Perspective Unlimited

Wednesday, March 28, 2007

Britain's Shining

This should be an uplifting post to distract the Singaporean blogosphere from the hoo-ha over pay increase for political leaders and civil servants. I was already in some kind of twilight zone when I wrote this post, caught between sleep deprivation of the past 48 hours and the adrenalin still rushing inside. But I was certain that this story was worth another few minutes of my sleep, and it would not be the same if I had waited another day to post this.

A Surprise and Lots of Anxiety

Sometime on Tuesday afternoon, in the middle of a conference in Nottingham University, I received a phone call from my wife Grace in London that the hospital was expecting an early delivery of our first child (a girl) due to some complications. Needless to say, I rushed to the train station to catch the first train back to London. As I had bought a restricted ticket to save on travelling cost, I was not supposed to be on this particular train, and a heavy fine was in fact waiting for me as the train pulled out from Nottingham station. But when I explained to the conductor that my wife was about to give birth in London, all she did was to smile at me and say, congratulations.

National Health Service

To spare the unnecessary details, Grace was checked into St Mary's hospital near Paddington. For those of you who do not already know, the National Health Service (NHS) in Britain is a taxpayer funded health service that provides healthcare free of charge. It is a colossal institution which employs, according to Wikipedia, 1.3 million people thereby making it the fourth largest employer in the world.

As an economist, I can only imagine the kind of waste, fraud, moral hazard and incentive problems that would naturally arise when any good or service, let alone one that is as important and yet ridden with information asymmetry as healthcare, is delivered free.

Every year, NHS lunges from crisis to crisis despite sucking up a vast amount of taxpayers' money. As we were waiting for the delivery, Grace and I had the chance to chat with a young English trainee doctor Hannah. This young doctor was obviously savvy enough to understand that NHS policies presented great financial stress for her country, but she was adamant that the ideal of universal healthcare provision was one that was worth fighting for.

Bleeding Heart Socialism

Take away my economist hat for the moment. As a patient and father-to-be, I begin to realise how wonderful a country Britain is. For all the problems facing Britain over the years, they have steadfastly held on to this uncompromising bleeding heart principle that everyone in this country should receive free healthcare as a fundamental human right. Since this is an unalienable human right, NHS coverage therefore extends even to all foreigners in this country. It is a case of principle over financial considerations to the point of what appears to be fiscal foolishness.

Grace and I are but foreigners in this country - we are neither citizens or permanent residents. We have no long term stake in this country. Yet, we were provided with what was in our opinion the best treatment money could not buy - a bunch of dedicated professionals* working to ensure the safe delivery of our child without us ever having to worry about the cost. As even the most complicated procedures would be free, it relieved us from any financial worries. In the time we have been in Britain, NHS has always taken care of us.

A Singaporean girl Elena Thia was born on the 28 March 2200 hours (British daylight saving time) at St Mary's hospital. Elena was truly born free, courtesy of Britain's generosity. For that, our small family would always remain grateful to this country.


*As far as I can remember: Two midwives, an English and an Ethopian. Anesthetists from India and Hong Kong. Doctors from Malaysia, Greece and UK. Nurses from Ghana. Talk about globalisation!

I am going to bed now . . .


Trivial Updates:

(1) Incidentally, the doctor who delivered Elena (pronounced as eh-LAYN-ah) was from Greece, her name - Eleni. They both share the same root name, which is Helen.

(2) Elena's birth was recorded at 2153 hours (DST), 28 March 2007. If she were born in Singapore, she would have the same birthday as her grandmother 29 March since Singapore is 7 hours ahead. Weight was 2480 grams. Go buy 4-D?

(3) Elena was registered as Elena Paul Thia on the 2 April 2007 at Westminster Council House at Marylebone. Paul is the name of the granddaddy (Grace's father).

76 Comments:

  • Big Congrats JP and Gracie!! :D
    Can't wait to see the pics of baby Elena! Take care and keep us posted on how mummy and the little one is doing :)

    By Blogger Jaszy, at 1:36 am  

  • Bart,

    Congratulations!

    By Blogger Speranza Nuova, at 2:24 am  

  • Bart

    Congratulations and best wishes to you & your family on a journey of discovery together.

