17 June 2005


"Next time, I'll just take a Panadol."

Straits Times, June 17, 2005
Making sense of health-care dollars
By Radha Basu

A 92-YEAR-OLD man walked into a Tanjong Pagar doctor's clinic on Wednesday night to seek treatment for a common cold and fever. The visit cost him $64.

Citing this example, his son-in-law, a well-heeled doctorate holder, complained to the Health Minister last night that medical costs were getting 'too unaffordable', especially for people well beyond the insurable age like his father-in-law.

The minister's response: 'His insurance is that he has a good son-in-law.'

With a mixture of witty repartee and cogent arguments, Mr Khaw Boon Wan stoutly defended his ministry's policies and candidly offered his own view on health care at a dialogue with National University of Singapore alumni and health-care professionals last night.

The topic of discussion: Is falling sick more scary than death?

The minister reiterated the long-held policy that the Government would not underwrite the medical expenses of the rich at the cost of the poor.

Pointing out that even barbers charged $20 for a haircut - as his did, even though it wasn't a 'fancy' one - the minister said that surely doctors could charge $64, especially since that cost included medicines too.

'If you feel health care is important, then you must be prepared to spend a certain
percentage of your income, say 10 per cent, on it,' said Mr Khaw. 'You can't say
health care is important but please could the Government pay for it.'

Citing Asian values, the minister said, where possible, children and other relatives should foot old folks' bills. 'They brought us up, we must be prepared to support our elderly.'

However, he added that those who could not afford to pay their medical bills would be taken care of by schemes such as the $2 billion Medifund.

The lively two-hour discussion, chaired by eminent eye surgeon Arthur Lim, also touched on contentious topics such as competition within the two public health-care clusters, waiting times at hospitals, why Singapore needs to attract foreign patients and when to pull the plug on the terminally ill.

When a member of the audience, Mr Johnny Tan, asked whether it made sense to have two competing public health-care clusters in such a small nation, Mr Khaw retorted: 'I am less interested in structure than substance.

'Is there a role for competition in health care? The answer is yes.'

Competition, he explained, drives down costs for patients. One of the most competitive 'medical businesses' here, he said, was obstetrics care - the delivery of babies. There were many players in the field, he pointed out, and the competition had kept prices flat for the past 10 years.

Prices for laser eye surgery were another case in point. After the ministry made public the prices charged by the various institutes for the surgery - some of which were 'ridiculously high' - all the institutes started lowering their prices.

'When there is competition, there is a limit to the premium we can charge,' said Mr Khaw.

The minister also denied that foreign patients would crowd out Singaporeans in the island's bid to become a medical tourism hub. Instead, practising their skills on an increased patient pool would only increase medical practitioners' expertise. 'The more you practise, the more skilful you are,' said Mr Khaw.

This obviously was a wide-ranging discussion and the ST could not realistically have reported more than the gist. Khaw's comments, in totality, would not have been as simplistic as they appear above. So we have to give the man some benefit of the doubt. My observations anyway:

The $64 example

Someone raised the example of a doctor charging an elderly patient $64 for treatment of a common cold and fever. Khaw's response was that the $2 billion Medifund was available to help the very poor, and that Singaporeans should support their older relatives.

This answer is not very satisfactory. The fundamental point remains unaddressed. Has basic healthcare become unreasonably expensive in Singapore? That is the question. It is not so relevant whether the patient is a 92-year-old retiree or a 45-year-old Chief Executive Officer who owns a bungalow and two BMWs.

The real point is whether Singaporeans are paying too much for basic medical treatment. For example, is $64 a fair price for treatment of a common cold and fever?

Mr Khaw's $20 Haircut

Mr Khaw, enjoying his million-dollar salary, probably does not know this. But there are many barbers who do not charge $20 for a haircut. There are still many places in Singapore where a man can get a haircut for half that price. Personally speaking, Mr Wang Zhen gets a $10 haircut at a barber shop along City Link.

