of Lords.

Can someone explain to me why the money I pay for my medical registration fees is being used to hire a Queen's Counsel in the UK to prosecute Prof Shovron?

Anyone?

This is what happens when the government tries to go naked!

A few days ago I wrote about asking the government to be more than transparent. That they should go naked.

Well sometimes the government does seem to go naked. But reading such letters from the government makes me wonder if they think Singaporeans are stupid and blind?

I mean I may be stupid. But I can still tell when the babe you are trying to pass off in Playboy is actually a man you know!

HDB consistently incurs losses selling new flats

I REFER to the letter, 'No subsidy in new HDB flats, just a discount' (ST, Nov 25), by Mr Cheong Chee Mun.

Mr Cheong said that HDB acquires land for public housing at 'very low cost'. This is not correct. The land for public housing is purchased from the Singapore Land Authority at market value, based on the Chief Valuer's assessment.

The total cost of developing four- and five-room flats is higher than the example of $200,000 mentioned in the letter. The development cost is even higher in mature HDB estates where the market valuation of the land is higher. Hence, the assumption that HDB enjoys a profit of $150,000 per flat is wrong.

HDB has consistently incurred losses in the development and sale of new flats. It is unable to fully recover the costs of development as it sells new flats at a subsidised price. Together with the other types of housing subsidy, such as the CPF Housing Grant and the Additional CPF Housing Grant for lower-income families, the sale of subsidised new flats results in a tangible and substantive cost to the Government. Specifically, over the last five years, HDB's home-ownership programme incurred an average annual deficit of $390 million.

Kee Lay Cheng (Ms)
Deputy Director
(Marketing & Projects)
For Director (Estate Administration & Property)
Housing & Development Board

You want Dr Patch Adams in Singapore?

Read this letter in the Today newspaper.

Where's the spirit of care?

A hospital should not be a place that patients dread

Letter from Adeline Ang P Y

I refer to the Coffee With interview, "A healer, not a doctor" (Dec 4).

Earlier this week, I visited a child cancer patient in hospital, and got the feeling that the human touch was missing in the healthcare services offered to the patients.

When I was a medical student, I did watch the movie Patch Adams starring Robin Williams. It was quite inspiring, but I doubt any medical student would have thought of doing such a thing.

Singapore is all about being conventional. Being careful. You simply don't try to be funny.

Ironically one of the leading stories in the Today paper this morning illustrates my point nicely.

YouTube, you leave

StarHub fires temp staff for 'misconduct' in office

Loh Chee Kong
cheekong@mediacorp.com.sg

THEY wore company T-shirts. They horsed around in the office and posted clips of themselves on the popular online video sharing website YouTube.

It was after office hours and in their mind, it was harmless fun, but the company did not see the funny side of it. Now one of the two temporary employees engaged by StarHub has been let go while the other is facing possible disciplinary action.

The two clips — posted in October — were two to four minutes long, and showed Mr Terence Tan, 25, and a colleague in a company T-shirt playing around with a small anti-stress ball, while others watched.

About a fortnight ago, Mr Tan said, the management reprimanded him and ordered him to take down the clips, which by then had generated some 460 hits between them.

So any Dr Patch Adams wannabes......you have been warned!

Cost vs Value?

I was listening to Derrick Paulo on NewsRadio 93.8FM today. He mentioned something about Singaporeans examining the cost of their citizenship against the value of citizenship.

Well we all know what the big "cost" is to most Singaporean males. National Service. Just those two words remain a huge sticking point in the locals vs foreign=talent debate.

Of course the government has now responded to our good citizens.

All this while we the citizens kept asking, what is the value of our citizenship? (we all know the costs already) We ask, "Isn't the value of our citizenship the same as that of a Singapore PR?"

And what does our good government do? They think about it for a long time and then decide that to appease us citizens, they will raise the cost of being a foreigner.

I mean they could have increased the value of our citizenship. But no, they choose to raise the cost of being a foreigner.

No wonder the foreigners are angry now. Well here's what I would like to say to the foreigners : "Welcome to Singapore! Now you know how it feels to be a true Singaporean!"

