Thank you

to everyone who has contributed to this CoP. From the bottom of our hearts, thank you for making this happen and if not for your support in our project and sustained interest in the topics of Singapore healthcare, this wouldn't have been possible at all.

We ended our presentation tonight, having presented these many weeks of CoP experience and shared our takeaways with the class. The practical value we derived from the CoP is a healthcare toolkit we came up with which we entitled, "Singapore healthcare: Myriad voices". It's a folder which we packaged for our professor and it consists of key takeaways from the topics and sub-topics, challenges we faced and recommendations, references we considered and studied in kickstarting discussion threads.

Because of the strength of your voices in the discussion, your quality inputs and your dedicated efforts in, simply, making this happen. Thank you.

Please, please continue to post your comments if possible and when you have time. Here are pictures of our presentation taken. Courtesy of a supportive classmate.

Kuan and Sufen deliberating on the presenting Wenger's principles of running Communities of Practice

JS highlighting figures from bar charts as part of his presentation on the statistical analysis

Kuan expounding on the visual roadmap of the CoP

JS "rewinding" and recollecting his thoughts.

A snapshot of half of the class

Figuring out how to get online and get hold of the Balance Scorecard

Would you like to be attended by a nurse?

It's not just a redistribution of workload, neither is it a lack of doctors.

If you've been to the hospital or polyclinic recently with a regularly ailment of flu, fever or cold, you might be attended by a nurse and what is technically known as Advanced Practice Nurse (APN). According to an ST article on August 26, 2009, APNs are registered nurses who hold master's degrees in nursing and have undergone an APN internship.

They are qualified to:

• take health histories
• conduct physical examinations
• diagnose and treat comnmon ailments, like coughs and diarrhoea, and chronic ailments like diabetes
• interpret test results such as blood sugar levels
• provide health teaching and counselling
• manage medications

They cannot however prescribe medication or issue MCs without a doctor's approval. Complex cases are still referred to a doctor.

From a knowledgement management (KM) point of view, it is improving customer service by reducing waiting times, directing quality resources (doctor's care) to where is needed most/more, leveraging on nurses' tacit expertise accumulated through years of practice that junior doctors otherwise do not have, giving nurses their due recognition as frontline operatives and driving innovation to the landscape of care in Singapore healthcare sector. Who says nurses aren't as qualified?

But would you want to be attended by a nurse?
                               

SiCKO & Singapore - Part #3

As much as SiCKO provides a fertile ground for us to criticise the US healthcare system (and ours), it actually offers many beautiful possibilities that Singapore can look forward to.

Through comparisons with other countries. France, Canada, UK and even... Cuba.

Here, M. Moore chats with a doctor of the famous UK National Health Services (NHS) and finds out that in a system where no one is denied medical treatment in the UK and costs of medicine and treatment are either zero or just comfortably affordable, a doctor like the one above can live in a one million-pound home, enjoy fine wine, family time and practise ethical consulting all at the same time

In fact, under a new system of the NHS, a doctor gets paid more if he can get patients to stop smoking. How wonderful is that? In driving continual medical improvements through meaningful KPIs. No wonder the NHS is a strong case study of success in the field of knowledge management, and other academic disciplines.

In France, Michael Moore found out you can even tap on the French government to provide nannies for your baby and well, do your own laundry. The people's welfare put at heart. In the film, Moore shadowed a government-paid mobile doctor who went around Paris performing housecall duties to ordinary folks ill at home. I remember one time, a friend of mine had her elderly landlady suffering in great pain and immobility. She called the neighbourhood doctor (HDB) and was told firmly: "You have to call the ambulance, we don't provide such services."

You mean to say, if someone within a 1 km radius of your clinic is immobile and needs resuscitation (or even revival for life-and-death cases), your doctor will not come to save a life?!?!

Of course, many or in fact the Singapore government may argue that welfarism of this kind breeds complacency and over-reliance on government resources, we are for workfarism. But we would say that real world outcomes have shown that, the dichotomy in the welfare the French people and Singaporeans receive in terms of healthcare is so vast. Self-sufficiency is good but more government help is appreciated--it alleviates so much anguish and stress.

There's one place under the purview of the US government where medical facilities are accessible and guaranteed--ironically, the Guantanamo Bay where terrorists are imprisoned. As the film suggests, this place is better than any place on the mainland where basic healthcare services are concerned. On the premise of international human rights, even terrorists who perpetuated 9/11 receive better care than Americans.

The lady above featured in SiCKO is a 9/11 heroine and through rescue work on Ground Zero, she has been suffering severe bronchial damage due to inhaling waste, debris and dust. You would imagine that a self-sacrificing heroine like her should deserve free healthcare services in the States but no, she struggled, and had to move out of her city home to somewhere more affordable. Compare she... and the Guantanamo terrorists.

And in a touching turn to the film, Moore brings the individuals denied of health services featured in his documentary to nearby Cuba in search of medical treatment. He finds the insulting cheap prices of the same medicine in Cuba and finds medical treatment affordable, available for these victims of America's healthcare system. He brings 9/11 heroes to a local fire department where they are recognised and respected in deference for their rescue work. A totally different treatment from what they got in the States. Here, the heroes exchange handshakes and heartwarming hugs with the firemen.

