Thursday, 15 March 2007

Question for Oral Answer: 28 February 2007

This question was triggered by a news story a while back, about a study that found that after MOH began publishing the costs of various treatments across different hospitals for comparison purposes and benchmarking, Singapore's public hospitals (especially the so-called "outliers") were able to cut the costs of treatments without compromising the quality of patient care.

So then I wondered: how did they manage that? Was there some mismanagement before that, leading to unnecessarily high costs?

I think in a way, that was the case. In a nutshell, the Minister's reply was that hospitals did things in different ways, some ways being more expensive than others. A reasonable conclusion to draw would therefore be that the more expensive hospitals were doing things unnecessarily and/or inefficiently.

Having said that, I applaud MOH for its practice of publishing treatment costs and now specialist waiting times for benchmarking purposes. Our public and restructured hospitals are subject, to a large extent, to the discipline of market forces. But it is a fundamental tenet of economic theory that free markets operate efficiently only if information is available to all market actors. This practice of publication hence makes available and transparent previously opaque information.

Even if, as the Minister noted, the public does not really refer to the statistics (and I think he is spot on there), the fact is that they are in the public domain. And as the Minister pointed out, doctors will look at the figures.

The market actors themselves, in this case the hospitals, will also do so. And the outliers amongst them will be forced, either by themselves, their boards, or the Ministry, to review their practices to determine why they are outliers, and then take steps to rectify that.

I must say that I really respect and admire the Health Minister. He makes a lot of sense, and he approaches issues in an eminently reasoned and rational manner.

There are a lot of areas in our public health system that can be improved -- perhaps one day, I will talk about my dad's unpleasant experience with SGH, which greatly informs my own perception of our public hospitals when it comes to non-standard conditions and explains why I will always hope, pray and wish that I can afford private medical care if I need to.

But there will always be areas for improvement. I think the Minister has done an excellent job to date, and I only hope that he can continue to improve our public health system.


(Prices for treatment)

Mr Siew Kum Hong asked the Minister for Health (a) how do public and restructured hospitals set their prices for treatments; and (b) why and how were they able to reduce their prices for various treatments without compromising the quality of patient care or length of stay, after the Ministry began publishing the bills for such treatments across different hospitals.

The Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir, public hospitals set their treatment prices based on their operating cost and the prescribed subsidy policy.

After my Ministry published the hospital bills sizes for the 70 most common medical conditions, the hospitals were then able to more systematically compare their cost performance with the others. This has allowed the cost-outliers to review why their patients ended up with larger hospital bills.

A significant factor is the way doctors undertake their clinical practices and treatment processes. For instance, there are several ways to treat patients requiring gall bladder surgery. One hospital used to admit such patients for pre-surgery preparation a day before surgery. However, most hospitals prepare their patients on an outpatient basis and admitted them only on the day of surgery. This avoids one day of hospitalisation and led to cost-savings for both hospitals and patients.

There are also ways to save cost for patients by using more cost-effective but equivalent substitutes in the treatment process. Staying on the example of gall bladder surgery, patients used to be given antibiotics through intravenous drips until their discharge a few days later. Now, they take the antibiotics in pill form from the day of surgery, which cuts costs as intravenous antibiotics are many times more expensive.

The publication of hospital bill sizes has pushed our public hospitals to compete to bring better healthcare services at lower cost and also to learn best clinical practices from one another.

Mr Siew Kum Hong (Nominated Member): Sir, I am glad to hear that this practice of publishing different prices for treatment has reduced the cost of healthcare for the public. I would like to ask the Minister what are the other areas in which this can be done so as to further reduce the cost faced by the public.

Mr Khaw Boon Wan: The key is more information - better, relevant and timely information - because healthcare, as we know, is highly complicated. On the other hand, you can also have information overload if we publish too much information and nobody would read it. So you have to be able to, in a smart manner, pick up the key trends and then publish them in a way which people can use and understand.

Frankly speaking, I doubt patients go to our website and check before they decide to go to hospitals because very few are as well-informed. But I do expect their referring doctors, whether they be GPs or polyclinic doctors, who understand the subject better, to regularly look at our updates so that when they have a patient in front of them requiring specialist attention, they know which hospital and which doctor to refer to, in order to get the best value for money on behalf of their patients. That is why, besides bill sizes, I also publish information like waiting time and queuing time. The whole idea is to give more information to the marketplace, to the players, so that we can help level the patient load and along the way, hopefully, it will be better service all round.

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