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- 2May06: "Means testing itself is not wrong, but how to do it properly is tricky and needs time. Originally, I was more ambitious when I returned to (the Health Ministry) three years ago. I thought we could do means testing."
- Nov2006: "Mr Khaw dropped hints of retiring as he recalled how entering politics was never his wish"
- 7April07: Means testing may kick in within next 12 months
Oh... KBW has become ambitious again? Why the flip flop? ... oh, right, Kharma comes in waves...
Means testing put on hold
By : Tor Ching Li, TODAY
Date : 02 May 2006 0657 hrs (SST)
URL : http://www.channelnewsasia.com/stories/singaporelocalnews/view/206005/1/.html
SINGAPORE: Means testing - which would see public healthcare patients being charged according to what they can afford - will not be implemented within the next two years as originally planned, said Health Minister Khaw Boon Wan on Monday morning.
"Means testing itself is not wrong, but how to do it properly is tricky and needs time. Originally, I was more ambitious when I returned to (the Health Ministry) three years ago. I thought we could do means testing.
"But after discussion with people, I think let us do other proposals first," Mr Khaw told reporters during a Sembawang walkabout.
Instead, Mr Khaw said he would focus on revamping the MediShield national health insurance system and on improving healthcare for the chronically-ill.
He was responding to Workers' Party (WP) chairman Sylvia Lim's questions on how means testing for healthcare would be carried out.
She had raised the issue during a WP rally at Hougang on Sunday night, stating that present indicators such as house size and household income may not be accurate or appropriate benchmarks for how much a person could afford to pay.
"If we make the same amount of money, it does not mean we have the same amount of money to spend," said Ms Lim.
Mr Khaw stressed that nobody can fault the principle of means testing. This included WP chief Low Thia Khiang who, according to Mr Khaw, had raised in Parliament the idea of means testing for Government polyclinic patients because Mr Low felt that rich patients were "overcrowding" the heavily-subsidised polyclinics.
However, whether means testing will eventually be carried out will depend on whether it is practical to do so.
Said Mr Khaw: "I will do it only if it is practical, because the theory may be sound but if the implementation is more costly ... then it's not worth the effort.
"So whether to do it or not, I don't know. It depends on whether we can come up with practical ideas."
As for how long it would take to work this out, Mr Khaw replied: "I don't know. You know my attitude to work, I am single-minded about things and I focus my energy on a particular issue. Right now, my big issue - besides Sembawang - is the chronically-sick. I think they can get better healthcare than they are receiving now."
When asked for his response to WP candidate Perry Tong's proposal for the Government to scrap the Goods and Services Tax (GST) on drugs - as well as to charge at cost medication for chronic illnesses such as high blood pressure and diabetes - Mr Khaw said the answer to rising healthcare costs was not so simple.
"If it was so simple that just one or two simple ideas from Perry Tong and the whole healthcare issue disappears, we would not have healthcare problems around the world being such a major political issue, not just here," said Mr Khaw.
He accused the WP of trying to score political points by proposing populist healthcare solutions that have proved disastrous in Britain, Europe and elsewhere. In Britain, he said, patients wait for months for even simple procedures.
And ideas such as reducing GST for medical bills, which is already being done for subsidised patients, would benefit the rich more than the poor. Private hospital bills are many times the size of Class C hospital bills.
"Instead, our solution is to provide Class C with the greatest subsidy (at 80 per cent of cost)," he said. - TODAY /dt
Copyright © 2006 MCN International Pte Ltd
Reducing subsidies to the middle class... But: "complexity of means testing"... ..." waiting time is already very long... ... We will end up doing only means testing and no treatment. So it's not practical unfortunately."
Means testing may kick in within next 12 monthsChannel News Asia7 Apr 07
Means testing may kick in within the next 12 months, says Health Minister Khaw Boon Wan.
And the first to be affected will be patients in C-class wards who stay more than five days in hospital.
Patients in C-class wards now enjoy an 80 percent subsidy. But the Health Ministry realised that not all patients need such a subsidy, as there are some in the high income bracket who choose to be hospitalised in such wards.
To ensure that there is no abuse of the system, the Health Minister says means testing must be done on those who stay more than five days in hospital - the average length of stay. Means testing, which is a way to determine how much subsidy a patient should get, is already done in nursing homes and community hospitals.
