Regional Conference On Cost-Effective Healthcare 2004

22 Oct 2004

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: Grand Copthorne Hotel

Opening Address By Dr Balaji Sadasivan, Senior Minister Of State For Information, Communications And The Arts And Health At The Regional Conference On Cost-Effective Healthcare 2004 Held On Friday, 22 October 2004 At Grand Copthorne Hotel

Prof Tan Ser Kiat, CEO (SingHealth)

Dr Peter Mack, Organising Chairman

Ladies and gentlemen

Friends and colleagues

In the opening scene of the comedy Monty Python's "Meaning of Life", a lady goes into labor. The doctors ask for all the latest equipment to be brought in including the most expensive which is a machine that goes "ping". Suddenly a doctor remembers and asks "where is the patient?". She is lost behind all the technology. Meanwhile, the hospital administrator walks in. The doctors are in awe of the administrator. The administrator says "Ah! I see you have the machine that goes 'Ping'. This is my favorite. You see, we lease this back to the company we sold it to. That way, it comes under the monthly current budget and not the capital account." The doctors applaud. The patient is forgotten.

The scene is a parody of a modern healthcare. During this meeting, I am sure that there will be passionate discussions on cost effective healthcare. Sometimes, to an outsider, it may appear that the patient has been forgotten. This is of course not true. The reason doctors and health administrators need to worry about cost effective healthcare is that since resources are limited, only by using resources effectively, can the best possible care for patients be provided.

The traditional relationship between the clinicians and the administrator is one of delicate tension. While clinicians have generally focused on doing the utmost to satisfy the health needs of their patients, administrators consume themselves with the tasks of running efficient systems and balancing competing resource needs.

Medicine is a costly science. Every medical advance creates new needs that did not exist until then. Physicians are often reputed to be men and women of great compassion. In the absence of resource constraints, they feel compelled to perform ever more expensive interventions for their patients as long as any of their patient's health needs remain unfulfilled.

However, a limitless resource utopia is a fantasy. Man's ever-increasing expectations of medical care have shown a propensity to outstrip even the means of the richest of nations. The result is often tension, especially when administrators have to deny the clinician resources when balancing against competing needs.

Such tension is not necessarily always a bad thing. By coming from two different perspectives, clinicians and administrators provide a form of check and balance against one another, with the clinician softening the administrator's usually more detached and utilitarian view of the healthcare system, and with the administrator moderating the clinician's all consuming dedication to that one patient.

However, at the end of the day, both clinicians and administrators need to remember that they are part of the same team. Both are driven by a desire to increase societal welfare, and seek to accomplish this through their own unique skill sets. The way forward is therefore not one of continued tension, but rather one of cooperation and joint accountability for delivering cost-effective care. Both clinicians and administrators will need to break down their traditional silos and work together to ensure cost effective healthcare.

For example, a child who is born with HIV may consume about half a million dollars of healthcare in his lifetime. But both the tragedy of a HIV baby being born and the cost of looking after the child can be prevented by screening mothers. This is because with screening and treatment of the mother, the baby can be born free of HIV. By working together, administrators and doctors can develop a system that ensures every mother is screened. No mother would wish her child to catch HIV if it can be prevented. So this should be an achievable goal.

Singapore has been able to provide affordable healthcare through our 3M framework. I use the word affordable and not cheap because healthcare is expensive. Healthcare is expensive because the cost of skilled healthcare professions, the cost of drugs and the cost of medical equipment is expensive. Although healthcare is expensive, it is affordable because the government provides a 65% to 80% subsidy for patients. The 3M framework-Medisave, Medishield and Medifund helps pay for the rest. Going forward there will be some improvements to Medishield so that there is better protection against catastrophic illness. This will further enhance our 3M Framework.

To remind doctors that their first duty is to do no harm, in the early 20th Century Sir Robert Hutchinson wrote this Medical Litany: "From inability to leave well alone, From too much zeal for what is new and contempt for what is old From putting knowledge before wisdom, science before art, cleverness before common sense, from treating patients as cases from making the cure of a disease more grievous than its endurance good lord, deliver us."

I don't know if there is a similar litany for administrators managing a good working healthcare system, but if there isn't, until some one writes an eloquent litany, I would suggest - the following: If ain't broke, don't try to fix it".

Conferences such as this one are important for the opportunity they afford for clinicians and administrators alike to share and discuss new ideas on cost-effective healthcare, as well as network and develop the spirit of cooperation and joint purpose. It now remains for me to wish you all a fruitful and instructive seminar, and to those of you who are visiting, I hope you will enjoy your stay in our country.