Novel? One of our fellow thinker, medical specialist had already proposed this some one year ago. so...
There was so much praises and publicity as though this is the panacea to this long standing problem. Is this ? Or is this uniquely Singapore that everyone must blow the trumpet and applauds when some gods sneeze?
This $50 off A & E fees may even backfires. A person who wants to go to the A & E can now go to the participating GPs, twist or threaten them with a law suit if they were proven wrong, and get a letter that gives them a discount at A & E...
Not to throw a wet blanket, but I would like to look at this problem from a few angles.
Patients
People must be repeated educated as to what constitute an emergency in "Medicine". Otherwise you can't blame them to panic with the slightest rise in body temperature or any pain that lasted more than 10 seconds.
People must have more trust in their family physicians. Can't help it but felt that there were a lot of "doctor bashing" in the past ten years or so. Yes, trust and respect must be earned, but negative publicity can be very powerful, too.
Employers
Many people have to go to the "government polyclinic" during office hours and only the " government restructured Hospitals" after that because their employers would only reimburse and only recognise the medical certificates issue by them. This will have to change.
Doctors
Ask any doctor in private practice, is there a shortage of doctor? The answer is inadvertably a big "NO". Of course, there were attempts to tap them like CHAS, Chronic Illness schemes, Baby bonus scheme etc. Sounds good. Why was the response not 100 percent?
There were so many hospitals sprouted up in Singapore in the past few years plus the tightening of the whole labor market, most clinics are facing manpower problem as well. Many would choose not to go onto the scheme or risk losing their staffs because of the further increase in work load.
Despite the CMEs, there is really very limited post graduate courses for the GPs to develop their skills in various areas of interest to them. There could be more recognised structured Postgraduate Diploma courses. "Recognition" is important here because so that their hospital colleagues and the media would not talk down on their trainning and therefore the patients would trust them to continue the follow up of some of their chronic illnesses with them. Then, all these doctors, and not just the few "privileged clinics", would not only take some load off the A & E , but also the Specialist Outpatient clinics and the hospital bed crunch problems as well.
Managed Care & Insurance Companies
Theoretically in Singapore, the doctors are not allowed or supposed to solicit business or given any promotions, discount etc... But for some reasons, managed care companies have not only been allowed to, but have also been handsomely rewarded from doing so. It is not good for the patient, as the clinic would have to mark up more in order to pay for the "commisions".
The GPs would also tend to do less at the clinic because of the limitations set by these companies
. So they will just refer the more complicated cases, or the cases that the managed care companies would not pay, or those that exceed what they could charge to THE A & E
Government
Some of the things mentioned above obviously need a lot of government support, of course if they are sincere in wanting to improve the situation.
Besides that, I believed instead of setting up more polyclinic to compete with the GPs , they could help set up more supporting facilities so that the GPs can operate at a higher level.
Set up more X rays facilities so that the GPs do not need to refer all the minor sprains and falls. Maybe even a shared minor OTs so that minor lacerations, lumps and bumps need no be referred to the hospital. Nursing facilities so that the family physicians could help to monitor some of the chronic conditions. Just to name a few.
Of course I am no expert and no politician. Just providing some feedbacks from the ground.
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