Letters to the Editor
ACHIEVING GOOD QUALITY AND AFFORDABILITY HEALTHCARE TOGETHER.
In a major policy speech on 6 November 1997, the Permanent Secretary (Health), Mr. Koh Yong Guan announced that good quality health care and affordability are not irreconcilable objectives. He added that, On the contrary, we can achieve both objectives together, provided we put in place the right regulatory and professional framework. This policy speech is reproduced in full in this Newsletter as the lead article.
The medical profession could help to shape this framework. The Ministry of Health has now defined in concrete terms what the objectives of the health service should be. These are more understandable than the concept Towards Medical Excellence. In framing the regulatory and professional framework alluded to, we hope that three basic concepts are considered namely, broad competency for all, a role for all and involvement of all.
Broad competency for all
Through the attainment of broad competency for all, we do not always
need a multitude of sub-specialists tending to the same patient most of
the time. Such fragmented health care will neither be good nor affordable.
Every doctor, be he a GP or specialist should be encourage to deal confidently
with basic problems and not refer just because the ailment falls outside
the confines of his chosen field of interest. The training at the undergraduate
and postgraduate levels as well as continuing medical education programmes
must bear this in mind.
Much more can be achieved if we ensure that both specialists and primary care doctors, in-patient and ambulatory services care for the same patient together. There will be appropriate care at the appropriate level over time. This paradigm will become more and more important in the years to come with the greying of our society and the shift of disease pattern to that of a developed nation.
To control costs effectively, doctors need to work together with the patient at various health care levels. Diabetes mellitus is a good example. Better metabolic control remains the cornerstone for preventing and delaying complications. When complications occur, timely intervention by specialists will help to reduce the adverse consequences. When the complications are under control, the patient returns for continuing routine care. The organisation, training and financing of healthcare services must bear this in mind.
Involvement of all
It is myopic to consider each sector hermetically. Thus, our government primary care is said to be affordable but there are doubts raised as to how this impacts on the overall quality and affordability of the whole system - a paradox highlighted in an article in this issue (N3). If perverse financial incentives exist that lead to inappropriate patients demands and care, then these demands may have to be modulated and utilisation pattern changed. More healthcare services do not necessarily equate with more health. More appropriate services on the other hand will.
As a profession and as a nation, we need to strive towards good quality
and affordable healthcare. We agree with the Permanent Secretarys caveat
that it is achievable provided we put in place the right regulatory and
DR CHEONG PAK YEAN