Mr Khaw says: "We are in this business where all of us want to constantly improve our service level. But if your prices are wrong, if they are heavily subsidised or free or whatever, you are going to attract more and more patients to you, including those who can go to Gleneagles Hospital and Mount Elizabeth and so on. And we have very good doctors, very good specialists. So we know that at the end of the day, means testing are important.
"And until you introduce proper means testing, I'm afraid all these problems will remain, will simmer. I'm seriously thinking about all those who are long stay, who should now be discharged to community hospital, we should do means testing on them. Now they are saying that if they go to nursing homes they will be means tested but if they remain at SGH they are not means tested, therefore it's cheaper - then we will never solve this problem."
Mr Khaw says for those who can afford to pay more, their subsidy may be reduced to less than 80 percent but they will not be asked to move to a higher class ward.
However, he is not keen to extend means testing at the polyclinic level for practical reasons. Mr Khaw says: "It's not just looking at your personal income - we are talking about family income here. The whole family should be supporting the patient. So therefore I need to know how many children you have and how much are they earning. And we cannot have self-declaration because everybody will say they are poor, they earn $800 when actually it may not be so. So you begin to see the complexity of means testing.
"We know that at our polyclinics, waiting time is already very long. If at the counter we are going to start asking all these questions, you know, I think we cannot do business. We will end up doing only means testing and no treatment. So it's not practical unfortunately."
Mr Khaw was speaking at a dialogue session on on Saturday with unionists in the healthcare sector, where he answered several questions.
[Abridged]
http://www.geraldtan.com/medaffairs/meanstest.html#C16
SAF: our enemies will die laughing.
"Just before the accident, she had informed her family that she was feeling dizzy".
"She and her fiance were heading towards camp to hand the MC to her supervisor when she was killed".
Still cannot get over this incident...Dis is just so stupid!!!, either superior in charge an idiot, or the employee's a robot. Either way, a totally tragic yet stupid outcome has occured.
As I know, Ms Siti will be fully compensated by SAF because travelling to camp is considered 'service'. (Full workman com, salary 1 yr, insurance etc)- total waste of taxpayers $$.
And to add salt, the Army's recruitment website is totally idiotic i must say: " http://www.mindef.gov.sg/arc/intro.asp ": (is probably out to entice techno freaks); furthermore, like this one, the 2Lt Li Hongyi case simply typifies the fact that attention to HR, safety and dicipline best practises is seriously lacking. Thus shouldn't a formal inquiry be conducted? Similar:Warrant officer complaintReservist complaint
Home > Most Read Stories Oct 19, 2007
Bride-to-be killed in accident 6 days before wedding
She was thrown off her motorcycle and landed in drain By Elena Chong, Court Correspondent
Investigation showed that Ms Nur Baidura had apparently lost control of her 125cc motorcycle.
The bride-to-be, Ms Siti Nur Baidura Mohd Yusof, 22, was on her way with her fiance, full-time national serviceman Fareed Serlan, 20, to hand over her medical certificate at Maju Camp at Clementi Road on July 23 when the accident happened. No other vehicle was involved.
The couple were to wed in six days and invitation cards had been sent out.
An inquiry into her death heard that her fiance, who was riding pillion, was warded for five days for injuries to his face, knees and left elbow.
Investigation showed that Ms Nur Baidura had apparently lost control of her 125cc motorcycle along the right-most lane with intermittent gouge marks. She was thrown off from the motorcycle and landed in the drain.
Just before the accident, she had informed her family that she was feeling dizzy. She consulted a doctor at Bedok Polyclinic and was given a day's MC. She and her fiance were heading towards camp to hand the MC to her supervisor when she was killed.
State Coroner Ronald Gwee recorded a verdict of misadventure.
Her elder brother, Mr Mohammad Noor Azhar, 24, who attended the inquiry, is now riding her motorcycle which she had bought about six months before the accident.
He described her as a talkative, sporty and very active person, who loved karaoke.
'I miss her so much,'' he told reporters outside court.www.straitstimes.com/Latest+News/Courts+and+Crime/STIStory_168465.html
A committed and good journalist, salute him..."Mr Hwang acquired a reputation for short but incisive court reporting that showed up a lawyer's or judge's competence or otherwise."
