Official Opening Of MD Specialist Healthcare

10 Jan 2001

By Mr Lim Hng Kiang

Dr William Chong, Managing Director, MD Specialist Healthcare

Distinguished guests

Ladies and Gentlemen

I am happy to be here this evening to officiate at the opening of MD Specialist Healthcare. This private medical group, comprising consultants in 12 medical specialties and 3 dentists, will offer patients multidisciplinary specialist care in an environment that emphasises continuing professional education and research. Such a multidisciplinary group private practice approach will help add another dimension to our private healthcare sector.

THE IMPORTANCE OF THE PRIVATE HEALTHCARE SECTOR

The private sector plays an important role in our national healthcare system and also contributes substantially to Singapore's standing as a regional medical centre of excellence. The private sector complements the good and affordable medical care available in the public sector, by providing medical services for Singaporeans who want personalised care in a private setting. The reputation of our private specialists is also generally high, as reflected by the substantial numbers of foreign patients who come each year to seek medical care in our private hospitals and clinics.

CHALLENGES AT THE PUBLIC-PRIVATE SECTOR INTERFACE

Looking ahead, however, there are a number of important issues which need to be addressed. The first is the fact that by and large, our current system maintains a sharp demarcation between public sector and private sector medical practice - a doctor either works within our public medical institutions, within which premises he takes care of subsidised and private patients; or he works in the private sector, providing care solely to private patients.

One adverse consequence of this sharp demarcation is that each year, as some of our best public sector doctors leave for private practice, their clinical expertise and experience are no longer available to subsidised patients in our public healthcare system. In addition, medical students and specialists-in-training also lose the opportunity to learn from such top specialists.

The second major issue is the fact that the private sector in Singapore is currently dominated by solo practices. This means that each private specialist generally manages a very broad spectrum of conditions within his or her specialty. Solo practice provides few incentives and opportunities for sub-specialisation, which is essential for the optimal management of rare or complex medical conditions. In a busy solo practice, doctors may also have insufficient time and opportunities to upgrade their medical knowledge and skills through continuing medical education and research.

RESPONDING TO THESE CHALLENGES

In responding to the first of these issues, the public sector will continue to work hard to retain the best doctors so that our public institutions can maintain their high level of medical care and training. With the completion of the restructuring process for Alexandra Hospital, Woodbridge Hospital and the polyclinics, and the formation of the 2 public healthcare clusters, our public hospitals and centres will have the operational autonomy and flexibility to vary remuneration and working conditions to maximise retention of key staff.

The lure of the private sector, however, is strong. Despite the public sector's best efforts, it is likely that we can ameliorate but not completely stop the continuing loss of key doctors from the public healthcare sector through these means.

FOSTERING PUBLIC-PRIVATE HEALTHCARE SECTOR COLLABORATION

In view of these considerations, my Ministry is working towards the development of a new framework for public-private healthcare sector collaboration for doctors.

Today, specialists in the public sector are all based in our restructured hospitals and centres. Since 1980, under the Consultation Fee Scheme (CFS), public sector specialists are allowed to devote a number of consultation sessions a week to see private patients. Specialists who opt for this scheme are entitled to a share of the fees collected from these private or Class "A" patients. With a few special exceptions, such private work takes place within the public hospital premises and public sector specialists are not allowed to do private practice outside their institutions.

Under my Ministry's new framework for public-private sector collaboration, the public sector healthcare clusters can opt to extend this arrangement by introducing a new component called the Faculty Practice Plan. Under the Faculty Practice Plan, selected public sector specialists, of consultant grade and above, can opt to work part-time in private practice, outside of the public hospitals' premises. However, the specialists will continue to be under the clusters' employ, and for the majority of their time will continue to carry out clinical, teaching and research duties in the public institutions. Through this arrangement, public hospitals and centres can continue to benefit from the clinical service and teaching expertise of such specialists who would otherwise have left the public sector entirely.

Such schemes are already in operation in the US, UK and Australia, with successful results. In Australia, for example, all senior medical staff (consultants and above) appointed to public hospitals, university and research institutions are eligible to have private practice.

