Thursday, May 5, 2011

431. GPs can't compete with subsidized health care at polyclinics in Singapore


Vets are equivalent to General Practitioners (GPs) in Singapore as both have first degrees. However, the Singapore GP have to compete with the subsidized health care at Polyclinics.

Some facts and figures from The Straits Times, April 25, 2011 - Let GPs handle the poor and polyclinics the elderly.

1. There are 1,600 GP clinics compared to over 45 veterinary clinics in 2011.

2. The PCPS is introduced by the Ministry of Health (MOH) 10 years ago for elderly patients to see a GP in a private clinic but pay subsidized polyclinic rates. The GPs get paid by the MOH.

Vets - More than 10 years ago, the Animal Infirmary at Kampong Java Road provides subsidized veterinary treatments to dog and cat owners. Subsidized in the sense that the cost of rental of the premises at Kampong Java were not included in the expenses of accounting. However, this is history. There were 2 or 3 private vet clinics as competitors.

There is a spay subsidized scheme for stray dogs and cats to be sterilised at private clinic. The vets get paid by the SPCA.

3. 200/1,600 GP clinics participate in the Primary Care Partnership Scheme (PCPS). Vets - those clinics participating are paid by the SPCA.

4. The PCPS is restricted to the elderly, the disabled and with low incomes. Those incomes at the bottom 30% of families, i.e.. a per capita income of $800 a month. Eligible are the disabled, unable to work due to old age, illness or disabled and those receiving Public Assistance.

Vets - no such scheme in Singapore although UK has the PDSA scheme similar to the PCPS. The PDSA does not restrict the scheme to only the low income group of the elderly and the disabled.

5. Consequently, more than 50% of the GPs provide aesthetic treatment to booster their income instead of focusing on practising mainstream medicine.
Vets - cosmetic surgeries are almost non-existent.

6. Polyclinic workload increase significantly in the past decade. In 2000, 18 polyclinics had 2.7 million consultations. In 2010, 4.3 million i.e.. 60% jump due to increased number of elderly people with chronic illnesses (high blood pressure, high cholesterol and diabetes).

7. Now the polyclinics try to assign repeat patients to the same doctor and to cut down waiting time. That means more consultations, taking patients away from the GPs.

Vets - no subsidized vet health care from the government.

8. Polyclinics doctors have o follow a set of treatment guidelines given by the specialists. E.g. diabetic patients must have blood tests, feet screened and eyes checked regularly. Well equipped with staff and equipment to do it. Polyclinics become centres of excellence for treating chronic diseases.

9. Rapidly aging population. One in 5 will be aged 65 years and older by 2030. So, polyclinics will have more patients, treating the poor and the chronically ill since healthcare is subsidized. Therefore GPs will likely get fewer patients. With high rentals as there are not many commercial properties being built, I don't know how GPs can survive in the next decade.

Vets - those renting are at the great mercy of landlords due to scarcity of commercial properties. No choice but to pay whatever amount the landlord wants. I think the new vet clinics will be able to survive as Singaporeans are time-pressed and prefer to go to a vet nearby. So, there is great hope for new vets who also charge lower fees. Unfortunately, it may not be economically feasible to go for low pricing and low workload to open a vet clinic. In 2011, it is believed that there are 600 pet shops are having difficulties surviving. Some 5 years ago, there were 200 pet shops and half close per year, according to one salesman.

Perhaps, it is better to be a commercial property landlord than to be a GP or vet if the person has no interest in practising.

There are some trends for GPs that need to be researched if the GP wants to sustain his business in the near future. The Animal Infirmary and its proposed privatisation are history now. It is unlikely that there will be a PDSA or equivalent PCPS concept as the government's priority is in food health and hygiene.

For the older vets, under-pricing by new vets is not an issue confined only to the veterinary business. The internet empowers pet owners and some know more than the vets as the pet owners focus on one issue discussed at forums and do order products from the internet freely and from pet shops to treat their pets or ask the pet shop operator to do the treatment.

Older vets may need to review their operations by knowing the trend. Do one or more of the following in the marketing grid. Provide new services, develop new products, increase market share by improving existing services/product range or diversify into other fields?

Personalised and excellent customer service are now more important. The same vet assigned to provide a continuity of treatment is what the sophisticated Singapore pet owner nowadays. Branding may also be more important now. In the final analysis, a good clinical or surgical outcome breeds referrals. Performance still counts as in all professions and for the vets, that means accurate diagnoses and knowing what to do in the treatment at affordable competitive costs. Merely being the cheapest vet in Singapore seeking high turnover may not be sustainable for the clinic business in the near term.

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