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