Apr 10, 2014

    Chance for docs to boost seniors' quality of life

    THE recently announced Pioneer Generation Package ("the Package") has generated much excitement and buzz.

    One of the issues raised about the Package is whether it signals a shift towards "medical welfarism". But this concern is dispelled by the key conditions of the Package itself.

    First, it is a one-off gift to a very clearly delineated and limited cohort of senior citizens, in honour of their role in nation-building.

    Second, unlike the usual social welfare programmes here, the entitlement is not based on any form of means testing.

    Some observers are worried that MediShield Life, being a health insurance that covers acute and catastrophic illnesses, will inevitably lead to a slant towards a contractual, rights-based posturing in patients.

    It is also possible that seniors or their families may demand care with little regard for medical appropriateness. Indeed, we have seen countries where such behaviour, if left unmanaged, can lead to uncontrollable escalation in health-care costs, with no better outcomes.

    Doctors should advocate policies and practices that reduce waste and unnecessary medical interventions, while improving efficiency in areas of appropriate care.

    At the clinic and bedside, doctors should help patients select treatments known to be effective and should also minimise the use of marginally beneficial tests or interventions unless there is no better option.

    Doctors should be happy if the Package results in an increase in appropriate treatments (supported by legitimate medical indications) for seniors who previously declined them due to affordability issues.

    For example, a total knee replacement in an otherwise healthy and independent senior who desires to be active again may now be less prohibitive in terms of cost.

    This will not only provide the senior with a new lease of life, but it may also improve this senior's cardiovascular health as he or she becomes more active and mobile. This may potentially reduce future health-care burdens on the individual, family and society.

    On the other hand, it would be meaningless and medically inappropriate if the same total knee replacement was proposed for treating the osteoarthritis of a group of seniors who are permanently disabled, bed-bound and uncommunicative due to advanced vascular or neurodegenerative disease.

    With a rapidly ageing population, the Pioneer Generation Package is an excellent opportunity for doctors to take up the challenge of improving the health and quality of life of seniors.

    As more resources are made available, the medical profession must ensure that they are well utilised.

    Doctors can do this by applying their technical expertise appropriately, and holding fast to the principles of medical ethics and professionalism.


    The writer is president of the Singapore Medical Association (SMA). This article, excerpted from the March issue of SMA News, the association's monthly newsletter, was also published in The Straits Times. A longer version is available at http://sma.org.sg