Biomedical and Healthcare
This we discussed about biomedical and healthcare. We looked at the rising costs of healthcare and the management of health and the biomedical business.
Healthcare
According to the healthcare ranking by World Health Organisation (WHO), the 1st is France, 6th is Singapore and the Unites States (US) is a dismal 37th. Most rich European nations tend to rank higher as they have socialised healthcare.(http://www.who.int/whr/en/)
This underscores the inequality of healthcare in the US. The US has one of the most advanced medical treatments in the world with it high investments of Research and Development (R&D). However, many treatments are only within reach to the few rich people in US, the majority of the population has very little access to good healthcare. The history of big medical lawsuits and the medical insurance system in the US have drove up healthcare costs putting reasonably good healthcare out of the reach of majority Americans.
Huge frivolous medical lawsuits have made doctor very cautious in their diagnosis. Doctors order a myriad of different tests even though 1 test would be sufficient in most cases. MRI scans and such are very expensive, the proliferation of the use of diagnostics drove up the cost of insurance premiums and medical bills(for those without insurance too).
The medical insurance system in US also encourages people to go for unnecessary treatments or checks. The ‘kiasu’ mentality, that is to get more mileage out of their insurance, Americans sought more expensive treatments or opt for unnecessary surgeries or stay in the hospital longer than necessary. Therefore, driving up insurance premiums too.
Singapore has been very successful in balancing costs and good healthcare coverage. Various measures such as co-payment insurance and government subsidy has keep healthcare affordable for majority of the population. For those who are poor, the government would have counsellors to help the patient and his or her family to find financial support to help with the medical bills. Which means that the no Singaporean should have not have access to healthcare. However, there are other aspects to healthcare that Singapore does not do so well in. Singapore has excels in critical medical care. However, it has long waiting periods for its non-critical medical cases. Wait time for diagnostics scans and consultation in such cases usually take a few months and in some cases 6 months of waiting. This may be the reason why Singapore is only rank 6th by WHO. The government’s reason for this is that the hospital needs to balance cost and service. Unlike countries like France (13.7% GDP) and the US (16% og GDP), the Singapore government only spends $2.5 billion on subsidising its population for healthcare or about 4% GDP on healthcare. (http://www.singhealth.com.sg/AboutSingHealth/CorporateOverview/Newsroom/NewsArticles/2008/Pages/Spendingonhealthcare'boundtogoup'.aspx)
(http://www.oecd.org/dataoecd/35/42/43925776.pdf)
Singapore has the most ‘bang for the buck’ compared to the countries on the raking by WHO. (http://takingnote.tcf.org/2008/07/health-care-in.html) Singapore has recognised to shortage problem and has 2 new hospitals in line, Jurong General Hospital JGH) and Khoo Teck Phuat Hospital (KTPH), though KTPH is replaces the current Alexandra Hospital. This will help to lessen the waiting time. In addition, the new Medicine course at NTU will help increase the supply of doctors in Singapore. Other measures such as step-down care to medical centres and nursing homes will help improve the situation as Singapore expects more people to require rehab, physiotherapy and non-critical care by a nurse due to aging population. The Singapore government has also done well to recognise that improving wellness can keep the people from falling ill in the first. The government have taken steps to encourage people to eat well and exercise through media and providing sports facilities and parks. Continuing in this direction to encourage health lifestyle will certainly help.
However, Singapore can do a lot more to improve in patient’s waiting time. Singapore’s hospitals have to restructured to operate under 2 management companies, Singhealth and National Health Group (NHG) to improve competition. Improving sharing of information is one major area. Currently, many reports and scan results are not being shared among all the hospitals in both parent companies, it is only shared within the hospitals under its parent company. This creates duplication and addition waiting times.
Singapore has only recently begun to computerise patient’s records. Hospitals can improve their IT systems to tap into next generation technology such as Sematic Web to make reduce patients’ visits to hospitals, reminding patients of appointment times, sharing for reports and consultation through video conferencing will help reduce waiting times, especially for those with chronic conditions. Currently, Singapore government has improve its Internet network by upgrading its cables islandwide, but this upgrade is 1 generation behind the state of the art which has been used by countries like South Korea for a few years. Thus, the Singapore government should leapfrog to the state of the art network data transmission cables than upgrading over time.
In addition, Singapore can go 1 step further than Preventive Medicine into Pre-emptive Medicine, to look at risk factors in health and try to manage the risk even before the disease happens. The most obvious benefit is in Oncology where early detection is most critical to treating the disease.
Healthcare in 3rd World Countries
Bringing in some things related to IT, which was discussed last week. Using cheap technology like radio, doctors can provide medical advice to people to improve primary healthcare to the poor as hospitals are far and few in 3rd world nations. In short, this measure can help improve access. In addition hospitals can straight away leapfrog to use electronic patient management systems which can drastically improve waiting time, sharing of patients’ information and reduce errors. Such software is widely available little or no cost and a small investment in hardware can make a big difference in healthcare and reduce costs or treating patients whose condition have worsen from the poor access or long wait for treatment.
Pharmaceuticals
Asia has become a big player of biomedical outsourcing, especially India. Businesses have been set up to provide clinical testing services to help pharmaceutical companies do their research. Developing nations benefit from the booming business which helps them to develop. Pharmaceutical companies benefit from the lower costs as these SMEs are more efficient and the allowance for the test subjects are lower. However many ethical issues have cropped up.
1 major area is whether these test subjects are being exploited. Pharmaceutical companies move to developing countries to do clinical testing because costs are lower and there is lesser regulations concerning the clinical trials and then make big profits from the drugs when the drugs are approved. Thus it may seem unfair to these people in the developing countries.
Therefore, it is the governments’ role of these developing countries to have regulations to protect their people. In addition, international organisations such as the WHO can have regulations to govern this aspect of biomedical. This institution can then reject the results of the clinical trials forcing pharmaceutical companies to abide by these rules.
Overall
I give this lesson 7 out of 10 as the presentations were not very interesting. However, I find the topic very interesting though.
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