Home Forums Discussions General Discussion Healthcare in Singapore

No, this is not a joke! As part of my medically-imposed vacation, I have been reading a bit about various healthcare systems, and someone sent me some info about Singapore's. They actually have one of the best. I was just about to respond to the spammer's thread, but when I hit "submit", the original post was deleted. So I am putting it here...please don't delete me!
Singapore is an independent country, not part of the PRC.
They actually have an extremely efficient, cost effective health care system. It is consistently ranked highly (far higher than the US), costs much less, and covers a greater percentage of the population than our own. It does so with a mix of public and private systems that we might be smart to model.
Just take a look at the Wikipedia page. Imagine if you could describe our whole system, including the entire description of "means testing" on a page or two.

If xierdaxinxi was trying to sell us a healthcare system, rather than almonds and eggs, I might be interested in buying.

Jon,
I have never been to Singapore but my brother in law the IT guy down in Ft Worth/Dallas area has spent time there. Several things come to mind the population density is quite different, I think 1200 per sq. mile vs less than 0.1 per acre in Montana--I think are the numbers we ran when he was there about 3 years ago. Also the country is extremely affluent and much smaller ( I think smaller than Delaware). I don't pretend to know anything of the medical system there but the country itself is quite different than here--I know I am stating the obvious. jimmie

You are absolutely right, Jimmie. Singapore is more comparable to a big city in the US in terms of size and population density. One of the challenges for the US healthcare system is our tremendous economic and demographic diversity.
Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt.
The specific features of the Singapore healthcare system are unique, and have been described as a "very difficult system to replicate in many other countries."

Still, I think we have something to learn from them.

It is a pretty amazing healthcare system, with government involvement limited to regulation. The fees are kept down partially by competition, since there are no "free" services -- everyone must have savings and pay something. It also allows for a patient paying for extra services and supplementary private insurance.

In other words, everything that the Affordable Care Act is not.

These are part of the ACA.

From what I have read, the "Cadillac health insurance policies" will be discouraged by taxing the policy cost under the ACA.

As far as the balance billing issue, this can be passed onto the patient by "out of network" providers, but won't be the responsibility of the healthcare plan, except in emergency situations. Highly unlikely to get paid by an out of network patient, in my experience.

So we agree; the ACA DOES allow for a patient paying for extra services and supplementary private insurance.

Notice how in Singapore it is "extra and supplementary services" and here it is "Cadillac policies" and "out of network providers".

True. Not ideal, but true.

Jon,
thanks for the link, and finally got to read about Singapore medical system. I'll talk to my brother in law and see if he as a foreigner got to experience the medical system at all while there--I recall he really loved the culture and the country itself, and was extremely impressed with the work experience.

I am enjoying how the US is being compared to a country that:

* Controlled its post world war II baby boom with public exhortation among other things.

* In the 1970's began to actively encourage educated females to have children and actively encourage uneducated females to get sterilized.

* After realizing they had gone to far with the post world war II family planning programs, are now offering bonuses to get people to have babies as their replacement rate is too low.

* The elderly are only 8.3% of its total population as opposed to a much higher percentage in the U.S.

Point: It is not enough to say: "such and such country has a better healthcare system than we do so we should mimic it." We should also be asking questions such as:

* Does such and such country have a large elderly population like we do?
* Do the people of such and such country have the same ethnicities that we do?
* Do the people of such and such country have high salt diets like we do?
* Do the people of such and such country have high sugar diets like we do?
* Do the people of such and such country exercise more or less than we do?

It's easy to have a superior health care system when your people are less inclined to be 60 lbs overweight, less inclined to be lifetime smokers, less inclined to be life time drinkers, etc. In fact, at that point I'd say most any health care system would work. It's easy to boast a superior infant mortality rate when most of your moms are highly educated women (remember: you discourage the uneducated ones from having kids) who know to keep their diet clean to avoid things like gestational diabetes.