    Warm regards

    By Anonymous Anonymous, at 5:51 am  

  • To think I have to receive this news via your blog!!!! Congratulations, Grace and Bart, we're so happy for you! Linda

    By Blogger Ocean Deep, at 8:11 am  

  • Congratulations! :)

    By Blogger ringisei, at 9:39 am  

  • Wonderful wonderful!!!! praise the Lord for baby Elena!!! pictures when you get a chance please!!! :) very happy for both of you!!!

    ps, high frequency of exclaimation marks denote high level of excitement at recent developments :) hehe

    By Anonymous Anonymous, at 10:01 am  

  • Bart and Grace,

    Congratulations. :)

    By Blogger Bernard Leong, at 2:41 pm  

  • 恭喜恭喜!身为人父,可喜可贺也!

    Don't forget the pictures when you get the chance to! :D

    By Blogger Aaron, at 2:50 pm  

  • "Take away my economist hat for the moment"

    This is my first comment on your blog... because I generally dislike talking to economists - too cold and calculating. My question to you is... when you took your economist hat off for a moment, what did you become? a human being? Wouldn't it be nice if economists kept that human being identity even as they put that economist hat on so that they do not lose sight of the essence of humanity even as they compute the cost of being humane? Yes, being humane is sometimes inefficient, but where the two clash, which should prevail? Should efficiency only determine the best means of being humane, or should it also determine how human we should be?

    Congrats on the birth of your daughter. I hope you are not already doing a cost benefit analysis on how best to bring her up.

    By Anonymous Anonymous, at 3:34 pm  

  • This comment has been removed by a blog administrator.

    By Anonymous Anonymous, at 6:07 pm  

  • Bart,

    Congrats! :-)

    It is a case of principle over financial considerations to the point of what appears to be fiscal foolishness.

    The KTM will admit that he doesn't understand British politics (Yes Minister doesn't count does it?). It seems to the KTM however that NHS is not only about principles, it's also about politics.

    Warmest Regards.

    By Blogger kwayteowman, at 6:32 pm  

  • First let me thank you friends and bloggers alike for your warm wishes. But sorry Aaron, I will not be posting any more pictures. Only personal friends will receive pictures when things are more sorted over here.

    I was inspired to write this post in part because of my new born daughter (though that was only a personal matter). I wrote this post mostly because I was inspired by the Brits, their worldview, and their humanitarian instincts.

    KTM might well be right to say that NHS was a political issue, not necessarily a humanitarian one. That made sense mostly. However, that would not explain why NHS coverage extended even to foreigners. Surely, a political move would have the Brits cut healthcare for foreigners and target more money for their voters instead. As things stand now however, NHS may be forced to end free healthcare for foreigners as funding is very short. But boy, have they tried.

    To Human Book: I have no wish to discuss Malaysia's policies here, but I would just say that I have indeed noticed a high number of Malaysian Chinese working in NHS at various levels (nurses, doctors, sonographers).

    And finally, to Anonymous 3:34 (it looks like I am quoting a bible!). Economists analyse the tradeoffs society faces in a rational, scientific way. However, it is ultimately politicians who decide on the actual tradeoff and the kind of society one becomes. I therefore think your opinions of economists are misdirected. Of course I have done a cost-benefit analysis. I am convinced I will get enough utility out of the adventure of parenthood to be worth the high cost of doing so.

    By Blogger Bart JP, at 9:55 pm  

  • Bart,

    Singapore once also treated foreigners like locals when it comes to healthcare. However that privilege has since been withdrawn because it was felt that there was a need to make the locals feel like they are treated better than foreigners.

    Our citizens have this strange need for affirmation. They need to feel valued by the Government in order to be good citizens. The KTM never quite understood this concept and still doesn't understand.

    Difference between Brits and Singaporeans is probably that Brits are 70%(?) idealists and 30% pramatists (KTM is guessing :-)). Singaporeans? Probably 60% pragmatists, 1% idealists and the rest neither care or have any clue about what I'm talking about ('apatheists').

    Diff between British and Singaporean politicians is that the Brits care about this amorphous thing called 'high moral ground'. Ours are more concerned about high pay. Question: do the Brits withhold upgrading for votes? Again, there's a difference in our political culture (or lack thereof).

    Since NHS is so good, perhaps you can propose to the Minister when you get home to ship all the sick Singaporeans to London so that our former colonial masters can pay for our healthcare? :-P

    Human Book is clearly a spammer. His comment has no relation/relevance to your post. Don't have to be too kind. Should just delete. :-)

    By Blogger kwayteowman, at 10:26 pm  

  • Congrats Bart and grace!

    Best wishes to you and baby Elena.

    Hopefully u can try to convince MOH the merits of higher medical subsidy in S'pore when are back lolz

    By Blogger at82, at 1:29 am  

  • Congratulations JP! I never thought I would only get to know through your blog! Of course you would be, quite understandably, too busy yesterday. Tried to call you but I seem to have the wrong number on my phone (again). Talk to you soon though.

