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.

    

Reflection - healthcare issue

Taking time to reflect how our CoP has come thus far, we would like to thank you all again for spending time to think about our discussion topics and contributing value to this blog. Whether it's a mere 2-cents' worth of personal opinions, references to what others have said or honest insights into the industry, it's nothing short of creating value for our project. Your input reflect the breadth of knowledge and depth of thought.

Many times in our posts, we have centered our conversations around the issue of caregiving and put focus on what the voices of the communities are saying. Saying to policy makers, opinion leaders of the industry, researchers, health service providers. In a handful of comments, we sense passion in your beliefs, we see revelation of the health sector.

I was watching tonight's documentary on the phenomenon of depression in the Singapore society, Channel 8's 无忧无郁 and for moments of the enactment of a depressed caregiver tending to her elderly mother and her emotional breakdown, I can almost identify with the trials she goes through, save for, maybe, the suicidal tendencies. And it dawned even more heavily on me (aside from the fact that this series on depression is shown) that as a people, each of us is experiencing some extent, some form of depression. In each of our very own right, we are.

The issue of health care is not merely a national concern taxonomized into the areas of medical research, caregiving, hospitals, medical ethics, epidemics and so forth, it complicatedly involves the society we're in. We are, but a stressed nation and each of us is a participant of the health sector. There's no avoiding this.

It is an unsettled community, perpetually never at rest for fear of contracting H1N1, for fear of being quarantined for long and losing our jobs, for worrying over our babies and geriatric members of the family, for rising medical costs, for deficiencies of national health insurance system our cases fall into, for seeing an unethical GP.

For a population that has increased exponentially in the past one year, for an alarmingly overburdened economically active population of this society, for limited and affordable medical facilities catered to the average Singaporean... each sub-issue under the arc of 'health care' never stands alone, and when we try to contemplate or when the government strives to tackle its problems, we ought to take into account our very social fabric, the availability and accessibility of medical technologies, the affordability of hospital facilities, the psychological experience of our loved ones as patients, the planning of a household for the future, the mental fortitude of a caregiver in tough times, the social network of friends and relatives leveraged for support and help.

The health sector is more than dynamic, it's more than what an academic journal can critique; it's intertwined with so many issues at hand. It should be viewed in the larger context of population control and management, the politics that defy change and curb grassroots voices, national funds, the social and private environments we live in. Each issue should never be siphoned off and taken separately from the larger webs of context the issue is embedded in.

When you embrace one, you embrace all the baggage that comes with it.
      

Take more fruits... still

2006. TV news reported the collaborative project between HPB and Cold Storage. Results show 60% of Singaporeans do not eat enough fruits and vegetables and are at high risk of degenerative diseases. This video features the same news coverage on Channel 5, Channel 8 and Channel U.

HPB TV Ad

Some time back, some said it's lame but I think it drives the point home.

MediShield questioned

Indeed, we concur with insurance veteran's statement:
Without transparency, there is a risk that a huge reserve will never be used in the lifetime of the contributing members

As contributors to the pool, we have a right to know how MOH intends to use MediShield to cover congenital illnesses so that it can build up sufficient reserves to fund future claims. This is because variables such as individual claims experience, medical history and age determine a contributor's premium and if MOH were to apply a one-size-fits-all approach, there are people who will be unfairly treated without even knowing the methods and principles adopted by MOH to adjust premiums.

We say no to unnecessarily add to the cost of health care.
      
Source: Tan Kin Lian. ST Forum. MYPOINT. October 3, 2009. Pg. A43.
           

Humour in hospital

The beautiful architecture of Alexandra Hospital caught my attention this morning

Tranquil, colonial, serene, austere





And in one of the men's...

screams this joke of caution. Surprise surprise =)

    

    

Letter to the forum

Dear ST Forum:

I refer to Richard Seah's letter on the forum, "HPB shouldn't be playing catch-up on healthy diets" dated October 10, 2009. The writer raises interesting points about healthy diets and points out some things I didn't know about, such as "the goodness of medium chain fatty acids found in coconut milk and coconut oil, which the board discourages people from taking."