The issues of health care in the US are the result of a high demand but low supply. Too many people in this country are sick - even the young generation (they are all overweight and diabetic). Further, the issues you as doctors deal with include, but are not limited too:

* A population that honestly expects to be healthy and have a pill to cure everything without any effort on their parts. Let's be truthful, most of the stuff you guys deal with is completely preventable if the patient would just stop eating at McDonalds and get a Gold's Gym membership.

* Attempts by the government to control the pricing fluctuations that are the result of supply and demand. Remember your economics class? How much more money would some of you be charging if you could charge what you wanted? I have seen many complaints on this forum from those of you who consider your reimbursements for some procedures to be completely unfair (read: to low).

* Criticism created by the fact that too many doctors are poor business people. I'm sorry, but I think way too many doctors should just work for a group or hospital as an employee since they don't have a clue as to how to run a business. I hear doctors complain all the time about employee issues, IT expenditures, dealing with accountants, and all this other stuff that "stops me from seeing patients every second of every day." Sorry for your tough luck, but all that goes with managing a business and many doctors simply have no idea how to difuse employee issues, budget for various expenditures, or figure out what their accountant is asking for. In many cases your college did not make you take business classes while you were getting your degree. In other cases doctors fail to realize that just because they are a ninja with a scalpel doesn't mean they are Warren Buffet with a bank account.

Unfortunately, there are no easy answers to any of these problems. Even if you can wave a magic wand to make everyone stop eating junk food and start doing 3 hours of cardio at the gym every week it's already too late. Most of the damage has been done already. We have one of the largest baby boomer populations in the world and they all suffer from a life time of smoking and drinking (remember back in the 70's and 80's when you were growing up how it seemed that EVERYONE smoked?). We have too many youths that are already diabetic.

As a society, we should have started seeking answers to these problems 20 years ago. Since it is already pretty much too late, we have 30 more years to go before things start getting better.

JamesNT

JamesNT,

My father in law is a farmer and showed me an article a few years ago that compared the percentage of millionaires comparing physicians to farmers, and the percentage of millionaires was substantially higher in the farmers.
Only 1% of the population are farmers producing not only the majority of the food for the good ole US of A, but also exporting to other places (?Singapore)
My brother in law who has taken over the family dry land wheat farm has to be one of the most savy business men I have ever met in my life. Typical expenditures are relatively fixed such as property tax (on 20,000 acres can buy you a brand new Yukon Suburban) a combine with a 36 foot canvas fed header is about 450 grand, and during the harvest you may need 5 of those machines running from about 9am to about 1am till the moisture starts gumming up the wheat feeding into the header. You have to do this for about 3 straight weeks as the weather allows till you get your grain in the bin. Fuel costs for a season could probably buy your house and the chemical costs are about what fuel costs.
Then you have the world market causing the fluctuation of wheat and if your protein content is no good then the price bottoms out, my point is what we as physicians do from a business perspective is much simpler on a daily basis then a lot of other people, particularly farmers.
I would argue that most if not all of the docs that have gravitated and utilize AC are extremely business savy and I suspect have extremely well honed people skills/managerial skills. Now the typical AC user may not reflect physicians as a whole and maybe your point about doctors being poor business men may generally be true. Just 10 years ago 40,000 docs were employed by hospitals, now over 110 thousand are hospital employed, so there has been a significant shift in just this decade. But I think the doc in a small office and a farmer do have a lot in common. If one just uses good common sense and remembers simple mathematics, overhead - collections= what i put in my wallet; one does control his own destiny. I think the physician who chooses to run his own business can not only survive but excel in this current environment, especially with a fantastic software product like AC, and combine that with guys like Bert,Leslie, John, Jon etc. you can't ask for a better profession in my opinion--I'd do it again in a heartbeat.
The Singapore stuff--I claim little knowledge other than discussing with my other brother in law the IT guy who spent 3 weeks there several years ago.

Jimmie,

As I have discussed with Bert and others, when I discuss "doctors in general" I am obviously NOT talking about those on the AC forum.