    By Anonymous Anonymous, at 6:24 am  

  • Congratulations!

    We'll save the arguments on the fiscal foolishness for another post.

    Cheers!

    By Anonymous Anonymous, at 7:12 am  

  • Congrats!!

    By Anonymous Anonymous, at 2:23 pm  

  • KTM,

    You know what? I actually think your comment makes a lot of sense. The is some . . . a sense of nobleness? generosity? ideal. . . that is missing in Spore national life.

    Today, we were discharged from hospital. We packed, thanked and hugged the staff, signed the papers, and walked straight out of the hospital. Not a penny paid. Almost surreal.

    By Blogger Bart JP, at 11:01 pm  

  • KTM wrote:
    "Diff between British and Singaporean politicians is that the Brits care about this amorphous thing called 'high moral ground'. Ours are more concerned about high pay. Question: do the Brits withhold upgrading for votes? Again, there's a difference in our political culture (or lack thereof)."


    Hi KTM,

    Unfortunately it appears that the British have far surpassed Singapore in the withholding-for-votes stakes:

    Government punishes Tory voters by demolishing their hospitals

    Hospitals in Tory seats are 'targeted for closure'

    *sigh*

    By Anonymous Anonymous, at 8:46 am  

  • nom de gloom,

    Whoops. The KTM spoke too soon and stands corrected. :-(

    Perhaps we ain't so special after all. :-(

    By Blogger kwayteowman, at 1:25 pm  

  • Gloom, KTM,

    My impression is that NHS is run by private health trusts, which make independent decisions. Given the financial strain, it is not surprising that more hospitals in Tory wards would close - since Tories have more rural wards served by community hospitals. I think it is a decision to streamline, rather than political.

    Anyway, I do agree with KTM's overall point that political culture matters.

    Regards.

    By Blogger Bart JP, at 2:17 pm  

  • "Our citizens have this strange need for affirmation. They need to feel valued by the Government in order to be good citizens. The KTM never quite understood this concept and still doesn't understand."

    Reason 1. National Service
    Reason 2. No crutches (only for poor) - $290 vs a 1 million dollar raise.
    Reason 3. Theytookourjobs!!

    Probably there's a lot of other reasons, but I'm too tired.

    By Anonymous Anonymous, at 4:27 pm  

  • the thing about the NHS is that in reality it is still a very bloated and inefficient system. i did not have any nasty encounters with it during my university days in England, but it is a huge bugbear for every single British person I know, and you only need to track the healthcare stories in the Guardian and the Times to know how bad the situation can be.

    one example: my British boyfriend's mum recently fell very ill due to a kidney problem and needed surgery urgently, within the next few days. unfortunately the NHS could only schedule an operation *three weeks* later, thanks to a long waiting list. if she waited that long, she would die. the family was at a loss because if they wanted to treat it soon, they would have to visit a private surgery which would charge loads more (for a healthcare service which she, as a taxpayer, should have gotten for free).

    in the end the dilemma was solved, but not in a good way - her condition worsened dramatically one day, and she had to be immediately rushed to a hospital A&E, where she eventually got the treatment which she needed on that day itself.

    as an idealistic person, i totally agree with the bleeding heart principle behind the concept of the NHS, but when you hear of such situations where someone has to be on the brink of death before getting treated properly, one cannot help but wonder if this system can really work. it is one thing about providing healthcare to everyone for free, and another to provide *quality* healthcare.

    (also, I am not too sure how NHS works but it is not totally free for foreigners in some aspects. each time i fell ill while I was in the UK, I had to pay for my own medication - the school health service doctors would diagnose me for free but i still had to trot down to Boots to buy the drugs I needed to get well. but that was for outpatient illnesses - perhaps it is different when you have to enter a hospital.)

    By Anonymous Anonymous, at 5:59 am  

  • Anon 4:27 PM,

    I think you misunderstood the KTM. The KTM has been around and has heard all the reasons why people say they are not being valued.

    Question is: why do Singaporeans have to feel valued to be good citizens? What is loyalty?

    In any case, most of the reasons you've suggested is not about "being valued". It's just about "me me me" (at least that's what the KTM thinks, but the KTM could be wrong).

    It also begs the following questions: what does it mean to be valued? Is there an objective definition or it is subject to one's perspectives? Are all citizens "valuable"? In what way and why? Can we quantify value? Should we?

    The KTM has no answers to these questions. Just thinking aloud.