However, what I find odd about the letter is that such detailed, prescribed health diets should fall on the shoulders of the HPB, simply because what is deemed as harmful, such as "pasteurised, homogenised and otherwise processed cow's milk", "chlorine and flourides" in Singapore's drinking water and "white sugar", stems from nothing but a very niche belief of an interest group supporting health diets, which, the mainstream, even after 30 to 50 years of health diets advocacy in Western societies, do not adopt wholeheartedly.

Simply, the likes of vegetarian meals, brown rice, organically produced food are not everyone's cup of tea. The HPB can make recommendations on healthy living such as the Singapore Workout (successful in the 90s), community walk-a-jogs and ideas of generally balanced meals to the public, but it is not their role nor there is a need for any health-related statutory board to revamp what is otherwise a commercial F&B landscape or dictate what kind of food should be sold in foodcourts.

Seah's writing is irrelevant and overlooks the wider business and social concerns surrounding diets and the F&B industry. Individuals of the public should enjoy the personal freedom of being able to choose from variety and not from a reduced variety infused by health foods purported by a niche group of such supporters.

It is not the job of the HPB, nor is there a need for such prescription.


Best,
Kuanzhong

***************************************************************
The above letter was submitted but has not been published.
      

Run for Hope 2009 – Support Cancer Research

Run for Hope 2009 is Singapore’s most established non-competitive charity run in Singapore. In its 17th year, it will be on the 22 November, 7am, at Angsana Green, East Coast Park. Routes are 4km and 10km.
Organised by The Regent Singapore and Four Seasons Hotel Singapore, the proceeds raised from the run will support cancer research projects implemented and sustained by the National Cancer Centre Singapore (NCCS).

Fees are $35 (adults)/ $18 (18 and below). Registration closes 16 October 2009, so hurry up and register now at http://www.runforhopesingapore.org/.

You can make a difference to the lives of many cancer patients by helping NCCS to have faster breakthroughs in cancer diagnoses and treatments.

        

Doctors speak up

Today's ST published a slew of commentaries on 'Greedy' Doctors. We know some, if not most of you, belong or are related to the health sector and we are moved by the overtones and point-blank messages of the commentaries to ask this question: Are doctors in Singapore really ethical?

In two pieces of writing contributed by Singapore Medical Association and College of Family Physicians Singapore, it is said that we should not judge all doctors based on a few black sheep. Dr Chong Yeh Woei, president of the Association pointed out the recent, in fact, longstanding abuse of benzodiazepines, phentermine and Subutex which the authorities should investigate and tighten control of.

Both professional bodies do not condone Ms Salma Khalik's last Wednesday article "Tame doctors' greed and protect patients" and further state, on the forum, reporters should guard against the dangers of unfair reporting and Ms Khalik's commentary tone actually move the public against doctors. Pretty blatant remarks, eh?

All said and done, we would like to ask your opinion on the matter, based on your personal involvement in the profession. It would be most interesting to hear from you.
              

Healthy Living @Junction 8

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For enquiries, contact Ho Ping 6435 3012

Information source: http://www.junction8.com.sg/promoDetail_HealthyLiving.htm
  

Don't deny single mothers Baby Bonus and other benefits

Believe the following grassroot opinion on ST forum speaks volumes about our healthcare infrastructure (funding support) against niche group, i.e., single mothers.
Taken from the Straits Times. Forum. Monday, 14 September 09. Pg A25


I refer to Dr Ng Liang Wei's letter, "Set up pregnancy fund to curb abortions" (Aug 22).

I am an unwed mother. At one point, when I was struggling to decide whether to keep my baby or abort it, I realised I was not entitled to Baby Bonus, four-month maternity leave, six days of childcare leave and other benefits. In the end, however, I decided to keep the baby and managed to borrow money from friends and relatives.

Last month, I delivered my baby boy and I am so delighted I made the right choice to keep him. But I know my problems will not end here. Indeed, I will need to work doubly hard to support myself and my baby.

