Wednesday, April 11, 2012

Don't Get Sick

According to the KPMG May edition of their publication "Issues Monitor - Healthcare" (thanks, TK of Apr 10, 2012 12:12 AM), there is a booming medical tourism trade ripe for the picking. Besides geographical proximity and cultural similarity considerations, they highlight cost savings as a major pull factor.

This is what they write about the government initiatives in action:
- Over 2006-08, the annual number of medical tourists to Singapore jumped more than 16 percent, from 555,000 to 646,000 visitors. By 2012, the country aims to attract 1 million medical tourists.

- The government is promoting medical tourism with a network of high quality clinics and hospitals than can cater to foreign patients.. This is in addition to various drug manufacturers and biomedical research laboratories owned by large foreign pharmaceutical manufacturers that have established themselves here in recent years. Apart from the 15 hospitals that are equipped to treat foreign patients, the government has aggressively worked to attract top doctors and scientists from around the world and pushed for major foreign pharmaceuticals to establish operations.

Using sample data from the Ministry of Health website, one can see that the hospital bill for heart surgery can vary quite a bit depending on how deep your pocket is, or how the Means Test determines your fate.

We all know what happened to housing prices when that minister-from-hell decided to use market valuation for land allocated for HDB flats. His sickening opportunity cost argument was that the same designated plots would have generated more revenue for the government if used for private development. Now, imagine what would happen if the supply of hospital rooms in the country is tilted towards the deep pocketed medical tourists instead of the "subsidised" lesser mortals. For all we know, it has already happened. Please don't get sick, you may not be able to afford it.


  1. That is why I've said, if you have to fall seriously sick, you may as well die. One cannot foot the medical bills even with subsidies in Singapore. It is a playground for the super rich and top civil servants. The rest, please do not clog the hospital beds!

  2. didn't you know that nobody lives forever ?

    1. No, we didn't, thanks for your wise & profound question/comment! We are not called daft for nothing!

  3. As long as they are happily making money off the medical-tourism and privatising the whole hog of healthcare, they wouldn't need to care about how healthcare bills are escalating now are they? Just earn enough to pay for your insurance, people!

    And no, you can just take your common, everyday health problems like cancer, diabetes and shove off. The rich are talkin' here. They probably need three doctors to assist them on their gout, from eating too much foie gras.

  4. It's no use giving "constructive feedback" to the deaf frogs.

    We are stupid.
    We are not elite.
    So just vote Opposition.

    And wait until the Proud Arrogant People give us "constructive proposals" as to why we should vote for them.

    Stay out of their elite uncaring face.
    And just vote Opposition.

  5. All these restructured medical centers are out to make money from us.

    SNEC charging $6 for a simple visual test which most optical shops do it for free. This test known as pre-consultation evaluation involves reading of alphabets/numbers from a chart. Those evaluation test done by optical shops are even more detail than the one in SNEC. Taking a conservative figure of 1000 patients per day, SNEC revenue from this simple eye test alone will be $120,000 per month! ($6 x 1000 x 20days). This means SNEC is making $1.44 million a year for a simple eye reading test lasting less than 2mins !

  6. Yes, this PAP regime is an evil one. My child has regular appointments at the child guidance clinic. In 2008, we paid about $10 for each session. Now, we pay $18, a hefty 80% increase. I am sure our household income did not even go up by 5% during the same period.

    This is a child who needs some support from the community. If this child is not receiving proper, timely intervention when young, the society might incur more costs when he is older. If MOH is adopting "market rate subsidy", while the rest of the government is throwing free money to foreign "scholars", then you know PAP does not care about developing the true potential of Singaporeans.

    Wake up, Singaporeans! PAP is going to squeeze us one by one, all for the benefit of the elites in this country. Who knows, one day ordinary Singaporeans may have to play "Hunger Games" for the amusement of the elites.

  7. 6 mths ago Alex Au has written extensively on the bed crunch situations in hospitals. Not sure if it has improved but given the immediate full occupation of KTP wing, it gives some indications. More people need to come out and share their experiences.

    SGreans refuse to get medical help when sick (or keep delaying or denying it) due to fear of medic cost, but PRs/foreigners are all taking advantage of our subsidized healthcare here.

  8. Great post Tattler.

    Those who are more inclined, below are few papers/reports argued on the effects of medical tourism have on social equity (there's convincing evidence from Thailand and around SEA) largely because it

    1) diminish physician's time spent on local patients vs foreign
    2) extra demand pushed the cost of health care services
    3) puts strain on local citizens/patients when there IS/ISN'T universal coverage.


    Just saw the response from MOH for the revised rates for subsidies!! Few thoughts : -

    1) Less subsidies for PRs merely translate to more profits to hospitals. One thing could result from this shift - physicians may actually favor PRs more. Why else do they like foreign patients but because of the higher rack (full) rate they can afford to pay, thus higher face/personal attention. Susan Lim's case is already an example.