    By Blogger kwayteowman, at 11:15 am  

  • KTM:

    Now, let's say that you are born. Mother and father care for you, do things for you. Sure, they may scold you at times but at least they take the time to understand what you are going through. In fact, they show concern. They ask you how you are doing, they help you out whenever you are in trouble. Of course you would feel valued and will help them when they are old. It's part filial piety, part gratitude.

    Now, let's say you are born in another family. Father and mother scold you, don't listen to your woes (or at the most pretend to), tell you to do chores all day long, and go to their jobs and ignore you all day (partly because they are busy, partly because they don't really care.) You're just there as insurance against their old age. You get into trouble, they scold you and punish you. You do well, who cares? Do better next time and Don't Screw Up unless you want to be beaten. There is no second chance for you. Now, it may be that you would still help the family in need (because after all, we are family) but some would just say ...hm. Maybe we ought to search around for better parents. People who care for us, not just take us as burdens when it's convenient for them. Sure, you may not find better caregivers but as they say, the grass is greener on the other side. Wouldn't hurt to try. After all, they don't really care and will adopt another son/daughter.

    By Anonymous Anonymous, at 1:17 pm  

  • Bart,

    I'm a little late, but here's wishing you a very hearty congratulations. A new life brought into this world (and being a father) is a cause for much celebration and happiness.

    Warmest Regards.

    By Blogger Fearfully Opinionated, at 2:05 pm  

  • Thanks Fearful.

    Anon 4:27 - you have lost me.

    Hi Atarashi,

    I understand what you say. NHS is not flawless - they are v stretched. By media accounts, there are also many cases where patients are not treated in time. One also suspects lots of mismanagement (as the BBC link pointed out).

    In this world, no system is perfect. But in NHS, there is an ideal. The professionals in NHS are underpaid compared to private sector, but they are highly dedicated.

    My experience with NHS is that one cannot expect NHS to provide the best (since it is a free service). But NHS will do its best.

    You know what, they are still sending staff over to our residence every few days to check on the mother and baby. And medication is completely free for Elena until she is 5.

    I have not had a child in a Singapore public hospital before. Can someone tell me how their child delivery service is compared to NHS?

    By Blogger Bart JP, at 4:03 pm  

  • Well Bart, you don't need to have a kid in Singapore to know that as much it is a joy to have a baby here (there for you), much of it constitutes paying and paying of bills and what nots. So there.

    By Anonymous Anonymous, at 5:05 am  

  • Try getting cancer or a stroke in the UK.

    By Blogger blacktag, at 2:04 pm  

  • One of the problems with the NHS is that the service that you get is highly dependant on the area in which you live and much of the service varies depending on how much funding the Trust gets. It is also dependant on the hospital managers who decide which services are important and which are not.

    You may be fortunate to have had treatment in a Trust which takes pride in it's obstetric service and postnatal care.

    However, if you had been living at a different postcode, you might not have had such a rosy experience.

    Imagine if your wife had to wait hours for an anaesthetist whilst she was in pain. Or if they had chosen to use outdated methods of foetal-monitoring during the birth. Or if there was no funding for midwives or child health teams to work in the community and give her the support she needs.

    Or worse, imagine that Elena was born sickly, and there was no funding for a neonatal unit.

    By Blogger tscd, at 4:06 pm  

  • oooh... So cute!

    :)

    kh

    By Anonymous Anonymous, at 5:23 pm  

  • Anon 1:17 PM,

    Two points: (i) you don't get to choose your parents. Is filial piety a function of how much attention your parents showered on you? (ii) Seriously lah, the Garmen is not your father. :-)

    It seems to the KTM that your analogy is not a very good one.

    Perhaps the KTM can share his perspective: he doesn't come from a rich family and never lived in anything bigger than a 4-room HDB flat. The KTM however did okay and found a decent job that pays him enough to get by. Didn't feel at any time that the fact that his surname was not Lee, that his father is not an MP or that he was not rich was much of a problem.

    "Do better next time and Don't Screw Up unless you want to be beaten".

    Never felt that the Garmen "scolded or beat him" leh. So really cannot empathize with your analogy.

    "go to their jobs and ignore you all day"

    The problem with Singapore it seems is that the Garmen is too much of a nanny. Seriously, the KTM would rather be left alone.... therefore, seriously not following your analogy. :-(

    By Blogger kwayteowman, at 7:38 pm  

  • Congrats!!!

    Your baby looks like you!!!

    Kway Teow Man,

    I've never met a kway teow man who can write like that.
    You ask 2 questions 1) What does it mean to be valued 2) How to quantify value?. You're right...why does one have to 'feel valued' to be loyal?

