Monday, March 25, 2013

Seek appropriate health care

22 March 2013

Forum Page
Straits Times

The Minister of Health wants to review the health care system to make it more affordable to the public.  I wish to bring forward the following issue for his consideration in this review. 

When a person gets old, say beyond 80 years, some organs are likely to fail, or cancer will creep in. It is a matter of time before they have to say goodbye. There is nothing much that can be done to "cure" the illness. Even if expensive treatment is carried out successfully, other parts of the body will fail. This is 
described as "complications".

Treatment has its risks. some people die earlier due to the treatment. If they are untreated, 
they might, in some cases, live longer and have a better quality of life for their remaining months.

Trying to treat old people, and often with unsuccessful results, is the source of escalating health care 
costs in many countries, including Singapore. Using private medical insurance or increasing the public funding to pay for these expenses is not the solution. We need a more sensible approach towards this issue. 

Some types of treatment should be encouraged and other types should be discouraged, and these rules 
should be made by medical experts who do not have any vested interest.

If the family receives impartial and proper advice on what can and cannot be treated, they will save a lot of pain and anguish for their elderly parents and also avoid spending a lot of money on futile treatment in the mistaken belief that they are doing the best for their parents. 

This will also stop the country from wasting a lot of resources that can be put to better use.

Tan Kin Lian


Edmund K F Ho said...

I think one point need to be looked into.

A category of aged (70 upwards) is resistant to medical checkups like geriatric assessment. It might be geriatric illness(es) in formation. They are not aware of say their physical, mental, biochemical changes. Family memebers are ignorant too. Most importantly, there is no law to force these afflicted aged to go for assessment/treatment. And most of them can have depression, quite a norm.

The law states that you can't get the police for help unless the elderly's life is endangered or others are.

I have highlighted this the Mr Lim Hng Kiang two years ago, who replied that the health ministry is actually looking into making it compulsory for elderly of certain age group to have annual health check.

The untreated elderly are suffering like mental patients for they have insomnia, depression, bipolar swings, etc. They don't realise it and best part is family members shun them as stubborn, unreasonable whatever.

I feel such category actually is placing heavy resources overall. Think further, the well-being of our economy is affected accumulatively.

Spur said...

True. After 70 years old, genetics and previous lifestyle determines how long and how well a person lives. It is far better to spend money in your earlier years to have healthy lifestyle and annual health screenings. Doesn't even have to be expensive.

Another review of Medishield and adding more bells & whistles will be yet another opportunity for private insurers to jack up their premiums for private integrated shield plans by another 40% to 50%, just like what happened recently in March 2013.

Btw, the private insurers don't give back the Medishield discounts (for longtime policyholders) to you if you're on the integrated shield plan. This is even if you had first joined Medishield many years ago. In this way, the private insurers are pocketing your money as they should be getting discounts from CPF for the integrated shield plans.

My older relatives have confirmed this after checking their bills for their private integrated shield plans. Even though some of them had been on Medishield since 1989 and signed up with the private integrated shields in 2005. Most are now in the process of canceling their private shield plans and stepping down to the basic Medishield, where they can enjoy the discounts for being longterm policyholders.

Sobri said...

@ Edmund. Geriatric assessment is not cheap. One has to undergo brain MRI which is costly. Most families would just accept old age illnesses like dementia as part of growing old. Medication to slow down Alzheimer, e.g. can be very expensive too. Thus, despite the problems family members simply tolerate often to the point of broken family ties.

David Soh Poh Huat said...

In the past CPF Board does not have the expertise to manage the medishield schemes which resulted in them in the 'red' and have to outsource to introduce the integrated shield plans.

Maybe it is time MOH and CPF board should take back and have a National Insurance plan with minimal deductible and co-insurance to prevent 'abuse of the system'.

Treatment of elderly just to quote an example. My late father was prescribed with Parkinson medicine and as main caregiver I refused to give him. 3 months after, he was accidentally assigned to the Professor in-charge which discharged him. Think about it, if he had consumed the medicine, what other side effects will there be.

I totally agree about treating elderly. From his experience and others, I can say I may know some of the unique causes of pneunomia affecting elderly which I have shared with MOH and todate no public awareness being created.

As we aged, what elderly need is good medical care and not 'wrong diagnosis' which sometimes will cause an elderly to pass on faster.

The focus is how to enhance the skill levels of our medical profession, maybe by engaging private doctors to help out. We lack highly qualified professionals as most of them have gone private. Why?

Maybe MOH should get patient families involved in interactive dialogue to explore how further enhancements can be made.

Most of the time, I feel that feedback given is just filed away. That's the way our government service work.

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