Friday, January 23, 2015

Our dishonest doctors

I read the stories of how some of these local doctors were caught for inflated or non existent treatments. They were stupid. It was easy to catch them. What about those who are more careful and meticulous. How many of them and what are the sums involved. It is impossible to tell.

Friends have been complaining about how expensive it is to visit the doctor. Attendance at Polyclinics have sky rocketed.

Wifey's O&G doc always asked if we are claiming insurance, i.e., the charges would be higher.

A couple of days ago, both girls had to see the doctor. In the morning elder girl was charged $66 and in the evening her sister went for a minor eye problem and had to pay $31 for consultation and a small bottle of antibiotic eye drop.

Have they liberalized medical charges? Unlike my visit to the dentist a couple of months back I don't see a schedule of common treatments and their charges any more.

Dental treatment here is very expensive too. Some friends have decided to hop over to Johor to for the more pricey procedures.

I digress, but the common thread here is that medical cost is going up and in a pooled system like insurance and government reimbursement, it is likely to go up faster and further because for every dishonest doctor you catch you don't know how many got away laughing to the bank. You always guard your own little pot of scarce money far more closely than those paid to watch and pay from a very large pool. Whatever, doctors reputation among us can only head south.

Why wouldn't our doctors be less money minded than their American counterparts or anywhere else in the world? It is a matter of money making opportunities. In China many kids do not want to be doctors for exactly the opposite reasons American or our kids desire to be.

In a society where money acquisition is so highly valued, an SAF where too many learned that you can do anything you want as long as you aren't caught, we must not be surprised if corruption is creeping back. And I haven't talk about imported corrupt habits.

Many years ago my boss and I were invited by one of the richest man in HK for lunch. I do not know why, but he spent half the time with us explaining why there is plenty of moral corruption in Singapore. I said you can't charge somebody with that but eventually that corruption will grow and we will be arresting it very late as a culture of corruptibility would have permeated the system. I think we are closer to that now. Like suicide rates, we only count those that died but how many doctors in the privacy of their mind are thinking how to get more money from the government and insurance companies than is owed to them? How many in the civil service and in corporations? Some were afraid of collecting money so that had sex instead. If we don't work harder at this they will become bolder and have both.

We must not forget we are not like New Zealand a society which values honesty more than we do. We checked corruption with harsh punishments. It doesn't come naturally to us. For the same result we have to work much harder than Denmark, Finland, Sweden and New Zealand. But I think the situation in NZ is worsening. Why this is happening there is the subject of another post if I have the time.



  1. There is an inherent 'conflict of interest' in the current setup that is the doctor both diagnose and sell medicine. In some countries eg Australia, the doctor can only prescribe; the patient buys the medicine from a pharmacy. And very often in the pharmacy the patient has a choice of cheaper versions of essentially the same medicine. Such a setup prevents the doctor from prescribing medicine unnecessarily.

    In the current setup there is nothing to stop the doctor from making more money through prescribing and selling medicine more freely. This is evident when doctors prescribe antibiotics for viral infections knowing full well that antibiotics only work for bacteria infection. Is it 'dishonest' on the part of the doctor? Well there is no way of telling broadly but systemic separation of 'doctor' and 'pharmacy' might at least address this 'conflict of interest' part of the setup.

  2. Fai is right. Doctors should not peddle medicine. Dispensing medicine is in the better hands of pharmacists who probably know more about the various (and necessary) medicine than most doctors. It can be very scarry that doctors, in pursuit of the big Dollar, will help push some "questionable" medicine for some kickback!! And they have a bad habit of collaborating to absolve responsibility thereafter

  3. Despite subsidies, medical charges are still high. Private doctors are out of reach for common folks. Majority who go for subsidize care usually get "rush and delay" attention because of high demand.

    The medical and legal profession are no longer an honourable or noble occupation. Just like politicians, they are all tainted by money

  4. I think its a bloody time to pay doctor millions

  5. How about the other "professionals"??
    Two articles to ponder over this weekend

    High-Frequency Probe’s First Target Is Barclays - others coming up??

    This Is Why You Pay Your Lawyers And Don’t Ask Questions (JP Morgan Edition)
    By Elie Mystal

    and with the exodus of (retrenched?) bankers from foreign banks (front to middle to back offices) into our local banks, will the latter be the same again?

