Sunday, August 20, 2006


Attended the SMA convention on MHC yesterday.

Take home message: MHCs are here to stay. And GPs will need to put their brains together & come up with a way of managing their practices in order to manage the managed care companies in a way that won't compromise on quality of care or cause them to lose their livelihood.

How did the local situation in the private GP sector arrive at this stage? $5 consults? Losing money because reimbursement for medicine is less than cost?

I have never set up my own clinic. Never wanted to because I knew the sacrifices it would entail as far as my personal life & quality time with family is concerned. But I never foresaw that competition would heat up to the point where docs would be willing to sign up with money-losing MHC contracts just so that they would gain (or hope to gain) market share.

One of the speakers mentioned that we need to include an accounting module in the GDFM course. I wholeheartedy agree. Perhaps it's even time to include a Business module in NUS's Medicine curriculum called "The Business of Medicine". Let's face facts. Medicine is not all about altruism; in order to survive in this dog-eat-dog world, we need to be wise to the ways of the world.

After all, doctors set up clinics to treat patients, and yes, there will be patients who may not be able afford to pay for medications, and I know that doctors DO give allowance for this; but they also need to earn enough to pay their rent, their staff, feed their family, pay their monthly mortgage installments etc.


pretzel said...

Not sure about the quality of MHC in the other countries. Personally, I don't like the current version of MHC in S'pore.
As a pte individual patient, i have to go to a panel of Drs, and the nearest panel clinic may be 20min bus ride away. Doesn't make sense when there's a GP 2 mins walk away.
As an employer, i still can't see the returns of going into MHC for the outpatient GP portion. However, i end up breeding a group of employees who abuses the system: insisting to go see the outpatient Specialists for every ailments they can get their GPs to write the referral letter.
My conclusion: the insurers are the ones in win-win situation but not the companies/employers nor the Drs.

aliendoc said...

My impression is that the employers (companies) think that they are saving money by going with MHCs. Unfortunately, I don't think they realise that quality of care may be compromised if all they think about is the bottom line.
With the way things are currently, MHCs are trying to squeeze every cent they can out of the GPs by minimising how much they want to pay for consultation & drugs. I don't think the employers/companies realise this. Maybe they don't care as long as they don't have to pay too much for healthcare.
And patients can be "kiam siap" too as far as medical care is concerned...but they won't mind spending on facial/spa/manicure/pedicure (which probably costs more per session than a GP consult+drugs!!!)...but they will make noise if their doctors' bills go beyond $30!

Dr Oz bloke said...

The very common word going around patients is that while we doctors say we have to pay for mortgage, feed our families etc, they feel doctors are earning too much money still.

We should be earning like $2k a month like most average Singaporeans BEFORE we can say things like "we need to make a living"

I feel ashamed to be earning a higher salary as a doctor than the teachers, taxi drivers and blue collar workers. That's how my patients have been telling me and making me feel.

I think it's time to kill myself. Doctors are such greedy and evil people. Sigh.

aliendoc said...

Gosh, you must be seeing some patients who bear a grudge against doctors or have a really strange way of looking at society & how it works! I wonder how they judge & decide who should earn how much? By what criteria?

Dr Oz bloke said...

But I also realise they have a point.

When we doctors say we cannot pay our mortgage and all. It is at least for a 5 room HDB flat and a Japanese car.

There are people far worse off than we are.

aliendoc said...

Oh yes, there are people far worse off than we are. But how do we draw the lines between who should earn how much? Perhaps we should just leave it to market forces & see what happens.

Dr Oz bloke said...

And that's exactly what is happening now. Market forces are saying let's squeeze the GPs.

The market is going to the Polyclinics.

GPs are charging $5 for consultation.

Hence, that is why I'd rather work for the govt and PRAY that they don't decide to pay me $2k a month.

People are however willing to pay for non-evidence based treatments. Which is also a market force that has pushed GPs into doing aesthetic, mesotherapy etc.

aliendoc said...

I meant the REAL market (i.e. excluding the polyclinics!) :)

From what I have heard, I hope/think that the 'gahmen' realises that the polyclinics are crowding out the GPs with the highly subsidised prices. Not too sure how/what they can do about it without causing too much of an upheaval (politically).