Cutting Waiting Time at Government Hospitals: Have Private Patients Seen at Private Hospitals

21 Jun 2005, The Straits Times

Question

Cutting Waiting Time at Government Hospitals: Have Private Patients Seen at Private Hospitals

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'?

Reply

Reply from MOH 

Good Basic Medical Care Accessible to All 

In "Cutting Waiting Time at Government Hospitals: Have Private Patients Seen at Private Hospitals" (ST, Jun 21), Mr Leong Sze Hian suggested that public hospitals do not serve unsubsidised patients. If they do, Mr Leong felt that the hospitals would end up being discriminatory as patients would inevitably receive different treatment or levels of service. 

Much as this would be an ideal, no society can guarantee equal treatment for all patients. In practice, for example, even the same surgical procedures performed by two equally-competent consultants cannot guarantee identical outcomes. 

But what is achievable is to ensure that all patients have equal access to good basic medical care. For example, all patients with emergency medical conditions will receive immediate medical attention, regardless of their paying status. 

For non-emergency elective cases, service levels do differ. For instance, unsubsidised patients expect and are prepared to pay for branded drugs, when generic drugs will suffice. They would be most unhappy if we do not dispense such drugs. 

To reduce waiting time, Mr Leong would like us to emulate the British National Health Service. But we have been able to achieve better waiting times. According to UK data, the waiting time in 2004 for cataract surgery was up to 8 months; 11 months for hip replacement surgery; and 12 months for knee replacement surgery. As a result, patients who can afford it opt out of public hospitals for unsubsidised care. The end-result is that a non-discriminatory outcome remains elusive.