In addition, my Ministry intends that the Faculty Practice Plan will be a two-way process, which should also provide a viable mechanism for attracting specialists currently already in full time private practice back to part-time public sector work. Such specialists could be given a package of remuneration and terms tailored to the amount of time and effort which they can commit to patient-care, teaching and research in our public institutions.

Private sector specialists who do not wish to return to part-time public sector practice under the Faculty Practice Plan, can still be given admitting privileges to public hospitals, provided they meet the hospitals' credentialing and other criteria. In this way, specialists in private practice will have a wider option of institutions to which they can admit their patients for inpatient management.

BENEFITS OF THE NEW FACULTY PRACTICE PLAN

It will be up to the clusters to decide whether to introduce the new Faculty Practice Plan for its doctors, as part of its human resource management effort. It would assist in the retention of the services of good medical talent in our public hospitals and centres. At the same time, it would allow subsidised patients access to the expertise of some of the best private specialists, who have opted to return to part-time public sector institutional practice. For specialists in general, practice within such a framework would enable the tertiary clinical skills of our top specialists to be maintained, where they may otherwise be lost if such specialists only operated in solo full-time private practice.

Private specialists who opt to return to part-time work in our public hospitals or have admitting privileges to public institutions, will also benefit from the opportunities provided by public institutional practice to keep their medical knowledge up-to-date, and to participate in research and training of the next generation of specialists.

ADDRESSING CONCERNS

Concerns have been raised that public sector doctors already have a high subsidised clinical service load. If public sector specialists are allowed to do part-time private practice outside of our public hospitals, the fear is that this would result in a lowering of the quality of the care for subsidised patients.

Another concern which has been raised is that the Faculty Practice Plan may lead to inadvertent cross-subsidy of the specialists' private practice by public sector resources.

My Ministry acknowledges these concerns. However, these concerns have to be balanced against the very real problems associated with our current "all-or-nothing" system of demarcation between public and private sector medical practice, which I have alluded to.

My Ministry has been putting in place measures to ensure that the level of clinical service and teaching in our public institutions are maintained at a high level. Firstly, the Health Regulation Division (HRD) of the MOH already monitors a series of clinical quality indicators in all public and private hospitals. Over the course of this year, the HRD will be extending the number and scope of these indicators, to include specialty-specific clinical indicators, which would provide regular comprehensive information on key areas of clinical care in the public healthcare sector.

Secondly, my Ministry will continue to closely monitor key indicators of service levels such as waiting times for subsidised patients at Specialist Outpatient Clinics. Thirdly, at the individual hospital and department level, Heads of Departments will be given the responsibility for monitoring the work of the specialists in their departments to ensure that quality of care of subsidised patients and teaching are not compromised.

Fourthly, proper operating and financial firewalls will be put in place to ensure that cross-subsidy between private and subsidised patients does not occur. All dealings between the public healthcare clusters and the private facilities set up by our public hospitals as part of the Faculty Practice Plan, including rental of space and purchase of services, will be at arms-length, priced at market rates and subject to independent audit.

INSTITUTIONAL MODEL OF PRIVATE PRACTICE

Earlier in my speech, I had alluded to some of the potential problems associated with solo, full-time private practice. The new Faculty Practice Plan will provide private specialists many opportunities to participate in, to contribute to and to benefit from public sector institutional practice.

At the same time, I would like to encourage the private sector specialists to evolve their own models of institutional private practice. The objective should be to further improve the coordination of multidisciplinary care for patients with multiple medical problems, while augmenting the existing channels for continued professional development and upgrading of the skills of the private specialists.

Private group practices, such as MD Specialist Healthcare, can play an important role in helping to foster these changes.

CONCLUSION

With the proper checks in place we will be able to realise the benefits of a new framework of public-private sector collaboration, over the long-term. Such collaboration will benefit both sectors, and will position them to meet the challenges of a rapidly changing medical practice environment, and to collectively ensure that Singaporeans will continue to receive a high level of medical care.

Finally, I would like to congratulate Dr William Chong and the doctors of MD Specialist Healthcare, on the occasion of the opening of this centre and wish you and your team success in your efforts to provide high quality care and services to Singaporeans.

It is my pleasure to declare MD Specialist Healthcare open.

Thank you.