Don't you know that this is how our country works? Everything is about increasing costs. ( One wonders where all that increased revenue collected goes)

You are not happy because you feel you should be getting more than the other guy? Ok we'll make you happy by making the other guy pay even more than you ok? But no way in hell will we ever make it cheaper for you!

Cost vs value. Dear government, how about increasing the value of the citizenship for a change? Take the carrot approach. Make the foreigners feel they can gain MORE VALUE than they have now as foreigners rather than INCREASE COSTS for them.

Perhaps the Ministers still don't get it. Well here's how I think they will definitely understand.

Instead of raising Minister's salaries every now and then, why not we ask the leaders of other countries to be paid less! Or instead of saying we need to peg our salaries to the top 6 earners hence the need to raise Minister's salaries, how about we lower the pay of the top 6 earners every now and then? Get it now? If you still don't get it....sigh.......

Wednesday, December 06, 2006

Do you really want to know?

Those of you who know me in real life will know that I have a Fellowship in Clinical Nutrition from the USA.

Nutritional therapy is gaining recognition these days. In fact the USFDA approved omega 3 fatty acids as a drug in 2004. Reliant pharmaceuticals has come up with a drug called OMACOR. No prizes for guessing why they chose to name it OMACOR. Zocor, Lipitor, Crestor anyone?

But I'm beginning to realise it is useless having this knowledge in Singapore.

Singaporeans would always question you when you advise them on lifestyle modifications, diet modifications, nutritional modifications either via natural foods or supplements. They would question how it works, why it works etc. But most of these people have no real interest in the answers. Or for the matter, most of them have so little background knowledge that they simply will not be able to understand the biochemical pathways to how these nutritional therapies work. So why ask? But if they ask I have to answer right?

And of course you will have the objections.

"Fish oil is for kids. Not for adults!" (good for kids = bad for adults?)

"My doctor said I have high cholesterol levels and taking fish oil will raise it further!" (could your doctor be out of date?)

"Take so much fish oil? The salesgirl in the health food shop says take 1 capsule a day enough already!" (so the salesgirl knows more about health right?)

"Yuck I hate the taste and smell of fish oil!" (gee I guess medicines taste really good eh?)

But if you told them to take a medicine, the majority would never question how it works. Even if you tried to give them some information, they would say "Sorry I am not a doctor, I won't understand all this"

So I'm quite glad that OMACOR might be making its way to Singapore. Now I don't have to feel like a cheap salesman anymore. I can be a simple salesman.

"This is a medicine that you need. Take 3 a day. Have a nice day."

Simple and sweet.

Tuesday, December 05, 2006

Singapura the music video!

Hossan Leong wrote and performed this song at the TalkingCock parliament some time back.

Now the music video is out!

Enjoy!

I say we SHOULD give foreign talents equal dues!

Reading this letter to the Today paper reminds me once again of all the reasons why we Singaporeans are unhappy with foreigners.

For this blog entry I'll be doing it differently by putting in comments in between paragraphs. I think it has better effect.

Give foreign talent equal dues
Why treat overseas employees differently?

Letter from Robyn M Speed

Robyn Speed chooses to title this letter "Give foreign TALENT equal dues". Why not just foreigners and drop the word talent? Or is the writer suggesting that we only give the "elite" foreigners equal dues but not the "peasant" foreigners? Minefield there. But it goes to show like attracts like.

I refer to the report, "Permanent Residents debate price of citizenship", (Dec 5).

One might argue that Singapore citizens in other countries should not be entitled to the same benefits as the citizens of those countries. It is only fair that they pay full health costs and pay more for education.

If they want the same treatment as citizens, they should take up citizenship in that country.

It should not matter if Singaporeans have been living in Australia, New Zealand, or the United States for a decade or more — they should not get the same rights as the citizens. They should expect to pay more.

It is only fair. Right?

Actually Robyn Speed has a point. I totally agree with him/her. But the whole idea rests upon this principle : Equal benefits and privelleges for equal contributions and sacrifices. I shall address this a bit more later to show something that Robyn failed to point out in this letter.

