Crossing the Causeway for Medical Care Affects Everyone

The New Paper had a story on Sunday about patients who cross over to Malaysia for cheaper medical services. Lucky Tan had one take on it, and Mr Wang another.

I had some thoughts on the story, but I had refrained from posting as I felt my thoughts didn't seem like they would be give that interesting of a perspective. Now however, since two prominent bloggers have expressed their views, and I share neither of those views, I think I will speak on the issue.

In actuality, I agree with both of them, but neither of these viewpoints were at the forefront of my thoughts as I read the story in The New Paper. Something else occupied my thoughts.

Like Lucky Tan, I consider the burden of providing affordable, and I mean truly affordable, medical care for Singaporeans as a duty incumbent on the government. But just like Mr Wang, I've long since given up hope on trusting, much less relying, on the state to do right by Singaporeans. The flipside of the Singaporean aphorism "you die, your business" is "the only one looking out for you, is you." In this country, you better believe it.

What occurred to me as I read the article was that the cost differential between medical care in Singapore and in Malaysia would have implications for all of us, even those of us who don't intend to ever travel to Malaysia for medical care.

If fewer patients seek medical care in Singapore, prices for medical services here are not going to fall. Medical services are like university education; the price only goes in one direction.

On the contrary, if more patients seek medical care across the Causeway, fixed expenses (such as building, maintenance and staff overheads) in the healthcare sector will need to be spread among a smaller number of patients. This will mean higher prices per patient even though the number of patients (customers) is falling. This is especially so if whatever subsidy the government claims to be providing the healthcare system is on a per patient basis, per admission.

If you're a hospital CEO in Singapore, you would probably respond to the phenomenon of fixed expenses spread among fewer patients in the following two ways.

The first would be to cut your expenses. This might mean a lower quality of service (e.g. foreign-born doctors from developing countries, which is already happening, cheaper medicines, fewer support staff). This is not so different from SMRT running fewer trains during non-peak hours; there might be fewer passengers, but the trains are just as packed and the commuting experience just as frustrating.

The second would be to pursue higher profit margin business: medical tourists. This might serve to cross-subsidise cost inefficiencies in the hospital. After all, it makes a lot more sense to invest resources in the segment of the business that is the most important from a revenue and cost-recovery standpoint. Medical tourists in their A class wards can expect high levels of attention and service, while the lower class wards would probably experience much less attentive service.

If you are Singaporean, all this will just make the prospect of crossing the Causeway for medical care even more attractive.

Even you are financially comfortable (but not wealthy) and are averse to the idea of traveling far from home for medical care, circumstances may change in the future that may warrant you to give this option some serious consideration.

The other option would be to purchase comprehensive and heavy health insurance coverage so that the expected cost of medical bills is transferred to a third party. For example, it is possible to purchase riders on Shield policies to remove deductibles, co-payments and category sub-limits. Under comprehensive cover, the total inpatient (but not outpatient) bill falls to zero. A patient under such cover would become indifferent to the cost of medical care. Such cover, naturally, comes at a commensurately higher price.