ST> Home>
Legal eagles recall old days to mark Law Society's 40th year
19 Oct07.
CJ and top counsel share personal reflections in special issue of Law Gazette
By K.C. VIJAYAN (Law Correspondent )
MENTION the name TF Hwang, and lawyers who cut their teeth in the 1960s and 70s will smile.
One or two might even scowl. "TF" was a journalist who could make or break a lawyer's day with his reporting.
Mr Hwang acquired a reputation for short but incisive court reporting that showed up a lawyer's or judge's competence or otherwise.
Chief Justice Chan Sek Keong fondly recalled the then Straits Times court reporter's regular post-retirement column, "Down Memory Lane".
Mr Hwang died in April last year.
CJ Chan added that, given Mr Hwang's knowledge of the law, "magistrates would become reticent whenever he was in the courtroom".
Writing in the latest issue of the La~ Gazette, he recalled other nuggets about what law practice was like in Singapore from 1963 to 1986. He was then in private practice.
He and other luminaries were asked to write about the era by the Law Society to mark its 40th anniversary.
The other personal reflections included those from Singapore's Ambassador-at-Large Tommy Koh and Senior Counsel K.S. Rajah and Michael Hwang.
Among other things, CJ Chan reminisced about professional ethics, compensation for solicitors' frauds and the founding of tile Law Society.
He noted a lawyer's trade in the 1960s was "generally slow and easy going' and he did "everything that came along".
This was "unlike today when young lawyers had to specialise", and there is lack of opportunities for lawyers in large firms "to get into the act".
He said the changes in law practice have "been vast and in some areas unrecognisably so".
"If I were to start practice today, it is most unlikely that I will end my legal career in public service, such are the current and future economic and social forces that bear, and will bear, on law practice," he said.
Senior Counsel K.S. Rajah, who started work as a deputy public prosecutor in 1963, said in those days, "trade unions, students and secret societies were in defiant mood but prosecutors were expected to be fair, reasonable and present their cases fairly to court".
Among other things, he said as DPP, he would direct a police officer to produce an accused person before a magistrate when told the latter wanted to make a confession.
He noted that in the Gold Bars murder case in 1973, seven confessions were taken this way.
Mr Rajah noted that the procedure adopted by magistrates then was different from the current practice of the police in recording confessions at police stations.
Senior Counsel Michael Hwang said lawyers in the 1970s led an eventful life and had "time for each other".
"We were certainly a lot poorer than lawyers are now, but (arguably) we enjoyed our lives a little more," he said.
Writing in a personal capacity on law and diplomacy in the same commemorative issue, Professor Tommy Koh said the "Singapore's school of diplomacy is a fusion of hard-headed realpolitik and pragmatic idealism".
"Singapore's leaders and diplomats are known and respected for their unsentimental and logical analysis of international situations and regional trends," he observed.
vijayan@sph.com.sg
"each dead patient is an administrative convenience." "The NHS is run from top to bottom, and therefore, from top to bottom, it is bad."
The NHS wins when its patients die By Charles MooreLast Updated: 12:01am BST 13/10/2007
Florence Nightingale's famous Notes on Nursing, published in 1859, state that "the greater part of nursing consists in cleanliness". In my edition, the foreword points out that much of Miss Nightingale's writing, excellent though it is, is now out of date. In particular, the need for cleanliness is well understood. That foreword was written in 1946.
Now it is 2007, and we learn that nurses in the hospitals run by the Maidstone and Tunbridge Wells NHS Trust told patients suffering from diarrhoea to "go in their beds". Between 2004 and 2006, 90 patients treated in those hospitals died from Clostridium difficile, and the disease was a factor in the death of a further 241.
Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died. Indeed, they would not have contracted C. difficile at all unless they had gone into hospital. So, after 150 years' advance of education, technology, prosperity and science, we have lost what Florence Nightingale taught.
advertisementIt was the distressing subject of diarrhoea, indeed, that provoked Miss Nightingale to one of her most trenchant footnotes. She gave the example of how, if a bedpan with a lid were changed only once a day ("As well might you have a sewer under the room"), by a maid rather than a nurse, the problem might go undetected. he bedpan must be changed frequently, inspected, and all of it, including its lid, properly cleaned.