I bet you would say no; that if you do the work, you should get fair and equal treatment. Yet, that is what Singapore wants to do to foreigners here.

Now I take issue with that statement that Robyn makes. Do you do the work? And I mean all the work! What about National Service? Do foreign talents here as PRs do National Service? They don't. Now let's not sidetrack into the point Robyn makes below about making Singapore an attractive place. But perhaps Robyn should put himself/herself in our shoes as Singaporean males.

We serve National Service for 2.5 years (now 2 years). We get called up for In Camp Training every year that disrupts our working and social lives. We have to go for IPPT and RT. This is all part of the "work" that we do as Singapore citizens. Do the foreigners do it? They don't. So can you really say foreigners "do the work"? Yes or no? If no, then can you still say "you should get fair and equal treatment"?

This is why we Singaporeans are so angry. Try to understand that before you write such letters to the press to fuel our anger further. It is not as if Singapore citizens get much benefits anyway.

You want the top professionals in the world to come and work here, to build Singapore as the top research place in the world, the top education hub. Yet you want to hold them distant, to treat them as second to the locals.

I don't like Robyn's tone here. Perhaps Robyn speaks the truth. Singaporeans are pathetic and we need people like him/her to come and help us. Or else we would die.

But I suspect Robyn has not lived in Singapore for very long. Because if he/she did, he/she would have come to realise that Singapore citizens get very little if not close to nothing in terms of benefits and privelleges by being citizens compared to being PRs.

(Sorry to bring up the NS issue again, but one forumer asked if we could pay more for healthcare like the PRs and not have to serve NS. I think most of us would gladly take it!)

What exactly are those "benefits" that the writer cannot get that makes him/her feel so second rate anyway?

Surely these foreigners are working for Singapore and her citizens, to build your country and economy, to add to your markets and prestige.

Some come here, with their families, for career opportunities. They pay rent at the market rate for a condo apartment, their children attend an international school (because they want a sense of continuity for their children's education). Add up these costs and they are paying a lot of money, while supporting Singapore's economy.

Why do these foreign employees come here? Because the employer decided that they were the best person for the job.

That last sentence "Because the employer decided that they were the best person for the job." makes me wonder something. If these foreign talents are the best people for the job, won't it mean they are also paid the best rates? Shouldn't their healthcare benefits be the best as well? If not then why work for such companies if you are indeed the best? Don't shortchange yourself. You are not a Singaporean!

Most TRUE foreign talents that I know and read about (eg our Ministers talk about them) are paid big bucks and have comprehensive healthcare insurance plans and if not even hefty expat allowances. They are usually well taken care of.

So it seems strange that Robyn Speed chooses to write this letter after the Singapore government announces that healthcare would cost more for foreigners (mind you at the subsidized government healthcare centres). The timing seems strange to me.

Can you thus fault me for suspecting that the writer is unhappy because he/she has to now pay more for his/her healthcare needs? What happened to the employer taking the best care of "the best person for the job". Whose fault is that really?

Singapore is a small country and it is difficult for anyone to have the same experience as a worker who has travelled the world, worked in massive markets and learnt from the top people in their fields.

More condescending statements from the writer to fuel the anger once again. We all hear these truths from our leaders everyday already. Is there a need to rub it in?

I am an expat. We all have a bond with our homeland and to turn one's back on it is considered to be almost despicable by many. Our homeland is our home in the world — you cannot lightly ask a person to give that up.

Excellent point Robyn. I would love to ask you what you think of Singapore as a nation, her government and how her people are treated compared to your lovely homeland. How would you feel if you were a Singaporean? That would be something the government would not like you to write about I am sure. So have some pity for us. That much we ask you.

Singapore wants to be an international hub of research, education, tourism and so on. And yet, this latest move smacks of: "You are welcome to come, but … ".

Foreigners are either welcome or they are not.

And beware, for there are always other markets for these people to go to.

Good point. Once again reiterates how "vulnerable" Singapore is.

Just a last point. This letter seems to spark a lot of debate and fans the underlying flames of discontent in the foreigners vs locals issue. Would we consider that as disrupting the harmony of our society? Seditious?

