Present Issue 
Past Issues 

Present Issue 
Past Issues 

SMA Editorial Board 

Letters to the Editor 


This site is supported by Health ONE


A recent article in Newsweek (November 8, 1999) has provided insights on how patients, the public and doctors felt about the present health care system in America. In that article, a survey indicated that more than 60% of the participants were “frustrated and angry” about the state of the health care system, with more than half believing that “fundamental changes” are needed. How could the health care system in America come to such a state and are there lessons for Singapore doctors?

America, by many accounts, has arguably the best hospitals, the best doctors,the latest and most advanced treatments and spends an enormous amount of its budget on health care. Why is it then that less than 40% of the public feels satisfied with the health care system?

It is educational to look at the response to one of the survey questions, “What do you think is the most important health-care-related issue facing the American public?” These were some of the answers given: High costs of prescription drugs, unaffordable health care, lack of long term care of the elderly, too many cover restrictions in insurance plans, health professionals no longer control treatment decisions, lack of focus on preventive medicine and the simple fact that quality care is declining. To another similar question, more than 70% of the respondents think that pressures to keep costs lower have hurt the quality of care.

In particular, the role of the health maintenance organization (HMO) came under the scrutiny of the public again. Introduced in the eighties, the primary purpose of managed care and HMO was to boost health care quality and cap costs at the same time. After more than a decade, it appears that both objectives in America have not been met the quality of health care has not been shown objectively to improve, and costs appear to be on the rise again after stabilising for a few years. In fact, many HMOs are going out of business because they could not give patients what they wanted for the price they were willing to pay. Can the two (health care quality and cost control) co-exist? America has not produced the answer to this question.

As doctors practicing in these challenging times, we will have to face changes and adapt accordingly. We should be aware of impending changes to our practice. We will be asked to help contain increasing health care costs. We will have to deal with an aging population with increasing burden on our health care system. We will face increasing demands from patients (and increasingly demanding patients) to prescribe the most advanced treatment. As we move first into privatisation and restructuring of our hospitals and now into health insurance, practice guidelines and casemix, let us look at how the health care system in America has evolved and avoid making similar mistakes. Let us remember to be true to our original mission and provide the best possible health care for our patients.