I notice that the Healthcare Commission's report on Maidstone says that stool charts, i.e. recorded inspections of the diarrhoea, were made in fewer than 15 per cent of cases.
Florence Nightingale adds: "If a nurse declines to do these kinds of things for her patient, 'because it is not her business', I should say that nursing is not her calling." It is a "waste of power", she says, for nurses to do things such as scouring floors, but if it needs doing, they must do it: "the true nurse-calling" puts "the good of their sick first, and second only the consideration what is their 'place'?".
The testimony of the families from the Maidstone area is that their relations who died were often humiliated, left in filth, and ignored. The weakest — the old — were treated the worst. It was a failure of systems, yes, but also of individual professionals and of common humanity.
Every year, as a journalist, I go to party conferences and hear politicians of all parties make speeches about how wonderful the National Health Service is. Gordon Brown got all weepy this year about how it saved one of his eyes.
Last year, David Cameron said that where Tony Blair had spoken of three words — "Education, education, education" — he would emphasise three letters — "N-H-S".
The point our leaders are constantly making is not medical, but moral. It is that the NHS embodies organised altruism. It proves that we, as a nation, care for one another. It makes us "the envy of the world", and it makes us good.
One naturally wants to agree. We all like to think that matters of life and death are well looked after. And most of us will have direct experience of NHS nurses and doctors who have treated us with great kindness, care and skill.
Nevertheless, the basic proposition is not true. The National Health Service is not, morally, or in any other way, the best system of healthcare in the world. Indeed, it is morally defective at its very root, because it does not — cannot — put the sick first. Until this is recognised, it cannot be reformed.
The NHS is, with our state school system, the last major survival in this country of the idea of the 1940s that government can decide what is best for us and make sure that it is done. Aneurin Bevan, who invented the thing, once said that not a bed-pan (that object again) should fall to the ground without the minister knowing about it.
A colleague of mine, who investigated alternative healthcare systems when the extreme dirtiness of many British hospitals first became an issue, went to France to compare. In hospital after hospital, he found floors so clean that you could have eaten your lunch off them. Did the Health Minister order them to clean them, he asked an administrator.
He was met with a look of incredulity. "Of course not. We run ourselves. Patients have a choice of hospital. If they do not choose us, we get no money. No hospital can survive if it is not clean."
Two weeks ago in Bournemouth, Gordon Brown was on to the subject of C. difficile, babbling about ordering "deep clean" and more than doubling the number of hospital matrons to 5,000.
"Bring back matron" has become a party conference cry, like "Bring back the rope" used to be. But matron will be only a name so long as Mr Brown (or whoever is Prime Minister) ultimately decides who should have what where.
We all know that a Minister for Industry could not possibly decide how many computers we produce or how many investment banks we should have. We all know that a Minister for Food could not wisely decree what vegetables should be sold in which shops.
But we cling to the idea that a single organisation employing 1.4 million people, with the GDP of an entire Scandinavian country, run by politicians, can meet our health needs.
Suppose Sainsbury's cold meat counter was found to have helped kill more than 300 people, would the company survive? Yet the NHS sails on, dealing death. According to a report four years ago by Professor Karol Sikora, we could save 10,000 deaths a year from cancer, just by hitting the European average; but we don't, and nobody takes the blame.
The boyfriend of the chief executive of the death-dealing Maidstone trust tells the press: "No way is she going to talk to you. Why should she?" The trust has arranged her severance pay of £250,000.
We all complain about the "target culture" that made administrators in Maidstone ignore actual human suffering before their eyes. But if you have a top-down system of healthcare, targets are the inevitable response to whatever is the latest disaster.
In this case, one of the targets was to cut waiting times in Accident and Emergency to four hours (four hours! You wouldn't put up with that to buy a cinema ticket, yet we have been brainwashed into thinking that it's not too bad for your child with a broken arm). In this world without choice, each claim of need jostles against another: either faster A&E, or cleaner bed-pans, but not both.
This is all, morally, wrong. It turns the patient from being the entity for which the service exists into a nuisance. Each new patient is just an added cost and each dead patient is an administrative convenience.
Under systems of social insurance, such as exist in Germany, Belgium or France, many problems remain, but this most basic one disappears. Money goes with each patient, who can choose who treats him. Therefore every doctor, hospital and nurse wants patients.