But it's printed in the papers so I would think this is not a OB topic.

Time for MOH to go Naked

Just 3 days back I posted an entry about how polyclinic bills should go naked.

Today a letter written to the Straits Times Forum basically validates that my assessment of sentiment on the ground is correct!

Hmm....maybe the government should hire me as an MOH advisor. No need to spend more money with all those REACH programs to listen to the ground. Just hire me!

Anyway here's what Mrs Tan has to say :

Polyclinics should review flat-rate pricing policy for drugs

I refer to the reply "Polyclinics' flat rate for drugs benefits chronic patients" (ST, Dec 2) by Ms Chan Soo Chung, general manager of National Healthcare Group Pharmacy.

Ms Chan stated that with the $1.40 flat rate pricing policy for essential drugs at polyclinics, "the majority of chronic patients who need to take more expensive drugs on a long-term basis will benefit from the flat rate".

I do not think this statement is accurate. The flat rate price applies only to "essential" or generic drugs which on average cost only a few cents per tablet. It does not apply to the "more expensive" patented medicines.

To demonstrate this, Ms Chan cited the example that a common diabetic medication that requires the patient to take six tablets a day over ten weeks would have cost $21 without the flat rate policy. This works out to five cents per tablet. I do not think any "expensive" patented drug will be close to this price.

The flat rate pricing policy inadvertently allows the polyclinics to "profit" from the sale of cheap "essential" drugs. For example, a week's supply of an "essential" drug that costs three cents a tablet and taken once daily should cost 21 cents, but with this policy, the same quantity of drugs costs $1.40 instead, which translates into a "profit" of $1.19 for the polyclinics.

And given that polyclinics dispense largely such essential drugs, I wonder how much money they make each year from such drugs.

The polyclinics' $1.40 flat price policy has been questioned in the Forum page every year since 2001. While the polyclinics may argue that the excess money from "essential" drugs is used to subsidise other services at the polyclinics, I do not think this is right.

The two healthcare clusters receive government funding and if the funds are insufficient, they should resolve the matter with the Ministry of Health. The patients should not be penalised as a result of their inefficiencies or inability to manage their budgets.

Cheap "essential" drugs, if priced at their actual per tablet prices, can mean savings for polyclinic patients, especially the elderly. I urge the two clusters to relook at this flat rate pricing policy at the polyclinics.

Mrs Tan Qui Boon

To summarize the main points:

1) "The flat rate pricing policy inadvertently allows the polyclinics to "profit" from the sale of cheap "essential" drugs."

You see, Singaporeans do not like this. Nobody wants to pay for healthcare DIRECTLY. While keeping the bill transparent but with strategic areas covered is one way to hoodwink the largely blind Singaporean, it is still too obvious. Raising taxes to get hte people to pay and fatten the coffers and then using that money to "subsidize" (it's still their own money anyway) the drug costs would be a far better option.

2) "I wonder how much money they make each year from such drugs."

See? Most Singaporeans think the government healthcare sector should be a "no-profit" organization. MOH, you better tell people the truth. Are the Polyclinics making money?

3) "While the polyclinics may argue that the excess money from "essential" drugs is used to subsidise other services at the polyclinics, I do not think this is right."

Once again. The spirit of giving is simply not here in Singapore. And I guess we are just learning from the best in the business. The best way is still to make people pay up first then use the money help them later. That way it is so convoluted it doesn't make a difference if you were naked or transparent!

Sunday, December 03, 2006

How come it's always MORE money and not less?

Whenever the government announces anything you can be sure it involves making the government MORE money, never less!

I read this article and laughed myself off to bits again!

Foreigners to pay more as Singapore says citizens the priority

Foreigners in Singapore will pay more for education and health care as the government puts a priority on its own citizens, Prime Minister Lee Hsien Loong has said.

Lee also defended a planned increase in the consumption tax, saying the extra revenues would go mainly towards helping lower-income families in one of Asia's wealthiest economies.

"We have to treat visitors well, too, but citizens have to be treated better," Lee was quoted as saying in The Straits Times.

"Citizens come first in our priorities, in our thinking," said Lee, speaking at the ruling People's Action Party (PAP) convention on Sunday.

