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Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye
Health care costs have been spiraling in many developed nations. They are driven primarily by hospital fees, physicians’ remuneration, and pharmaceutical expenses.
In order for healthcare expenditure, both public and private, to remain under control steps must be taken to manage the costs of the above three areas. In the third and final part of this series, we propose measures on how this can be done.
One, the Government should require drug companies to license their patents to the state for a fee. The government can then manufacture these drugs for the people at sell them at a controlled rate.
Expensive AIDS drugs and other medications should be negotiated intensely with the drug manufacturers. If this fails compulsory licensing should be enacted to circumvent unfair patent laws in order to combat serious diseases and epidemics by providing affordable medicines to the people.
In this way expensive proprietary drugs can be prescribed without ballooning pharmaceutical costs. This approach was adopted under the DOHA Declaration and is practised in countries like Brazil, India and South Africa.
We should also invest in the manufacturing of generic drugs as well as the production of medical devices such as stents, prostheses and other instruments. This will help to cut health care expenses and will have the added advanateg of creating more jobs. Deals with suppliers of such instruments must also be negotiated stringently to control costs.
Three, restructured hospitals should to be converted back to public hospitals and operated on a non-profit basis. At the moment, these state-run hospitals operate on a cost-recovery basis where the hospitals are expected to register profits.
All ward-classes should be removed. This reduces costs incurred by ward differentiation, advertisement for private patients, renovations/refurbishments of non-essential instalments, and marketing expenses. This results in more egalitarian and equitable health care delivery. Just because an A-class patient is richer, why should he get a hip replacement sooner than a C-class one?
Healthcare must not be reduced to merely a commodity to be purchased based on which patient can pay more. It is a service that is rendered to people who fall ill and to the elderly. The service to heal must be one based on care and compassion.
Four, medical practitioners and allied health professionals should be allowed to practice in public hospitals/polyclinics and vice versa. This reduces brain drain, redistributes talent more equitably between the public and private sectors, maximizes economies of scale, improves remuneration and working conditions for physicians.
In order to ensure that physicians don’t overcharge and contribute to spiraling costs, clinical practice guidelines should be standardized and formalised in tariff tables.
Additionally there must be legislation to limit damages awarded in malpractice suits. This not only reduces malpractice insurance premiums (which have been rising exponentially for the surgical disciplines) but also discourages defensive medicine where doctors order multiple, and often unnecessary tests to protect themselves from suits.
Finally, we should invest in health education, preventive healthcare and early detection to reduce overall costs, increase life expectancy and quality of life. Screening tests that have been economically evaluated to have a high cost-benefit ratio can be partially subsidized by the government.
Taken together, these measures will control healthcare costs in Singapore and make affordable medical care for all Singaporeans.
Drs Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye are medical doctors. They are also members of the SDP’s Healthcare Advisory Panel.