I contacted the Ministry of Community Development, Youth and Sports for aid, but its reply was that help is given only to couples with a child, not single parents. Will such a stand not push single mothers-to-be towards abortion?

Surely, single parents need more help than couples. Unwed mothers have to be brave to face single parenthood and shoulder the financial burden alone. I hope the Baby Bonus, leave and other benefits can be based on the child, rather than whether the baby was born to a couple or not.

It would also be helpful if hospital charges for unwed mothers can be 100 per cent deductible under Medisave so they do not have to fork out cash.


Peck Chai Hong (Ms)
        

Chewing the fat on 'globesity' epidemic

(Just a sidetrack) An opinion piece of the aforementioned title captured my eyes this morning which cites obesity as a public health issue that has been overrated, something mankind has (read: unnecessarily) created a moral panic about.


I didn't know that apart from Type 2 diabetes, increased rates of heart and cardiovascular disease as epidemics caused by fat, breast cancer is another example of manifestation.

Illustratively, the piece points out that causes of obesity include: 

1. Change in quality of life: longer life span and we have less physically stressful occupations
2. Easier access to more food
3. Abundant access to junk, cheap food
4. Absent opportunities for physical activity
5. Eating disorder; eating as an addiction
6. Ageing: the older we are, the fatter; an ageing population means a fatter population (?!)

Interesting read, do check it out when you have the time or you may email us for a copy. Have a great weekend.

 

Parents spend on brain training for kids

We are a little spooked by the idea of using software programmes that aim to train an individual's brain. In ST's Mind Your Body issue today, there is a feature on the topic. Parents are paying SGD70 on an hour session of brain training for their kids. For toddlers, the fees can fetch SGD550 to 600 for 12 one-hour sessions, according to the article.

The next question to ask: is it worth it?


Apparently, the software consists of games that target improving memory, sequencing, sound discrimination, pitch, vocabulary, comprehension and grammar.

Tract Alloway, a psychologist, offers a counter argument on her website that such brain training programmes need to be substantiated with measurement and research (see http://tracyalloway.com/index.php/working-memory/brain-training-does-it-work/). Scoring well in PacMan after some time of practice doesn't mean the child's IQ is improved. She says that before-and-after IQ tests need to be conducted to properly measure if playing PacMan correlates to better thinking and better IQ.

What do you think?

And oh, we just learnt something related to the psychological aspect of our KM course: in the brain, axons send out information and dendrites take in information.


Brain image taken from e-learning website: http://api.ning.com/files/9tcSfHhJzl2TPvCpu*rJ18shk8zYlamQiYFD6Mw2PDo_/brain.jpg
            

What area of our healthcare sector should be improved most?

Dear all,

Just a brief statement or two, what aspect of the healthcare system, services or infrastructure in Singapore would you like to see the greatest change in? Care to share your thoughts on your comments, please?


Jinsheng, Sufen, Kuanzhong

   

Our email address

In case you've forgotten, our email address is thecommunitychat@gmail.com. Feel free to email us if you have any query about this CoP (Communities of Practice), the administration of our project or technical issues with writing your comments.

Do keep your ideas coming, thanks heaps!
  

Medical tourism in Singapore

Reality or marketing speak?
.

Abuse to health workers: has it improved?

Chanced upon an archived news clipping about healthcare workers being prone to verbal and physical abuse by their patients and next-of-kin. I wonder if the situation has improved one year since the article was published? I am heartened to know many of your support for healthcare workers from your comments. From nurses who stood their ground during SARS to medical social workers who empathize greatly with their clients, on-the-job realities faced by healthcare employees are, no joke, tough. If you have stories to share, or experiences gone through by those you know in the industry, mind sharing a snippet or two?

Picture: Health workers prone to abuse from patients. The Sunday Times. Home, pg 12. December 7, 2008.

Email us for a copy of the article.