Official statistics say Singapore had a population of 4.4 million last year, but 18 percent of those were foreign workers who filled a wide range of jobs, from white collar to construction work.

The Straits Times gave no specifics on the increased education and health costs but said overseas students already paid 10 percent more for university and polytechnical studies.

For health care, permanent residents would pay more, and foreign workers would pay the full cost. Their employers would need to protect them with medical insurance, the report said.

While costs were going up for foreigners, Lee said Singapore's lower-income citizens would receive "far more" in terms of social programs and assistance from the government than what they paid, as a result of a planned increase in the goods and services tax (GST).

The main points :

1) "We have to treat visitors well, too, but citizens have to be treated better,"

2) "For health care, permanent residents would pay more, and foreign workers would pay the full cost"

Well that's what the government says. We Singapore citizens have been saying how about making the cost of healthcare LOWER for us since the PRs pay the same. After all we think as Singaporeans we should pay less than them right? Nobody was really asking for PRs to pay MORE. But rather for us Singaporeans to pay less!

And what does the government do? They RAISE the amount PRs have to pay, yet again fattening the coffers.

I think instead of saying "We have to treat visitors well, too, but citizens have to be treated better,", in reality it's a case of "we treat our citizens well, but we have to treat our visitors a bit less well now to keep the citizens satisfied"

You're just not transparent enough!

Picture this : A magazine cover reads "Zoe Tay in a transparent outfit!" You flip the magazine and you see Zoe Tay in a transparent gown except the important areas are NOT transparent.

Well after reading this letter in the Straits Times Forum, I can understand why people are calling for more transparency. And Ms Chan has got the wrong parts that they want transparent.

Polyclinics' flat rate for drugs benefits chronic patients

I THANK Mr Chua Koon Ngee for his letter, 'Why medicines cost more at polyclinics' (ST, Nov 28).

At all polyclinics, essential drugs are priced at $1.40 per week's supply per drug. This flat rate applies regardless of the actual drug cost or the number of doses taken per week.

While this means that some patients may end up paying more than the actual cost of their medications, the majority of chronic patients who need to take more expensive drugs on a long-term basis will benefit from the flat rate.

For example, a common diabetic medication that requires the patient to take six tablets a day over a period of 10 weeks would have cost $21 before subsidy. However, because of the $1.40 per week standard fee at the polyclinics, it would cost the patient only $14.

Similarly, the most expensive anti-Parkinson drug, given over 10 weeks, would cost $136.50 before subsidy but it would cost the patient only $14 at the polyclinics.

One should not just look at specific drug pricing which varies from institution to institution but rather overall affordability for the patient, and take into account doctors' consultation fee and other service charges.

Though the per-unit cost of drugs at the Specialist Outpatient Clinics (SOCs) may be lower than at polyclinics, the overall bill size of a patient seen at polyclinics is still lower and affordable, than if one is treated at an SOC or in a hospital.

With regard to Mr Chua's feedback on the need for transparency of charges presented on the invoice, patients can request a breakdown of their bill.

However, most of our patients do not require a breakdown as most of the drugs are charged using the standard flat fee.

To better serve the needs of our patients, we are in the process of enhancing our invoice presentation.

We thank Mr Chua for his valuable feedback.

Chan Soo Chung (Ms)
General Manager
National Healthcare Group Pharmacy

Just to recap the important points:

1) "some patients may end up paying more than the actual cost of their medications"

You see Ms Chan, this is really where people are not happy about. Nobody complains when they pay less than the actual cost of their medications. For the matter, do the MAJORITY of patients pay less than the actual cost of their medications? You have to understand, most Singaporeans are not interested in how much they are paying for the next guy buying those expensive medications. They only want to know how much they are paying for their medicines and how much the medicines COST to the Polyclinic!

2) "patients can request a breakdown of their bill"

3) "However, most of our patients do not require a breakdown as most of the drugs are charged using the standard flat fee"

Which leads us to points 2 and 3. There is little point in providing a breakdown of the bill if it does not provide the most important information that we want to see. What is the cost of each medicine given per tablet/per week whatever to the Polyclinic and how much am I paying? Do the bill breakdowns say these? They don't. So nobody bothers. It's like Zoe Tay wearing the "transparent outfit" but with the vital areas covered up.