    2) PRs are mostly here on work permits. The cost are therefore paid for by their employers. As such, there is no OPP (out of pocket) difference to the PRs per se.

    3) Healthcare doesn't just cover hospitalization/surgery. There are also the drugs/medications/consultations/test etc. Are these taken into account for differentiation too? Becos that's really the bulk of OPP expenses coming from.

    4) It still doesn't change the fact that there are 1 million medical tourists coming on shore to compete for medical services with locales. That's like saying you are adjusting the transport fares for local/foreigners but it doesn't change the overcrowding fact and deterioration in public transports.


    Just read the revision announced by MOH.

    1) PRs enjoy less subsidy just means higher profits for hospitals. One thing could happen, PRs might be more favored, This is natural. Why do you think physicians love foreigners businesses? Because they pay rack (full) rate and they are richer, thus more profits.

    2) Most PRs here are on work permits. Their employers bear the cost. So at the end of day, there is no OOP (out-of-pocket) change to PRs.

    3) When talking about healthcare, we don’t just narrowly mean – hospitalization, surgery etc. It should also include drugs/medications/ consultations/tests etc. Are there any REAL billing differences between PRs and locals here?

    4) Doesn’t change the fact that we are still looking at 1 million medical tourists into SG. Doesn’t change the fact they will be competing with locals for services and access. Until and unless we have a wider universal coverage, there is very little to take comfort with. It's like saying you make a difference in transport fare, but you are not addressing overcrowding and deterioration of public transport.

    1. why in the first place do singaporeans have to subsidize their healthcare? just like we subsidize their (resale) hdb flats so they can go sell off and retire to their home country one day? just like we subsidize these so called talented scholars when our children equally good or better can't get a seat? WTF is happening to this country?

      No thanks to "further privilege" MOH. Not impressive at all and you don't have to portray me as a spoilt child, getting more than we deserve. Go reflect!!!!

  11. This has already happened.

    All our public hospitals have business units called International Patient Liaison Office to entice international patients to use them (it is even on their websites - check it out:

    Hospitals like SGH, NUH and TTSH have also sent business teams out to countries like Indonesia, Vietnam, and even Russia to try to get them come to these hospitals. Consultants treating such patients can surcharge these patients to a higher quantum compared to local private patients – this fact was published in Strait Times recently.

    To facilitate such arrangements, SGH even have clinics in Mount E and Gleneagles, where their consultants can see private patients – this is called faculty practice. Yet these hospitals argue that the wait time for the SUB patients is long cos’ of the huge patient load. Remember that these same consultants cannot be at two places at the same time – so something have to give.

  12. Healthcare is big business, and has become a growth industry no less, chasing the medical tourist dollars. Hippocrates will be rolling in his grave.

    Just like housing, when the rich come, the costs of everything go up. The government can mitigate this by spending more on healthcare and subsidies. But I give up hope when a DPM makes this egregious statement to a call by opposition MPs to raise healthcare spending from 1.6% to 6.1% of GDP in line with OECD countries:

    "...If it is GST, it has to rise to 20 percent. If it is corporate income taxes, it will have to rise to above 40 percent. If it is personal income taxes it will have to rise across the board with the top line rate moving to 60%, very high".

    I wonder how he derived the percentages.
    Universal coverage? Forget it, when this government has a GOP mindset.

  13. My mum has heart failure and was admitted to tan tock Seng hospital 2 weeks ago. No bed was available until almost a day later. Thanks to the large intake of non Singaporeans $$. I questioned why I ve to come out with thousands of $$$ cash for her medication and hospital bill when she has her own money of over twenty thousand $$$ in medisave that cannot be used to offset her medical needs fully. She is almost 80 and when will she get to use it. Today, she did a mibi scan that cost around $600 at Sgh and again cannot use her own money in medisave except cash. This is crazy and I ve to tell the nurse off for letting us wait for almost 1 hr after the appointment time. She said" sorry, too many patients today" really cannot believe that minister kbg paid around $8 if I recalled correctly for his heart problem. Really felt angry, frustrated and disappointed. Hope some minister can explain why can't we use our own money(medisave) to fully pay up for our medical needs and yet have to source for more money to pay up even when someone is sick.

  14. Seriously, now Dr Lam wants to defend those PRs and set up a fund to help them cope? Where is Vikram Nair & his nigerian scam question? Is only a 5% cut in subsidy and he's overreacting to rush and help them...

    Is very clear we SG govt want to help poor PRs who can't afford to live in SG but yet don't want to be SGrean...since they value so much of their host citizenship, they can always go back and enjoy the healthcare only guess that Dr Lam's clientele must mostly be PRs.