    I don't think the issue is being valued but being empowered. Feeling that you have a power to decide your fate. Empowerment is can somehow be quatified by the rights you have verses the rights you don't have. If you feel strongly about an issue how far can you take it? ...Can you protest against a stupid war at your nation's capital without being jailed and shot? Do you have to power to look into your govt (FOIA- freedom of information)? A Malaysian reported said she felt more empowered when she was in America, she was able to exercise this power even as a foreign to request for information something she cannot do in Malaysia as a malaysian citizen.

    A govt will never respect people whom they have 'dis-empowered', people whom they can fool by manipulating information, whose rights they don't respect. Ultimately, the citizens will feel they are of little value merely cogs in an economic machine, expendable and replaceable.

    I'm talking about other govts. The PAP is just excellent, they care so much for the people, to say they are compassionate is a monumental understatement. Their respect for the people means they never lie, spin and deceive to expediently carry out their will. Their respect for the people can be seen in the amount of time they spend to align their goals with that of the people - I'm sure many of us look forward to being top 1st world citizens. They work solely for the interest of ordinary Singaporeans not big businesses or special interents - that is the heart and core of the PAP value system....the one we freely vote for at every one of our free and fair elections.

    By Blogger Lucky Tan, at 2:35 am  

  • Congrats Bart.

    Good thing Elena is a girl. No NS curse to worry about. No need to worry about passport validity when she turns 12. No need to be forced to choose between citizenship or exile when she turns 17. Unlike my two boys.

    KTM, in another country, whether the government values their citizen would be a STUPID question, because if the government makes the citizens feel unwanted, the citizens will ask the ministers to update their resumes. But when the people have no means to control the government, then how the government treats the people matters a lot.

    I cant speak for the whole Singapore, but creating unequal treatment for foreigners like in polyclinic subsidies is not what we Singaporeans want. We want EQUAL ACCESS to jobs, scholarships as foreigners. Strict penalties against employment discrimination of pregnant women and national servicemen. A labour union that is not controlled by the government and would think of the needs of the workers, local or foreign, at least some of the time. And probably most urgently, a government that doesnt turn a blind eye to employers who abuse their foreign workers, be them maids or software programmers; strictly enforce OT pay issues and rest hours. When the employers cannot enslave their "foreign talents", they will have to learn to take locals seriously.

    Is it a lot to ask for?

    By Blogger Jimmy Mun, at 9:23 am  

  • "One of the problems with the NHS is that the service that you get is highly dependant on the area in which you live and much of the service varies depending on how much funding the Trust gets. It is also dependant on the hospital managers who decide which services are important and which are not.

    You may be fortunate to have had treatment in a Trust which takes pride in it's obstetric service and postnatal care.

    However, if you had been living at a different postcode, you might not have had such a rosy experience.

    Imagine if your wife had to wait hours for an anaesthetist whilst she was in pain. Or if they had chosen to use outdated methods of foetal-monitoring during the birth. Or if there was no funding for midwives or child health teams to work in the community and give her the support she needs.

    Or worse, imagine that Elena was born sickly, and there was no funding for a neonatal unit."

    Yes, now imagine you're in Singapore and you only have a monthly allowance of $290. Will you be better treated in Singapore? Will you get to see the doctor within 2 hours like LKY? At least the poor in the UK have a lottery chance of getting good treatment. That's more than what the poor here have.

    By Anonymous Anonymous, at 11:47 am  

  • I don't think Singaporeans will be able to accept free treatment, if it is actually at the expense of their own convenience.

    You complain about waiting hours at the specialist clinics and how much things cost. In the UK, things may be free, but you are talking about suffering a wait of several months, if not years, and for a service that is concerned more about how much things cost than what truly benefits a patient.

    At least, Singaporeans have pride enough to pay, which gives them the right to be demanding and to expect a certain standard of care. In the UK, you have to hope that your hospital has enough funding to offer you the best care available - if it doesn't, then it is just too bad.

    By Blogger tscd, at 2:36 pm  

  • Thanks Jimmy, Lucky,

    Hey Lucky - have we met before? How do you know that Elena looks like me? From the photo alone?

    TSCD - Again, no system is perfect. There are always tradeoffs.

    By Blogger Bart JP, at 10:09 pm  

  • It's nature's con job. The firstborn always resembles the father, in case there is any doubt who is responsible. Baby will look a lot less fatherly in about 4 months.

    By Blogger Jimmy Mun, at 1:13 am  

  • Bart,

    I thought you saw your photo on your blog. Those big intelligent eyes sure look like its from you.