Everyone suspects and will continue to suspect (and they might be right after all) that the Polyclinics STILL make PROFITS despite all this talk about "Similarly, the most expensive anti-Parkinson drug, given over 10 weeks, would cost $136.50 before subsidy but it would cost the patient only $14 at the polyclinics."

Why? Because the number of people paying MORE than the cost of medicines at Polyclinics are MORE than the people paying less and the amount collected from te majority is still MORE than the subsidies they give to the few patients who need the expensive medicines.

Admit it MOH, you run the Polyclinics, hospitals etc as businesses. All this talk about subsidy.....why not be COMPLETELY transparent?

There is a term for this. It's called being NAKED.

"Zoe Tay NAKED" Now that's what the people really want. Forget being transparent.

Is that transparent enough for you?

Friday, December 01, 2006

Did the government use the reserves during this time?

I was listening to the radio this morning. They had one of those "this time in history" sort of segments.

And they mentioned SARS. "Singapore was hit by a mystery virus which plunged the country into a crisis....."

All those memories came flooding back to me. It was one of those periods where we did not know whether to rejoice (because suddenly the work load at the govt hospitals dropped to all time lows. I'm still thinking where did those people go and why was it there was no rise in death rates despite people staying away from the hospitals?) or to be terrified that we could be the next victim? (I was admitted for suspected SARS myself and my colleagues did die after being infected, but that is another story)

Somehow the phrase "plunged Singapore into a crisis..." struck a cord with me. All this talk about raising GST, to raise the money to help the poor and how we "must not ever touch the reserves unless there is a crisis...."

Well did the Singapore government touch the reserves during the SARS CRISIS? As I recall businesses were hard hit. Many lost their jobs. But I don't recall talk about using the reserves.

In fact, they had ANOTHER one of those donating charity drives. And people donated. As a matter of fact, they donated so much there was a surplus! And we still don't know what happened to that surplus money!

The point I'm trying to make is this. If the Singapore government didn't touch the reserves even when the country was indeed in a crisis from SARS, then when will they ever touch the reserves? So dream on guys. I'm beginning to wonder whether the reserves are really "national reserves" at all? Do they exist? Or is it another one of those "terminology", "definition" games that politicians play?

Go figure.

The REAL reason why we won't exempt basic goods from GST!

I read this report in TODAY on a recent forum between Minister Tharman and certain Singaporeans.

One statement made by Tharman made me fall out of my chair literally!

It goes like this : "He added that if necessities were exempted from GST, the benefit would go to the well-off, who spend more on basic goods, than to the poor."

On first look I must say I fell off my chair. But on closer look, you can see many layers to this.

Most among the online community are cryin foul. They are saying that such basic illogic would qualify them to be Finance Ministers instead of Tharman Shanmugaratnam.

Illogical? Well yes and no. The catch is in the definitions of the terms used.

What would consitute as "basic goods"? Let's take a look.

1) Staple foods eg rice, eggs, chicken, fruits, vegetables

2) Clothes

3) Utilities eg Water

4) Utilities eg Electricity

Most people have harped on basic goods being staple foods. While that is one way to look at it, there IS a point that the well off stand to benefit more because they do tend to eat more. There is a possibility that the Finance Ministry has done some research showing that well to do people tend to be bulimic and thus eat ten times the amount of food and then vomit 90% of it out.

Next we come to clothes. Now you're probably getting the idea. Do you draw a line between "luxury clothes, not-so-luxury-clothes, staple-clothes"? Minefield there.

Water and Electricity is the next stop. Well we all know that the rich live in bigger houses and have more lights and sleep in airconditioned homes etc. So usage would be much higher than the poor.

I think the REAL reason why the government does not want to exempt "basic goods" from GST is because of the LOST income in taxes from the rich rather than because it would help the poor.

That seems the more likely answer, but of course it is politically not a wise statement to make.

No more dr Oz bloke, just me