Treat patients based on needs, not ability to pay

03 Jun 2005, The Straits Times

Question

Name of the Person: Leong Sze Hian

Treat patients based on needs, not ability to pay

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?

Reply

Name of the Person: Ms Bey Mui Leng

Assistant Director, Corporate Communications for Permanent Secretary

Ministry of Health 

Patient's needs are based on objective clinical assessment 

We agree with Mr Leong Sze Hian that public hospitals should "Treat patients based on needs, not ability to pay" (ST, Jun 3). This is indeed our approach. 

A patient's needs are based on objective clinical assessment, not a layman's individual preference. 

Hence, at the Emergency Department, all patients requiring urgent medical treatment are immediately attended to, regardless of their paying status. Others will have to wait their turn. 

For 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.