And the people say:

• Socialism is UnAmerican!
• Terrorists Won't Destroy America, Congress Will!
• The American Dream R.I.P

Thank you, all

Hi everyone, we would also like to thank you for your dedicated participation thus far. Wherever you are, your keenness in our topic and discussions has definitely made this CoP more interactive; your comments are insightful and add so much depth to the subject.


Thank you, so far, for playing a part in our KM project.


Do continue to freshen this blog with more ideas.
.

Health insurance products make a comeback

Stumbled upon a series of AIA one-paged poster on the Straits Times a week ago. Followed by other scream-in-your-face series by HSBC and NTUC Income (today), if I remember correctly.

A sign of market revival in health insurance products?

Following the collapse of AIG due to the financial downturn, Great Eastern has become the top player locally. I would think this means GE has the greatest market share; hence the almost ubiquitous ads on double-decked buses.

My take is that there will be a gradual surge in life/health insurance products selling in time to come. But whether or not this is done in compliance with MAS or Life Insurance Association's (LIA) guidelines, and in compliance with the Insurance Act, is another story.

You shall hear more from your colleagues, friends, relatives and/or indirect contacts of your personal network who are all insurance agents.

Photo captured from The Straits Times, 14 Sept 2009
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Thankless job of caregiving

I don't know about you but don't you think caregiving is often a thankless job? Imagine the work required for an immobile, bed-ridden patient at home: feeding through tubes, replenishing the drip, monitoring meal and poo/pee times, turning his body to avoid bed sores, massaging his joints and muscles, changing his diapers, moderating room temperatures, cooking for the patient.

Caregivers receive little thanks because often, the work done is monetarily immeasurable and takes place in the private domain of the home; beyond what others can recognise and valuate. I personally know one contact who previously took a few years off so that she can take care of her mother suffering from Alzheimer's Disease; the work done is tremendous: finding ways to stimulate cranal activity, encouraging patient to move into physical mobility, preparing food which boosts memory, moderating mood swings, cleaning up after patient and so on. It's not a 9-to-5, but a round-the-clock routine.

True, caregiving is born out of love, of filial piety, of selfless care and concern for someone else, but where many responsibilities are expected of an active Singaporean as prescribed by the government, how can Singaporeans be compensated (or even rewarded) for their efforts? For the time loss which could be directed at bringing home bread and butter? For the gap to fill in returning to the workforce? How can one catch up?

Take for example, the role of the Singaporean woman. She plays the dual role of staying economically active, i.e., employed, as well as caring for the elderly and her children. These are expectations set out by many instances of national rhetoric. Families can't be just single-income but dual income (wives have to work too); Baby bonus packages (give birth and take care of her kids); hospitals cannot support our elderly population, it has to be cascaded to home care (who else but the wives to take care of her in-laws?).

Face it, caregivers in Singapore are overstrained. To what quantifiable extent can workfarism work for caregivers here? It's time caregivers get their due welfare.
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H1N1 - The new flu wave

The World Health Organization is urging everyone on this planet to brace for a second wave of the pandemic spread as the heavily populated northen hemisphere edges towards the cooler season when the flu thrives. Countries that are in the southern hemisphere should remain vigilant.
Influenza traditionally rises to its peak during autumn and winter, WHO Director General Margaret Chan warned on Friday (21st Aug 2009) that there had been second and third waves in previous pandemics. “We cannot say for certain whether the worst is over or the worst is yet to come,” Chan said in a videotaped address to a symposium on flu in the Asia-Pacific region. “We need to be prepared for whatever surprises this capricious new virus delivers next,” she added.

In the headlines of STRAITS TIMES yesterday (5th Sep 2009): 'Hospitals on alert for new flu wave' and 'four-fifths of people in Singapore have not been exposed to H1N1 yet'. The hospitals in Singapore are making sure they have enough facilities such as wards, manpower, medical supplies and infection control measures in place to deal with the sudden pandemic, the Ministry of Health (MOH) told The Straits Times.
Ever since the first outbreak of H1N1, Singapore had came out with many initiatives such as National Environment Agency's Singapore OK programme, Health Promotion Board's posters for proper management of hand-washing and personal hygiene.