    Talking about babies, I'm collecting some info. on less fortunate children born with congenital health problems - these includes heart, pre-maturity etc. affecting 700 babies a year. Our medi-shield has a hole that cause many of such cases to fall through. Talking to people, I found that the medical bill can easily escalate to $50K to $200K if the baby requires operations and long stay in ICU. I've compiled 4 cases so far. I believe the govt knows the severity of the problem but simply keep mum and nothing much is done about it. The parents are put on various instalment schemes that are outsourced debt collection companies.

    This is just one hidden aspect of our medical system.

    The parents I spoke to are already very burdened & stressed by the special care the child needs...why can't the govt take care of the financial side of things. This is one situation where we are trying to save lives - the doctors are committed, the parents are committed, there're charities trying to help but don't have the means - Club Rainbow etc...where is the govt?

    I've worked out that the entire problem can be solved by just shaving 1% off our defense budget to save lives of new born. War might never come...some say probably never come. But sick babies, every cent you spend goes to help save a life and is never wasted.

    I would like to know how the British take care of such cases? Does the NHS give comprehensive coverage & support to such parents? The PAP threw spanner at the British system when Mrs Lee had stroke there.

    By Blogger Lucky Tan, at 3:38 am  

  • Lucky,

    I do have a friend in Singapore whose child was born 3 months premature. Burnt a big hole in the wallet since ICU care is very expensive. However, before we jump to conclusions, are there insurance policies for these? Can someone take a 'package' at the beginning of a pregnancy, pay a premium, and not have to worry about any escalation of costs?

    For those who cannot afford even the insurance, I am not sure how Singapore govt steps in to help. I cannot therefore comment. But common sense is that our hospitals will do their best to save the child and worry about the costs later? Is it common for costs to be written off for hardship cases? Surely the public hospitals will not bankrupt the parents if they chalk up a pregnancy bill they cannot realistically repay?

    Hope you can check up on all these before coming to conclusion. It will be interesting to see if indeed there is a public policy gap to be addressed.

    But I am quite sure NHS will not charge anything (but service standards differ from location to location as one blogger suggested, that is true).

    Lucky, I said before you were talented.

    By Blogger Bart JP, at 10:41 am  

  • Bart,

    Insurance is not practical, as I understand there is only one company that offers such insurance and you have to buy it 6 months before pregnancy - it is also expensive. Very few people ever get insurance for this because of impracticality.

    Treatment is not the issue. Treatment & money are 2 separate things. Each hospital has a business unit that will handle your bills. The doctors will treat the child. No one is denied treatment - whether you can afford it or not. If you're totally broke - have basically zero money, stay in rented flat and own no property, the Medifund will help...very simple if there is zero hope of you paying, they won't come after you.

    The people who are caught are middle-income families in 4-5 room flats. Usually they exhaust all their medisave to get the child treated. That is usually not enough because the treatment can go up to $300K in ICU, I'm sure you read about the 'famous' landmark case where Minister Lim Hng Kiang regretted making an exception for a baby to be transferred from private hospital to public hospital downgrading to subsidised class C. Middleclass families are made to pay bills of $50K-$200K through installment plans outsourced to debt collection companies. I have a bill of my neighbor with me, he gave me a copy of a $70K medical bill. He is put on a multi-year instalment to pay for his medical debts. His child needs 3 more surgeries each costing $29K-$30K. The child needs special care, medication and therapy...all paid from his monthly salary...wife can't work because child needs special care. The care for the child is already a big burden for the family, they love him very much, the financial burden just adds to the whole situation. The family does not qualify for any help because they can "make ends meet". Imagine a middle class family with a professional bread winner - "just making ends meet". ...no savings for retirement, money is tight with so many bills to pay.

    The govt considers this "affordable" medical care - putting people on instalment plans. How many are on these instalment plans administered by debt collection companies? Tell us? ...How many families did high medical bills jeopardise financially? Will the PAP tell us?
    Why use debt collection companies to handle such payments?

    There is much hidden beneath this medical system that they say is "affordable". The PAP has never defined what "affordable" is and has not put any caps on medical bills. The PAP is unconcerned because it has a friendly media and fearful obedient citizens. Because the people are silent does not mean everything is fine..it only looks like that on the surface. ...Just like the man who jumped onto the MRT tracks left with only $20 in his pocket.The nation was shocked because we didn't know people like him existed. Now, ee all know his name - Tan Jee Suan = his death woke all of us up.....but is only one of the many needing help.

