This is part 2 of a 3-part focus on healthcare in Singapore. Part 1 can be viewed here.

By Leong Sze Hian

F4.April 2007 – FEES COMPETITION:

In April 2005, 22 clinics that were willing to charge the same $8 fee as polyclinics were told by the Singapore Medical Association (SMA) that they could not list this information on a medical services website, because it infringed the SMA’s advertising guidelines (‘Does’ ads allowed, so why not discount scheme?’; Straits Times, April 13, 2005, and ‘Why stop doctors from charging polyclinic rate?’; Straits Times, April 5, 2005).

As a result, all 22 clinics stopped offering the $8 fee. Now that the fee guidelines have been withdrawn, will these 22 or more clinics offer the same fee as polyclinics again? By the way, since polyclinic fees have been increased to $8.80, it may soon be cheaper to go to a private clinic at $8.

F5.March 2007 – HEALTHCARE COSTS:

The 80-cent increase for polyclinic fees may seem small in absolute terms, but it is a 10 per cent rise.

According to the Department of Statistics’ (DOS) Singapore, 1965-1995 Statistical Highlights: A Review of 30 Years’ Development, government operating expenditure on health as a percentage of total government operating expenditure has declined from 9.5 per cent in 1970 to 7.8 per cent in 1980, 6.5 in 1990, and 6.3 in 2005.

The distribution of government health expenditure to private health expenditure has changed from a 50/50 percentage split in 1965 to 25/75 in 2000.

This trend of increasing fees for the lowest segment of needy Singaporeans should be curtailed or reviewed. The benefits of workfare and GST offsets for the lower-income may be diminished by all these increases in basic necessities and services.

While I can understand and appreciate the need to raise fees, I would like to suggest that fees for C class wards and polyclinics be kept unchanged by having perhaps higher hikes for higher class wards, because the needy should be spared the brunt of rising costs of so many increases all within a period of just one year.

F6.February 2007 – DRUGS LICENSING:

On the licensing and registration fees for medicinal and cosmetic products, before 1991, there were hardly any fees payable for the registration of medicinal products. When registration began in 1991, the per product licence fee was $66 a year.

Since a new regulatory agency was created a few years ago, the fees have increased to $80, $100, $120, $360, $750, and up to $77,500 per first year, in 1992, 1996, 1998, 2003, 2006 and 2007 respectively.

Not counting 2007, this fees increase was at a compound rate of 18 per cent a year, for the last 15 years until 2006.

This has resulted in pharmaceutical businesses reducing their product lines and is also a deterrent to expanding their product ranges in Singapore. The higher costs are also being passed on to consumers. More Singaporeans are buying from Johor Baru and neighbouring countries.

For example, the price of Norvasc 5mg tablet box of 30 for heart condition and Lipitor 10mg is $28.70 (RM65) and $55.30 (RM125) in Johor Baru, compared with $75.20 and $96, respectively, in Singapore.

To put this in perspective, according to the ChannelNewsAsia programme, War on Cancer, on Feb 11, the cost of cancer drugs has gone up 500-fold over the last decade.

F7.December 2006 – INCREASE FOR FOREIGNERS, WHO PAYS?:

Increasing medical costs for foreign workers may lead to employers reducing the take-home pay, particularly for lower-skilled workers.

In the past, when foreign worker’s levy, accommodation requirements, polyclinic and Communicable Disease Centre fees, were raised – take-home pay generally declined. With the increasing trend of outsourcing, particularly for low-skilled work, employers in the outsourcing industry typically have quite low margins, and are thus quite sensitive to higher labour costs, which they may have some difficulty in absorbing, because they may already have committed to long-term contracts with fixed pricing.

A spokesman from the Humanitarian Organisation for Migration Economics has already raised the concern that the increase in medical costs will be passed on to workers.

Instead of removing the subsidy for foreigners, reducing it for permanent residents, and maintaining the status quo for Singaporeans, why not increase the subsidy for Singaporeans using the expected $36 million additional revenue?