Mr Wang Zhen wonders whether Mr Khaw's $20 haircut example is another sign that our million-dollar ministers have lost touch with the ordinary Singaporean.

Obstetrician's Fees

Mr Khaw mentions that competition will keep medical fees down. For example, he notes that competition has kept obstetricians' fees flat for many years.

Mr Wang Zhen feels that it is difficult to draw any generalisations about Singapore's healthcare costs using obstetricians. Obstetricans' fees are an anomaly. The main reason why they have not risen over the past 10 years is that many Singaporeans have been refusing to give birth for the past 10 years.

In contrast, Singaporeans cannot refuse to have a common cold or fever. There is no choice in such matters.

Laser Eye Surgery

Laser eye surgery is another poor example cited by Mr Khaw. Mr Wang Zhen wishes that Mr Khaw was able to point to better examples, such as those relating to diseases and illnesses where professional medical treatment is essential. For example, what is the cost of medical care for people suffering from heart disease? Breast cancer? High blood pressure? Diabetes?

Laser eye surgery is a poor example because laser eye surgery is generally not necessary. If you cannot afford it, you just wear glasses and that's that. Yes, you are inconvenienced if you want to go swimming or play tennis. But since Martina Navratilova used to win Wimbledon and US Open tennis championships wearing her spectacles, you really have no cause for complaint.

The Grapevine Chatter
1. The Lovers & The Dreamers


Gilbert Koh aka Mr Wang said...


Maybe Singapore's bloggers should get together to start a new blog
"Consumer Singapore" where we exchange information about the best-value-for-$$$ goods / services; in Singapore or in neighbouring countries.

takchek said...

In a 'free' market, consumers would know the supposed prices for a particular product/service.

In Singapore's case, sometimes we don't know (and can't have access to) the 'right' price and then consumers get cheated.

Anonymous said...

Instead of seeing it as a rich vs. poor issue, one could see it as an issue of citizenship rights. There is no point talking about Asian values and what children "should" do for their parents when, practically speaking, the poor/ the elderly are not assured and ensured of the access to medical services.

In any case, the rhetoric of Asian values triggers a vicious cycle. When they are young, children use their money to "support" the elderly parents. The hefty bills limit their savings. When they grow old, they are dependent on their children. The same thing happens to their children and so on... (Different story if both parent and child are multi-million dollar ministers).

The issue is not about the individual's values responsibilities but about the state's obligation to ensure a minimum quality of life for the people. If the state thinks it does not even have such a responsibility, it is no better than a leech or a parasite.


P.S. Mr Khaw, Molly could stop herself from cutting her hair or even do it herself. But Molly cannot make medicine herself unless Molly goes up to the mountains and pluck herbs as they do in period dramas. But there will probably be some sort of tax for doing that in Singapore one of these days.

Beach-yi said...


the supposed to know prices is really just an assumption for economists to assume away the complications of information assymmetry.

You already know that right?

Anonymous said...

Any state welfare is a vicious cycle too. You will always be taxing the working and/or consuming population in order to provide benefits/services. The US and Australia are showing signs of winding back of benefits/services in view of their ageing population.

If you are asking the state to provide better and cheaper (perhaps free) medical services, you are actually asking for a more 'egalitarian society' by redirecting wealth from the relatively rich to the relatively poor. This is already happening in Singapore to a certain extent. Everyone says the state should do more, but isn't this really 'class wars' in disguise? Are there other ways to redistribute the wealth without involving the state? Perhaps a little tweaking of the balance is in order, albeit cautiously. Unless you think that the state should just print more money, which creates a whole new set of problems altogether.


Anonymous said...

If the state is going to take a passive role, perhaps it should also stop the CPF scheme and all its ideological mechanisms such as the rhetoric of "Asian values." It is interventionist and doing so at the expense of the poor whilst leeching the population with taxes and multi-million dollar ministers. The working and consuming population is already taxed heavily in many ways--the question is one of how to use the resources I guess.

I'm sorry I can't find a utopia on Earth to provide a perfect model for the state to follow. But I think there is no need to think in terms of extremes.