  6. Lesson here?
    We mustn't build a city that holds its people ranson to talented pigs

    1. Righto! and all these MBAs - do they really benefit society or the "paper farms"?
      Harvard Business School Dean Fights to Keep M.B.A. Relevant (WSJ Jan 23 2015)
      The golden era for US business schools is over. Gone are the days when a master of business administration degree was essential for a career at Goldman Sachs or McKinsey & Co. Young professionals now balk at the $100,000 price tag and two-year commitment needed for an MBA.
      The rise of Asian business schools poses another challenge. Top U.S. business schools responded by introducing shorter and more specific business programs, and adding international business cases for study.

      Excerpts from WSJ interview of Indian-born Nitin Nohria, the first Asian dean of Harvard Business School,
      "With Asia students, we see them from everywhere. The growth is explosive. One of the anxieties we have is we used to see 30 to 40 Japanese students out of 900 M.B.A. students every year, now it is down to four to five. Japan is only part of Asia that’s in retreat. They were so engaged in the global economy in the 1980s, now they have become more insular. Japan is the third largest economy in the world, it’s important for us to find a way to reach out. As for Greater China, our mix has shifted to mainland. Now a quarter of the students are from Hong Kong, and three quarters from China. It used to be the vast majority of Chinese students were from Hong Kong".
      WSJ: What’s your biggest challenge?
      Mr. Nohria: The biggest challenge is a lot of people are asking the question whether they need to go to business school at all. The golden era of business education ... is 1950 to 2000, where it was almost considered, if you want to accelerate your career, you’d better have an M.B.A. That sense of necessity of an M.B.A. has shifted. Even McKinsey has people from Ph.D.s and other backgrounds, they train them themselves. You go to an investment bank, they will tell people that you can just stay and become a managing director, you don’t have to get an M.B.A.
      WSJ: Is there pressure to do short courses?
      Mr. Nohria: The rise of [executive M.B.A.] has been the answer to this pressure, and the rise of one-year M.B.A. programs as supposed to two-year. The U.S. demand for two-year M.B.A.s has declined 20% from year 2000, so that space is shrinking. Demand for specialized master’s program is growing faster than two-year M.B.A.
      WSJ: What do you think of the business schools in Asia?
      Mr. Nohria: India might be a bellwether, demand for business education grew so rapidly so 1,000 business schools were open. Suddenly people realize just getting a degree from any school isn’t enough. Consolidation is happening. Same thing is happening in the U.S. People are more conscious that quality of education matters.
      WSJ: What surprises you about Asia on this tour?
      Mr. Nohria: Both in India and China, for the first time the conversation is about something that’s not growth. We got so obsessed about growth and forgot we have to build a stronger foundation. Now there is desire to build stronger foundation, more transparency, a greater focus on governance, and less corruption. You hear a different conversation, and there is a level of seriousness about that conversation.

  7. doctors also add quite a bit of extra to the meds they sell.
    prices can be as much as 3 times higher I discovered when
    I looked at what a pharmacy charges for the same thing.

    prices can vary significantly from pharmacy to pharmacy too.
    if you need an inhalant for asthma, get it from guardian. it's
    $120 there, $190 at unity....

    a doctor friend of mine who has been working in London for the
    last 30 years was incendiary when she discovered prices of meds
    in Spore. anything from 4 times more. she buys her mother's in
    London now -- privately, not on their national health service.

    we won't even talk about the prices vets charge for their meds.
    4 to 5 times a pharmacy's price seems to be standard.

    1. Only the minority of people know what you know today. Tomorrow more and eventually a too big number of people to ignore will also know. How quickly that day comes depend on many factors but foremost is how quickly healthcare costs climb. Then what happens? The guys with foresight in policy making planning for that day already? This is only one of many disruptions ahead.....but in general the information in the people's hands is subversive to all sorts of authority that do not have a sufficient moral foundation.

  8. So another banker drops dead - the countdown continues

    4th ABN banker since the crisis, 3rd this year alone with at least 36 last year.

    "Cheerful" Dutch Financier Becomes 4th ABN Amro Banker Suicide