Since many Singaporeans may have to bear the brunt of the increase for foreigners and permanent residents for whom they are responsible for, it is akin to a no-win situation for everyone, if the savings are not channeled directly back to citizens.

I would like to suggest that we explore the possibility of not charging foreigners and permanent residents more, but giving more to Singaporeans instead.

In so doing, all will be happy, instead of one out of four (non-citizens) on the island being unhappy, and perhaps another one or two of the remaining three (citizens) being unhappy too, because they may have to pay for the former.

Why not use some of the hundreds of millions collected in foreign worker levies annually, so that Singaporeans do not have to end up paying for them? In trying to address the issue that Singaporeans should have more privileges than non-citizens, are we inadvertently creating other problems for Singaporeans?

F8.December 2006 – EMPLOYERS’ HEALTHCARE COSTS:

Who will pay for the higher medical costs of the 160,000 foreign domestic helpers? Singaporean employers.

Who will pay for the 420,000 low-skilled non-domestic foreign workers? Singaporean employers, including many small businesses that may just pass on the higher costs to consumers — again, Singaporeans.

The 65,000 highly-skilled employment pass holders and the 25,000 mid-skilled workers holding S-Passes are generally on more generous employment contracts, which typically include perks such as paying for the medical costs of the employees and their family.

Therefore, any increase may drive up business costs, which may also be passed on to customers.

About 30 per cent of Singaporean men married foreigners and permanent residents (PRs) last year. Who will pay for the medical costs of their spouses and relatives? Of course, Singaporeans.

Perhaps foreign entrepreneurs and foreign students will also bear the brunt of the increase. There has been much debate about the problems of parents accompanying young foreign students here and the situation of the older students. The increase may add to their financial burden, which may have even greater social implications as they strive to earn more income here.

By increasing the costs of living and doing business, it may become harder to attract foreign investment and talent. At the end of the day, who may suffer? Singaporeans.

By the way, polyclinic charges for foreigners have already been increased from Jan 1 this year, when consultation and prescription subsidies were withdrawn for foreigners and a 50-per-cent cut was implemented for PRs.

F9.November 2006 – DRUG REHABILITATION?:

The first two Subutex abusers were jailed under the new tougher laws which have longer-term jail terms. Let’s just imagine and try to put yourself in the place of a Subutex user.

In the first place, it was prescribed by medical practitioners. So, should Subutex users be entirely to blame for ending up addicted to a drug that was approved by the MOH in 2002, to solve the heroin addiction problem, but became an even bigger problem?

If you were asked to voluntarily sign up for the rehabilitation programme within two weeks or be forced to undergo rehabilitation if caught, you would be understandably afraid that you may not be able to take the cold-turkey treatment.

So, you would likely err on the side of caution and give a fake identity, address and contact number. Some may have adopted a ‘wait-and-see’ attitude, to see how others fared.

True enough, the worst fears have come true, as shown by the large number who have skipped treatment, and gone into hiding. About half of the 3,000 Subutex abusers who initially signed up have dropped out.

If the programme had started with a small number as a pilot test, so that we can learn from the experience, one step at a time, to make it a success and to encourage others to follow, wouldn’t most Subutex users be better off now?

Instead of encouraging you to seek treatment again, the penalty of up to seven years in jail and six strokes of the cane, is akin to sentencing and punishing you for good, even though you have tried to kick the habit, but found it unbearable.

According to the dictionary, rehabilitate means ‘to restore to a condition of good health’. How can a rehabilitation programme fail to rehabilitate the majority, but punish the majority instead?

After this saga of a rehabilitation programme that has failed miserably to help the majority of users, who in his right mind would volunteer for drug addiction treatment in future? Perhaps it should be called a drug punishment instead of a drug rehabilitation programme.

You can read part 1 of this 3-part focus on healthcare here.