    By Blogger Lucky Tan, at 2:44 pm  

  • Lucky,

    We have always known that middle class is prone to financial strain as a result of medical exigencies. But maybe the more economically sustainable solution to this problem of medically challenging pregnancies is really to develop some kind of group insurance for citizens. It may not be easy for a private company to breakeven given the uncertainty, but there may be a case for the policy maker to step in to provide a cheaper (perhaps subsidized) group insurance.

    But this is just my immediate thoughts. I am not an expert in healthcare economics. I really do not know enough to say with any kind of authority as to where the policy gap is and how things can be improved on.

    The cases that you just mentioned is a genuine concern for many families. It can be put across in a reasoned manner. I sometimes feel that your satire trivialised the issues you are trying to highlight.

    By Blogger Bart JP, at 3:23 pm  

  • Lucky,

    Hope you also understand that though NHS has good ideals, it is a far from perfect system. In cases where demand outstrip supply, the long waiting line effectively becomes a rationing device. Like a blogger mentioned earlier, you literally wait until you collapse and get rushed into the A&E unit. The patient has very little control over the time and kind of service one receives.

    While the patient is assured financially, there is considerable uncertainty over the timing and service standards.

    Delivering healthcare service, balancing between costs and care, is a tricky business. No system is perfect.

    By Blogger Bart JP, at 3:32 pm  

  • The NHS system is not totally free isn't it? I work in the UK and 40% of my income goes to income tax and national insurance.

    By Anonymous Anonymous, at 11:08 am  

  • True, someone has to pay, and tax rate in UK is high. But NHS is 'free at point of delivery'. It does not matter whether one is a taxpayer or not, NHS will always treat for free.

    By Blogger Bart JP, at 3:38 pm  

  • Hi JP & Grace, heartiest congrats. I heard that you were expecting your bundle of joy but only learned about Elena's birth from my bf who recommended that I read this "post by a Singaporean in the UK about the NHS". Let's meet up when you 3 have settled in. Take good care! SY

    By Anonymous Anonymous, at 12:33 am  

  • Congratulations on the arrival of your baby girl!

    I had my first baby at Thomson Medical Centre, Singapore, 2nd baby in the US, at the UCLA Santa Monica Hospital.

    To answer your question on insurance against neonatal problems, I believe there are 2 options in Singapore. In general, KKH has the best equipped neonatal facilities, and the best neonatologists in Singapore. If you choose to see an OBGYN who practises at KKH, even as a "Private Suite" patient who has chosen the private route, with choice of OBGYN, single room wards, scheduled scans, delivery at KKH in your ward choice (excluding C class ward), you are eligible to be downgraded to Class C should your child require extended neonatal care. So this is your "insurance" against an obscene bill. If you choose an OBGYN in the private practice, like in my case, my OBGYN was only attached to TMC, I would not have access to KKH's class C neonatal ward, until I have chalked up a bill of at least $20,000, and provided KKH neonatal ward has a vacancy, I can then transfer my baby there.

    In short, many middle-class mothers in Singapore choose to deliver at KKH if they encounter any signs that they could have a complicated pregnancy. In fact, the OBGYNs in the private practise do advise their patients to transfer themselves to KKH.

    By Anonymous Anonymous, at 9:14 pm  

  • Congratulations on your beautiful daughter. My wife showed me your post – she's Singaporean, I'm British, and we had our son in Japan just five months ago. It is very interesting to read what you say about the NHS. Yes it has many problems, but if the alternative is something like the US system, then I'm more than willing to put taxes to it (and we could add another 20 billion quid from a totally unnecessary defense system too!)

    As a long term Japan resident, I know the country well and having a baby here was a worrying thing. In the end, tho', I think we got absolutely fantastic service and consideration, probably better than in many places in the UK -- all our requests and whims were met. But, you're quite right, the cost of it all was always there. Of course, I'd have paid unhesitatingly for anything required, but, unlike the UK, health services here are based on what you can afford and a hotel-like bill at the end. The most ridiculous thing of all is that, while the Japanese birthrate is plumetting at present, the compulsory and very, very expensive health insurance we are forced to pay, doesn't cover child birth at all! (You get an 'award' from your local government after the birth that covers 50% to 75% of the costs of a natural birth without complications, but that is also at the whim of the local council.)

    An interesting contrast I thought. Congratulations once again. I totally understand the zombie-like lack of sleep feeling, but as all our friends told us, it eventually gets better.... I'm sure, five months on, I'm still waiting, but I'm sure...

    By Blogger RL, at 12:38 am  

  • Doodbug - thanks for the information.

