Night clinics closed, GPs not an option for poor

23 Apr 2005, The Straits Times

Question

Name of the Person: Leong Sze Hian 

Night clinics closed, GPs not an option for poor

I REFER to the articles, 'Polyclinics to close at night' and 'Many upset with night polyclinics closing' (ST, April 21). 

A spokesman for SingHealth was quoted as saying the closure would allow it to channel resources used in the night clinics into prevention programmes, such as screening for diseases. 

A spokesman for the National Healthcare Group (NHG) said patients who want to see a doctor at night for immediate health care can turn to general practitioners (GPs), who provide services 'very adequately'. 

The reason given for the closures does not seem to make much sense, because providing night consultation and prevention programmes are entirely separate issues. 

If we go along with this line of reasoning, we may next be told that health-screening services would be reduced to allow the health cluster to channel resources to health-education programmes. 

GPs may provide services 'very adequately' but at what cost to the lower-income, as the Singapore Medical Association (SMA)'s fee guidelines for consultation start at $18, which is 125 per cent more than the $8 fee at polyclinics? 

Twenty-two doctors that were willing to offer the same $8 fee as polyclinics on a health services website no longer do so because the scheme has been withdrawn due to the SMA's objection to how it was being advertised on the Internet. 

Where else can the lower-income go at night? 

There are several clinics offering Traditional Chinese Medicine (TCM) free. 

GPs may lose even more business as people might be driven to TCM because of lower costs. 

Are there any free Western clinics in Singapore, other than the one at a Catholic church in Serangoon Gardens which operates on Wednesday nights and Sunday afternoons? 

Many Singaporeans may not be able to visit polyclinics in the day because they are at work or will lose their earnings because they are self-employed. The other reason is that the day-time queues at polyclinics are already very long. The closure at night may lead to even larger crowds and increased workload in the day. 

The lower-income may now be deterred from seeking immediate consultation at night because they cannot afford the higher fees at GPs' clinics. This may lead to medical complications because of the delay. 

This may, on balance, offset any benefits that may be derived from 'channelling resources into prevention programmes. 

Adequate' service, at a high price 

GPs may provide services 'very adequately' but at a starting price of $18, itis 125 per cent more than the $8 fee at polyclinics.

Reply

Reply from MOH 

Resources are finite, MOH has to prioritise 

In "Night clinics closed, GPs not an option for poor" (ST, Apr 23), Mr Leong Sze Hian and your editorial "Night clinics and demand" argued against the closure of (subsidised) night clinics.

If resources are plentiful, it would be good to operate night clinics. Indeed, why stop at 9 pm? It might be even better to extend it to midnight or round-the-clock. 

But resources are finite and we have to prioritise. More resources for night clinics mean fewer resources for other programmes. As polyclinics already operate a full-day session, running night clinics mean putting staff on expensive over-time. This is a costly way of treating coughs and colds. 

Polyclinics will continue to expand their services, but in meaningful ways. One current priority is to see how chronic diseases such as diabetes and hypertension can be better managed. These patients are currently treated at hospital specialist clinics by multiple specialists, at significant cost to the patients. Polyclinics are considering running Family Physician Clinics to offer a better and relatively cheaper service for such chronic sick patients. If successful, this will add value to the delivery of primary healthcare in Singapore. 

Meanwhile, the elderly poor who are eligible and who are unable to attend polyclinics in the day can go to selected private GPs with subsidy funded by the Ministry.