The Cost Of Medical Advice

When early tests showed an abnormal ECG stress test reading and high calcium score, Health Minister Khaw Boon Wan, 58, was in "denial" and in no hurry to schedule the angiogram recommended by his doctor. The CT angiogram on April 29 revealed a blockage in his left main artery, and he finally surrendered to open heart surgery for a coronary artery bypass graft. He lived to tell the tale on his blog.

But SingHealth's Group chief operating officer, Dr Wong Yue Sie, died at the age of 49 on Friday 28 May after developing a massive stroke. Being a medical professional, we assume he was more knowledgeable about his state of health than Mr Khaw. He could have been symptom-free too, as Khaw put it, "I was fit as a fiddle... I had never felt breathless climbing stairs or when running on (the) treadmill, let alone experienced any heart pain or angina".

Former honorary treasurer of the National Kidney Foundation ex-property consultant Loo Say San, 61, also succumbed to a massive heart attack on Sunday evening. As a member of the NKF's excutive and finance committees, Loo had the power to make investment decisions without the prior approval of the executive committee.

By virtue of their income tax bracket, all three would have been in the "private patient" category of a government hospital. In most countries, public hospitals essentially offer free medical treatment to their citizens, with funding derived from government taxation. In Singapore, however, the public hospitals charge patients according to the ward class that they choose to reside in, and subject to the newly introduced means test. There are essentially five ward classes; A, B1, B2+, B2 and C, with class A being the most expensive and C, the cheapest.

Being admitted to a A or B1 ward, one automatically becomes a "Private Patient". Outpatient charges will range from S$92 to S$46 per consultation, compared to the S$29 applicable to a "Subsidized Patient". Query the nurse at the payment counter about the vast disparity, and she'll tell you with a haughty air, "Private patients will be attended to by a consultant or registrar, subsidized patients will treated by any medical officer on duty." In other words, not all the sick in Singapore will receive the medical treatment  most suitable to their urgent needs, but rather to their ability to pay the bill. That pain in your chest could also be due to a hit on your wallet.