Poster source: Health Promotion Board

All of these initiatives need the support of the people and they heed the advices, especially when it comes to personal hygiene. In the Pre-schools, the young children are taught to wash their hands properly with soap, teachers and parents have the responsibilities to take care of these young children when they are sick as they are the vulnerable group. In the Primary, Secondary schools and in colleges, health talks are conducted to raise the awareness of these group of personal hygiene. For the public, the media has been playing a very important role, there was emphasis on prevention of the Influenza. However, there was a survey conducted by AsiaOne, and that 3 in 10 Singaporeans don't wash hands after toilet. This is about 30% of the surveyed, this is a very serious issue for Singapore when we should be more vigilant after the SARS in 2003 and the first wave of H1N1.

Some points to ponder on:
1) How else can we raise the awareness of the public to better manage their personal hygiene?
2) Will the reporting of figures of H1N1-confirmed cases be efficient in raising the awareness of the public of the pandemic?
3) Do you think there's a need for everyone to be vaccined against the H1N1 flu?
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Singapore's and Japan's Ageing Population: Are efforts enough?

There are currently 300,000 citizens in Singapore who are 65 years and older. This figure, will more than triple to 900,000 in about 20 years’ time, according to the Committee on Ageing Issues (CAI) in Singapore. In Japan, 25.7 million out of the country’s 128 million people is currently 65 years and older and in 20 years’ time, this number will rise to an alarming figure of 37.2 million, with the total population predicted to fall to below levels of 100 million (Source: Reuters)

Ageing population influences policy formulation as far healthcare and taxes are concerned. There are debates that the Japanese government is not doing enough in anticipation of the fast ageing population and its repercussion on the Japan’s already suffering economy and society. Japan's health-care costs are creeping up along with the number of elderly -- reaching an estimated 8 percent of GDP in 2005, compared with 4.4 percent 40 years earlier. More than 40 percent is related to patients aged 70 or over.

And experts say local governments are not planning enough new nursing care centers or recruiting helpers to meet predicted needs.

Other ageing nations will be watching closely to see how far the heavily indebted government can rein in costs especially as the number of elderly in Japan creeps up with projections that 40 percent of the population will be aged 65 and over by 2055.

Although the situation of Singapore’s ageing population is not as serious compared to that of Japan, we are fast catching up if nothing is done to address the problem. It is almost inevitable that Singapore will dwarf the steps of Japan given our falling birth rate and ageing population from the Baby Boomers. One of the problems faced by Japan is the issue on “Social Hospitals”, where elderly were being kept at hospitals just because there is no one to take care of them, depriving those with a true need of a hospital bed. Perhaps the Singapore government saw this coming and hence the new policy put in place as spoken during the national rally this year.

In retrospect, do you think the government has done enough to address the immediate concerns faced by our imminent ageing population? If not, why so?

Sources: http://www.mcys.gov.sg/successful_ageing/Report.html

              http://www.reuters.com/news/globalcoverage/agingjapan
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Hospitals twinning programme - a brief evaluation

In revisiting PM Lee's National Day Rally speech on healthcare--that an ageing population calls for a restructure of the whole healthcare system and how the hospitals twinning programme helps in such reform, we came up with a cursory list of demerits in the system (against the merits), which we cannot rule out in the forseeable future this implementation is carried out.

Hospitals twinning programme

Click on image for an enlarged view of the table

What say you, my beloved readers?
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If there's any similarity

in healthcare concerns between Singapore and the US, it's that the people in both countries severely lack health insurance. A study conducted by NTU Professor David Yee reports that Singaporeans are grossly underinsured by two-thirds of what is needed; in the US, it has become common knowledge that nearly 50 million are, altogether, uninsured.

While the US administration is still deliberating on the insurance approach needed--health insurance cooperatives vs. government-run plan--with President Barack Obama doing what it takes to appease multiple stakeholders of one of the world's most abused healthcare system... thankfully, Singapore has in place a health insurance system that is more sound and stable and less subject to the vagaries of politics.

