After a well-needed break last month, this hobbit is back with some New Year Wishes for 2019. Yes, some of these wishes are not exactly new stuff but hey, it’s like new year resolutions to lose weight. If it doesn’t happen, then you wish or resolve again in the new year!
MOH will finally fix all the lacunae in healthcare regulation – those “grey” area that have hitherto been deemed to be not worthy of direct regulation by MOH: Managed Care, Third Party Administrators, Medical Concierges and even Referral Portals that claim to represent all doctors.
These folks working in the shadows have been making a lot of dough because of MOH’s inattention and inertia!
Now that we have fee benchmarks for doctors’ procedure fees in place, it’s time to expand the scope and look at hospital, facility and implants charges etc. If not, private healthcare costs will continue to rise at an unsustainable rate.
Someone should look at public healthcare financing. The recent incident where an SNEC patient was only reimbursed for $4.50 from MediShield Life (MSL) is plainly unacceptable. Apparently, it’s because in this case, the patient went for the same procedure for both his eyes but MSL only allowed the claim to be made for one eye.
If possible, operating on both eyes actually is more cost-efficient and saves money in the long run. But if the funding mechanism cannot support such practices and generate bad press, then surgeons have no choice but to operate on one eye at a time. So much for innovation and efficiency.
The big healthcare news of 2018 was the Singhealth Cyberattack. We should learn from this incident and take a hard look at how IHIS is structured and governed. There is nothing much worse than a “monopoly vendor” whereby customers have to buy essential services or products from only ONE vendor. That’s what IHIS is – the public healthcare clusters have to buy essential IT services from ONE vendor – IHIS. Think about it, if you had to buy rice or toilet paper from only ONE supermarket operator….
Also arising from the ashes of the SInghealth Cyberattack – new laws should be passed that spell out clearly and safeguards patients’ privacy, confidentiality and security rights. The current situation whereby a National Medical Record (NMR) is exempt from PDPA requirements and the MOH/MOHH/IHIS guys “ownself regulate ownself” is unsatisfactory. Even if there are no new laws enacted, the whole NMR programme should be placed under PDPA to instill public confidence. Only with public confidence restored will public buy-in be re-established and the NMR initiative be put back on track.
Leadership renewal should be managed sensitively and transparently, especially in public institutions with a sizeable pool of talent and experience. In choosing a leader, one must balance the need to have a person who is perfectly aligned and loyal to the masters, as well as having a record of excellence and service to the institution. If it is too tilted towards one way or the other, either the larger system suffers or the institution in question suffers. If this sounds rather cryptic, just look at one of these institutions, resignations are spreading faster than a poorly differentiated cancer. The pool of talent and experience there is evaporating faster than a puddle in a dessert. Even neutrals will quit quickly when they realise meritocracy is a distant second to alignment.
The Courts are setting the pace in medical negligence, with their landmark rulings in the last few years. The Modified Montgomery Test is one such example. The recent judgment on the liposuction death is another. This hobbit hopes the SMC can also say something on important medical legal matters before the Courts issue definitive judgments (by which ‘case law’ is made). If SMC speaks up and provide guidance beyond the Ethical Code and Ethical Guidelines as well as the Handbook of Medical Ethics, the Courts will certainly have to take into account what the SMC has said on a certain subject before judgments are made and new case laws are set in stone.
The advantage SMC has is that it can say a lot of things about a medical-legal subject at any time even when there is no existing SMC case ruling, with the objective of educating the medical profession. The Courts on the other hand, can only develop new case law when there is a case before them to judge.
Someone should really look at the number of people studying medicine, whether locally or overseas. We all can feel it in our bones that too many doctors are being trained. The legal profession and Ministry of Law have taken swift steps to address their glut. What about MOH and SMC?
The same principles must apply downstream to specialty training. The boom and bust in residency positions in recent times is really embarrassing.
ACGME-I Residency – Kill it or keep it? This is a tough call politically even if logic dictates otherwise. Even if no one wants to press the kill button, at the very least, we should really remove the double-yoke from our residents immediately – of having to fulfill ACGME-I requirements and passing the UK exams. Just let them choose one or the other. Stop testing them or examining them to death.
Family Medicine should be made a specialty and those with the FCFP qualification should be recognised as specialists by the Specialist Accreditation Board (SAB). Plain and simple