As for doctors successfully running their own business, yes, there are clearly exceptions to the rule. We don't worry about the exceptions because they are making it. We worry about the rule. The ones who are having a tough time and also happen to represent the majority. As you pointed out yourself, the number of docs that are working for hospitals is way up.

Please extend my congrats to your father-in-law for being successful. However, even the majority of farmers are not good business people. The majority of farm land in the US is now owned by corporations, not family farms (note: I am counting family farms that are also under contract by a corporation in this group).

After reading my previous post again, I do see where I need to do a better job of making it clear that I am not talking to "you" as in the person reading the post. I overuse the word "you", I think.

JamesNT

JamesNT,

My father in law was sitting in the dermatologist office waiting room the other day and started chatting with an elderly couple, and they found out that he farms close to a casino on an indian reservation that just opened up a year or so ago, and the couple were amazed he hadn't been to the casino yet being so close. they would travel about an hour and a half once a week or so to do a little gambling, on a regular basis. My father in law's response was I gamble on a daily basis, I'm a farmer--and that's about the truth--but thank you for your response.

Thank you for yours.

JamesNT

I live on a small farm (walnuts) and play at farming, but certainly don't call myself a farmer. I have way too much respect for farmers (more friends in farming than in medicine). Don't know any that go to casinos, or Vegas, etc. they too say they gamble every day, and would make any "high roller" look like a Penny ante poker player. I've seen ane entire year's income wiped out by a few days of freeze, and entire year!
God bless the farmers, and Jimmie, please pass tht on to you dad.

Roger,

I should apologize to Jon for screwing up his thread, but I have never seen or heard of a walnut farm. You have me intrigued. Back in West Virginia (lived there for 10 years)we would get the walnuts as they dropped from the black walnut trees, put them in burlap sacks and drive over them to dehusk them to get to the walnuts, and the black stain on your hands would take a week to go away, and I still recall the tangy aroma of the husks. Up here in Montana there aren't any black walnut trees that I am aware of. So not to get too personal, do you harvest the wood or the walnuts or both? I will pass your blessings on.

Jimmie,

We grow Chandler walnuts, a variety of English Walnuts. Interestingly enough they are English walnut trees grafted onto Black Walnut root stock, which is much hardier.
the San Joaquin valley grows something like 80% of the world production of walnuts.
My apologies to Jon as well.

No need for apologies, guys. This is probably more interesting anyway.

Plus, walnuts and healthcare go together. As a (nearly recovered) bypass patient, I learned walnuts are tops for your heart. Who knew?

And Jimmie, I will PM you about the emu; I am not sure how much general interest that topic holds.

Yeah, when counseling patient about omega three foods I include a conflict of interest disclaimer.

Roger,

What you said about the high roller poker player seem like a penny ante player, compared to a farmer is right on point. My last year in college I also took a course studying American-English Regionalism -and learned first hand after starting practice in Montana 18 years ago there is quite a distinction between farming and ranching, something at least growing up in Indiana, I never learned, and was not taught in the Regionalism course.
I learned rather quickly that a farmer grows plants and a rancher raises animals--I learned if I called a rancher a farmer, because in Indiana a farmer did both, I was chastised to no end, and was told what a poor lot the farmer is. Or if I happened to ask a farmer if he raised angus or charlois--I was likewise told what a wild beer drinking bunch the rancher is.
The other thing I learned early on is never ask either one how much land they operated/owned--"by God kid why don't you just ask what I have in my bank account!"
However, I have had the same experience with the farmers and ranchers as you have, and have seen where a years worth of work was wiped out by disease, drought, fire, price fluctuations etc... The scenario I described above about my brother in law could be any number of my patients, some on a smaller scale, some on a larger scale.
So when you brought up that you farm walnuts, it made me realize that walnuts are farmed and not "raised". So I hope my question did not seem derogatory. I had never thought about farming walnuts before.