Our system also turns the nurse and doctor away from their duty, and therefore attacks their moral sense. It tells them to ignore "the habit of observation", which, said Florence Nightingale, was the key skill of nursing, in favour of through-put or targets or — for human nature reasserts its worse side when badly led — sneaking off home exhausted and disillusioned.
The NHS is run from top to bottom, and therefore, from top to bottom, it is bad.
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2007/10/13/do1302.xml
"Doctors have to meet higher patient expectations to minimise the risks of complaints and even lawsuits."Docs learn to avert patient disputes
Weekend • October 20, 2007
Sheralyn Tay sheralyn@mediacorp.com.sgDogged by rising numbers of complaints and lawsuits and the escalating costs of healthcare indemnity premiums, doctors in many countries have been leaving the profession in droves. While this trend has not taken hold in Singapore, the Government is keen to take steps to forestall this — especially as the number of claims reported to the Medical Protection Society (MPS), a leading indemnifier of health professionals here, is expected to rise here too. MPS, a UK-based not-for-profit organisation, has been in Singapore for more than 30 years and covers 90 per cent of doctors here. "It is increasingly more difficult for doctors to practise medicine today as compared to, perhaps, a decade ago," said Minister of State for Health Heng Chee How on Friday at the launch of MPS' Risk Consulting Service and Educational Services, which aim to teach doctors how better to prevent and resolve disputes.
"Doctors have to meet higher patient expectations to minimise the risks of complaints and even lawsuits."
As such, Mr Heng welcomed the entrance of MPS' training programmes which, among other things, teach better doctor-patient communication.
Dr Priya Singh, medical director of MPS, said: "Our experience is that where there is good doctor-patient communication, patients feel they have a good understanding of what went wrong.
"They continue to have trust in the doctor and are more likely to want to resolve things."
While the Subordinate Courts here handled only about 10 medical negligence cases a year between 2004 and 2006, the threat of lawsuits has driven up the costs of healthcare significantly.
Doctors find themselves having to pay higher liability insurance premiums over the years, and may conduct a battery of medical tests on patients to protect themselves against potential legal action.
For example, obstetricians pay $24,555 for annual MPS membership this year, up from $5,250 just six years ago.
According to Dr Ming Keng Teoh, International Medicolegal Advisor at MPS, there "may be a slight increase" in fees next year. Details are expected by November, he added. Copyright MediaCorp Press Ltd. All rights reserved.
http://www.todayonline.com/articles/217699.asp
Fear of the law makes victims cough up cashPosted: 19 October 2007 1100 hrs
SINGAPORE: First, they used their victims' greed and the lure of fictitious lottery winnings to con money from them. Now, phone scam artists have found a new tack: Exploiting their prey's fear of the law.
Over the past three weeks, Singapore police have received 35 reports from people who got calls from persons posing as police officers or Supreme Court staff.
The impersonators would tell them to attend court or ask for money to be transferred. They would try to get their victims to part with money in exchange for being exonerated from involvement in criminal cases or the failure to attend court hearings.
In reality, none of the victims were involved in any such criminal or court proceedings - but even so, worry led at least one victim to part with about S$10,000.
In a statement issued on Thursday, the police said that investigators do sometimes inform members of the public over the phone about court dates and appointments at the police station.
"However, police will never ask for money to be deposited into a bank account. If such requests for property deposits or personal information disclosure are received, they should be reported to the police immediately," said the police.
Likewise, the Supreme Court, in a separate email to the media, said its staff members do not ask for payment verbally over the phone.
"Any request for payment of monies to third parties in respect of court proceedings should be made only if supported by an official court order," the court said.
Anyone who do not have a pending case in the Supreme Court should "exercise caution" with callers who identify themselves as court staff, and who direct them to attend court or transfer money, said the email. In case of doubt, verify the source of the call with the Supreme Court at 1800-338-1034.
More generally, phone scams can take different forms and the public should be wary, said the police, advising the public to check the caller's identity with the organisation he or she claims to be from.
Last month, it was reported that 122 people had been deceived to the tune of S$1.5 million in total, in lottery or lucky draw scams so far this year. They were instructed to hand over money after receiving phone calls or SMSes claiming that they had won prizes in overseas lucky draws. - TODAY/ym
http://www.channelnewsasia.com/stories/singaporelocalnews/view/306555/1/.html
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