Michael Moore asks in his film: "Who invented his system?" (Read: ridiculous healthcare system)

And this post harkens back to our mentions of a strained Singapore population; Singaporeans, many of whom through a frugal approach to life walk on a tightrope, maintain self-sufficiency but at the end of the day, are driven to fatigue and depression because of the many expectations, and the many roles they play. Over the years, the rich-poor divide has widened very greatly in the city-state. Like the CEOs of US insurance companies who became/are billionnaires and milk the firms in their some 3-4 years of stint, our rich has become ultra rich and the sandwiched portiion of the middle class are struggling with caregiving, paying for medical bills--and with juggling with their full-time jobs.

Yes, Singapore is an Asian country and we need not model ourselves after Western healthcare, welfare-oriented models but surely we have a mature health market and surely, a little bit from the Republic can help the needy so much. We all need a break.
     

SiCKO & Singapore - Part #2

Medical workers with a conscience

One stream of revelations of the Michael Moore's SiCKO film has got to be the anecdotes from ex employees of the healthcare sector. They took the courage to spill the beans on the unscrupulous things that happened backstage.

An ex employee of the call centre of an insurance company. She recounts an experience when a customer on the phone was jubilant about [the assumption of] getting covered by health insurance and this call centre operator knew for certain that ultimately, she would be denied insurance, and it killed her to be in that knowledge about the certain outcome

In front of a public panel, this medical reviewer confessed the shame of denying policyholders their claims payouts and put under limelight the insurance firms' practice of denying payouts. A medical reviewer who hits a quota in denying insurance coverage saves money for the company substantially and will be rewarded via pay raise, bonuses and promotion

Ex insurance employee interviewed by Moore

Corruption at its core, isn't it? At the expense of lives, real lives of Americans.

And here's more. Footage of patients being dumped on the streets by the hospitals because they cannot afford to pay their medical bills anymore.

This scruffy-looking lady was in a daze when the taxi arranged by the hospital shoved her on the streets.

Footage of an old woman, still in her hospital gown but with the ID bands removed. She was dumped on the streets by a cab, also arranged by the hospital.

Pictures taken from screenshot of the film rented from VideoEzy

It is a breach of medical ethics on the corporate level to the extreme. Thank goodness Singapore at least has a system in place where patients of extreme cases and hospitals can turn to the government.
          

SiCKO & Singapore - Part #1

In 2007, Michael Moore, the underdog filmmaker known for making satirical films in criticism of the corporate, public and political landscapes of the US, made yet another sobering film on the healthcare system in the US. Which, at present time, is what President Obama is trying to overhaul. His critics slam new health policies for socialising America and socialising medicine in the US healthcare landscape.

At various times in these two years, we have watched Michael Moore's "SiCKO" and for one, we cannot deny that the documentary is powerful and well... we are convinced. Convinced by the reality that 50 million Americans are grossly underinsured or uninsured.

That's because the healthcare system in the US has been monopolised by the private sector of hospitals, pharmaceuticals and health insurance companies. There is no basic health risk coverage for these so many Americans, we don't need to talk about quality of care.

And this has gotten to a point in which the doctors of a hospital won't operate on an urgent, life-and-death case unless the patient's insurance is under the purview of the hospital or that he/she can well afford it. The hospitals have the right to reject those in need, out of business reasons.

We thought what a DYSTOPIC vision this is of a healthcare system of any developed country. When we saw the wreck brought about Hurricane Kathrina, we thought to ourselves, "Is this really the US of A?". When we saw exact footage on this film of how an elderly patient was literally dumped by the hospital, we were aghast and the same question surfaced: "Is this really America?"

Here are a few guys without conscience, who helped precipitated a deficient and unevenly spread healthcare landscape of the US:

Here's President George W. Bush

See the price tag pointed to him? That's what he's paid by health insurance companies for passing the bill to let them take the reins of America's healthcare system

Here's the entire Congress, many of whom were bought over at a price

The CEO of a health insurance company who repeatedly stamped his signature on denial letters that denied payouts given to claims made by policyholders and oh, he said he wasn't aware that many of the denials were fraudulently administered. Because...?

the denial letters were similar.

Pictures of screenshots taken from the video we rented from VideoEzy.

Now this is dystopic, but remember our 2nd post on similarities between S'pore's and US healthcare systems? We are not saying authorities in the Republic are like those portrayed in the film, but are there not people here in glorious Singapore who do not go treat their wounds at hospitals because they lack the money or are not covered by their health insurance policies? Are there not marginal(ized) people who can't afford hefty sums of surgery payment to treat their cancers and tumours and are left to pass, probably in support of the Advanced Medical Directive?

Do we not have many people writing to forums who express displeasure of being denied payouts of their claims, of insurance agents who elude customers at the time claims are filed, of inconsistencies expressed over policy contracts?

In our regulated media environment, a Singapore SiCKO would be otherwise banned and the filmmaker probably taken to court and sued to his pants, but say, if there is a Singaporean M. Moore who can give voice to those we have mentioned above and express their sentiments in an open, satirical way, we would be happy to see such craft of intelligent representation.

This is Part #1 of 3 of our posts on "SiCKO & Singapore". Look forward to hearing from you.