In the US, healthcare reform is politically driven by the different aims between the Democratic and Republicans. Whereas in Singapore, the situation is more controlled with the insurance department of the MAS already taking steps to clamp down on incorrect and unethical sales advisory conducted by insurance agents.

In an Aug 21 article in the Straits Times, it is reported that the average Singaporean "needs life insurance protection of $494,851. However, his existing life cover is only $165,628 on average, even after including mortgage insurance and CPF savings", which translates to an alarming shortfall to the tune of over $300,000.

The article lists the following as what the sum insured of the insurance policies should cover, in the event of death of policyholder:

• Outstanding debts and funeral expenses
• Housing costs
• Allowance to parents
• Children's expenses, including education

And this lack, according to MAS, has to do with the fact that insurance advisers are known to promote products that yield most commissions, rather than those that meet the needs of consumers.

Not forgetting that the nature of life insurance is to provide long-term protection to policyholders. Life insurance, contrary to unit trusts, investment-linked plans or penny stocks, is not an investment, but a form of protection of a person and his family against future, unknown risks.

Unfortunately--I personally feel it is lamentable that--we have left the decisions of insuring our loved ones against fortuitous risks to supposed [untrained] insurance advisers that belong to a system that continues to be unregulated and is made up of agents who do not know what to do when a claim arises or who disappears altogether after a few years since policy inception.

Agreed? Do you have similar experience with agents who do not conduct themselves in meeting your insurance needs in healthcare?

Reference articles: "State-run insurance plan may be ditched", ST, 18 Aug 09 and "S'poreans grossly under-insured: Study", ST, 21 Aug 09

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National Rally Speech - Singapore healthcare system

This blog is born out of the collective interests of a community most keen to discuss, debate or just say something about the issue of healthcare in Singapore. The recent National Day rally speech delivered by Prime Minister Lee Hsien Loong delves into the subject and raises salient concerns that, we feel, all Singaporeans and interest groups in the healthcare sector should be concerned about.

To present a key points:

• The government is working on a step-down approach of hospital care by cascading care to patients from acute hospitals to community hospitals. The 'twinning of hospitals' has it that a patient who is recovering from treatment in the former will be transferred to the 'sister' community hospital nearby, or literally next-door, where slow medicine is given to reduce the gap to recovery
• The 3M (Medisave, MediShield, Medifund) system is expanded such that Medisave now covers long-term outpatient treatment, MediShield provides higher insurance payouts and Medifund gives more help to the needy to clear outstanding hospital bills
• More (eg. more twinned hospitals) is not the solution to cope with the medical needs of a burgeoning ageing population and low-income families struggling to pay medical bills; the system needs to be structured and adapted properly
• Medical workers involved in controlling the community spread of H1N1--their efforts are lauded in Parliament
  

PM Lee's message is sombre, real and it leaves areas of questions for all of us--as if, there is yet a sense of closure.

• H1N1: there are daily reports of H1N1 infection and/or death cases--how long will it take for people to ride over the epidemic wave, like what happened with SARS? Or is infiltration into the community so rampant and deep that, perhaps, there may be no way we will be able to rid of it?
• Hospitals-twinning programme: the filtering of medical care reduces medical costs for the families and frees up beds in acute hospitals. Exactly how effective is this model of hospital recuperation care? Are medical workers from VWO hospitals (Ren Ci, St. Andrew's) sufficiently equipped and trained to handle patient cases fresh from surgery?
• Citizenry participation: To what extent can a government influence, even control or dictate terms on, how home care for the elderly should be run? Is it fair for a government to impose on caregiving in the privacy of home spaces? How receptive will people be in adopting an attitudinal change in [improving] their lifestyles?

 For full details of the National Day Rally's speech on healthcare, visit the article on Asia One here.

You can also email us at thecommunitychat@gmail.com. Feel free to share with us your views!