Protecting patients in S'pore's health services
Protecting patients in S'pore's health services
SINGAPORE: The objections voiced by the Singapore Medical Association (SMA) against night polyclinics and the Faculty Practice Plan (FPP) would strike many as a bid to protect the not-inconsiderable income streams of general practitioners and specialists in private practice.
The former move extends the service hours of polyclinics, while the latter allows public-hospital specialists to treat some private patients. The SMA's outburst is conduct unbecoming of a group of men and women who have pledged their lives to healing others.
Such deregulatory initiatives are consonant with the leitmotif of globalization, open competition and the rule of market forces in Singapore. The health-care sector cannot expect to be exempted.
Of course, the SMA did not oppose the government's earlier liberalizing move that allows private-sector specialists to use public facilities in restructured hospitals and specialist centers at full cost -- because this helped private practitioners.
Doubtless doctors, specialists especially, do not see anything wrong with asking for prices which they think the market will pay, however grudgingly.
But they forget that they can charge those rates only because there is an artificial cap on the supply of service providers like them.
In economic jargon, there is a market distortion. While it is to be expected that SMA would seek to advance the interests of members who are private-sector doctors, the government is under no such obligation.
As the 1993 White Paper on Affordable Health Care states in no uncertain terms, the government will "intervene directly in the health-care sector, when necessary, where the market fails to keep health-care costs down".
In this instance, its initiative is surely on higher moral ground than the doctors' response. For the Health Ministry's plan reflects two eminently defensible notions that could improve health care for the poor: caring for more people more of the time, and giving them more choices.
In stark contrast, the ethical foundations of the SMA's position are incomplete and inadequate. It focuses on what doctors think they are entitled to; it marginalizes those not benefiting from employment-based health insurance; and it does not ensure coverage of the poorest and the under-served.
Instead of disguising their pecuniary concerns as principled worries about night polyclinics being an inappropriate use of limited public funds, or the FPP leading to lower standards of care for subsidized patients, groups of doctors can organize themselves to provide competitively-priced services while ensuring that health-care quality remains sound.
In the past, the differences between public and private health care were clear. One was subsidized and, therefore cheaper, the other personalized and, therefore, more expensive. But with restructuring and liberalization, the lines are blurring.
Private services in public hospitals can be competitive against private-sector health-care providers, what with the former's size and more comprehensive array of specialities.
Not only is there no economic rationale for restructured hospitals to stay out of the private market, but the move is also likely to reduce specialist flight to the private sector, which is in the public interest.
As competition leads generally to lower prices and better service - and there is no reason to believe that the law of supply and demand does not apply at all to the health-care industry - the SMA should not fret but, rather, embrace competition as, increasingly, a fact of life.
-- The Straits Times