    Thanks Roy. You guys have a lot to be proud of. From the perspective of a foreigner, I sometimes feel that the media in Britain often make one feel like this country is a disaster, focusing on the warts and all rather than the big picture. Maybe the papers here should learn a thing or two from Straits Times and tell citizens how wonderful it all is (your wife can explain the last sentence to you).

    On insurance. It is not at all surprising that insurance companies do not cover pregnancy and childbirth (or if they do, it will be superbly expensive).

    By Blogger Bart JP, at 3:04 am  

  • Bart JP

    The tax rate is high, however, the reality is that it is the middle class and the working class which pays the rate, the upper & rich would just hire the tax accountants to reduce the tax to a very marginal rate.

    By Anonymous Anonymous, at 1:59 pm  

  • Hi Roy,
    I am a Singaporean who had my 2nd baby 9 months back in the US. In contrast, health insurance here in the US typically includes childbirth, delivery and neonatal care. Well this has its moral hazard problems too. Insurance premiums here are ridiculously high. Delivery costs are a non-issue in people's consideration here as it is essentially free (in the sense of zero marginal cost to he consumer) if you choose to have a baby. Admittedly, that was one huge reason why I wanted to have a baby here. It made my insurance preiums worthwhile and there isn't any other "happy" way to utilize health insurance, is there? Cosmetic surgery is not covered under insurance. Well an the added bonus of free US citizenship as a birthright - just makes it all the more appealing :)

    In fact, childbirth is such a sacrosanct thing here. All insurance companies must by law, cover t least 48 hours of inpatient care for natural delivery, and 96 hours for c section. In Singapore, I stayed in hospital for 3 nights after my first C section; I avoided the 4th night as it would cost me S$500 more :) Here, there is obviously more waste. I had a wonderful 4 night stay at the UCLA Santa Monica Hospital, in a huge private room, and noone tells me to go home any earlier as insurance covers the bill.

    Then, we have the issue of the uninsured. As childbirth is so sacrosanct here, any uninsured person, including illegal immigrants in labour MUST be admitted by the hospital, and must be given medical care. The government does reimburse the hospital a puny sum. So alas, we have this problem of many illegals rushing across the border to have a baby at a US hospital; for free, and more importantly, free citizenship!!

    By Anonymous Anonymous, at 9:29 pm  

  • Hi wang,
    I do not have access to IRAS information, but I tend to share your sentiments in this area. It is the same analogy with companies. Poor SMEs and small coys pay headline corporate tax when it is quite publicly known that big MNCs and certain targetted companies get to enjoy heavy incentives :( I'm not disagreeing with the policy, I'm just challenging the notion that the richest and biggest companies are most affected by tax increases.

    By Anonymous Anonymous, at 9:36 pm  

  • Hi doodbug

    I would respectfully disagree with you as the latest changes does result in marginal corporate income tax for profitable companies.
    In addition, if the SMEs and the small companies would just have time to sit down with their corporate accountants or tax consultants, there would be ways to reduce it even lower than MNCs.
    The problem is that a lot of SMEs do not register for GST and are not willing to keep good records which just basically results in them reporting the wrong or higher numbers.

    By Anonymous Anonymous, at 6:28 am  

  • Hi anonymous,
    I'm sorry I don't quite understand your first sentence....

    Because we do not have actual figures from IRAS on the level of corporate taxes paid by SMEs vs MNCs, I think it is impossible to argue either way of the corporate tax burden. One thing for sure, some huge MNCs are offered unbelievable incentives of all sorts, not just tax rates, to set up shop here because of the jobs they create.

    Please feel free to disagree. Because we do not have transparent figures, we are all going by gut perception based on our limited exposure and experiences. :)

    Oh yah, GST is supposed to be a business-neutral tax, erm, in theory of course.

    By Anonymous Anonymous, at 7:23 am  

  • Doodbug

    Apologies for the earlier anoynomous. That was myself commenting.

    Noted on your figures and comments but the problem remains the generalisation.
    If you were to look at the numerous grants/tax schemes available for both SMEs on the IRAS website.MNCs tax schemes are also publicised. As somebody who looks at it daily, there are numerous schemes available.
    Further, statistically speaking SMEs have a big failure rate worldwide within 5 years. After 5 years, such SMEs can survive. Or if you want a better chance, speak to the accountants on how to reduce risk and avail yourself of such tax schemes.

    GST is only business neutral if you are GST registered or you can pass on the cost as a business entity. Otherwise the busines entity would suffer tax cost as the final consumer.

    Regards

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