Tuesday, April 26, 2016
Singapore - Focus on cost-effective healthcare
Healthcare is a public good that can become rivalrous in nature when over-consumption leads to long queues for treatment, stretching over months as seen in various countries.
When health risks are pooled, unbridled costs are eventually passed onto all citizens in the form of higher premiums for health insurance. These are reasons enough to scrutinise how healthcare providers and patients are making choices when a range of options are available, including widely publicised technological breakthroughs. For example, an expensive new test might promise to exclude a wider range of risks but is it really worthwhile for all to be tested when the vast majority will encounter negative results? Such concerns have led to "choose wisely" campaigns elsewhere to help people avoid non-critical or duplicate tests and procedures and to reduce potential harm to them.
Singapore is keeping abreast of these developments in setting up the Agency for Care Effectiveness. Healthcare systems must be designed and managed to ensure cost-effectiveness. It would be not only wasteful but also slow down the delivery of essential health services if clinical policy decisions are led by public demands based on perceptions rather than evidence-based assessments. Universal healthcare would not be sustainable if a system prompts patients to opt for all that is available with insufficient regard to costs which are not borne directly by them.
At a basic level, there is a focus on issues ranging from discouraging the prescription of antibiotics to infants with a fever, to prohibiting CAT scans for some cancers and appendicitis because they expose patients to unnecessary and harmful doses of radiation. At a higher level, a degree of scepticism towards the benefits of expensive new treatment should engender a cost-benefit mentality among patients and professionals, even among those who are desperate. That rationality in turn should sharpen national consciousness about the possibilities and limitations of expensive medical treatment.
An estimate that 30 per cent of total healthcare expenditure in America goes towards unneeded care is a warning of the danger of good intentions that produce unintendedly wasteful consequences. Here, the Government has more than doubled its healthcare spending - from $4.7 billion in FY2012 to $11 billion this year. While this spending is necessary, it must not create a runaway culture of consumption that is not only fiscally difficult to sustain but is also medically unsound. It is important, therefore, to educate the public to help them make more informed decisions on treatment. The demographic need for this awareness is highlighted by the fact that rising longevity has also lengthened the years of ill health facing both men and women. Rising healthcare costs would drain the resources of seniors.