Diagnostics: Singapore vs. Hong Kong Lion City clear winner by cost & expertise

A good annual check-up is common sense at any age. Over 40 you’d be a fool not to, and at my age you almost deserve anything you get if you don’t. That said, do I follow my own advise? Foolishly I do not.


I’d lay odds that I’m not alone in this, particularly here in Bali where a relaxed attitude to such things is not unusual among foreign residents and local diagnostics hardly cutting edge.

My wife, who has way more than her fair share of health challenges, needed a simple procedure, that normally requires an overnight hospital stay, and a check-up. She insisted that I have a one too.

We went to Singapore and stayed three nights going to Raffles Hospital on North Bridge Road, next door to the Bugis Junction, for the medical.

I have to say I was impressed both with the hospital and the attention we received. First the hospital itself was pleasant, light and well-appointed. The staff were well-informed, helpful and went about their business with calm confidence. Compare that with the stress, crowded waiting rooms you find in most large practices in the US. Better yet, the cost of it all was a fraction of what we were used to paying in America or Hong Kong.

We chose the “Deluxe Plus” health screen which clocked in at S$450 (US$280), which with pre and post consultation with a doctor included a chest X-ray and ECG, plus 20 other tests. The other screens offered ranged from S$62 (US$38) for the “Basic” with six lab tests to the “Raffles Platinum” at S$7,880 (US$4,890) with 70 tests, which will give you an idea of how the nomenclature relates to what you get. We reckoned the Deluxe was broad enough to show up anything we’d need to be worried about and good value. We were done in a couple of hours and they even serve you a decent buffet breakfast for gratis while you wait. We were back the following day to review the results with the doctor.

Subsequently my wife went back for a minor procedure which normally required an overnight stay. Given the time constraints and cost factors the consulting doctor couldn’t have been more helpful, stretching a point and performing the procedure in clinic rather than in hospital (all in the same building, different floors). “It’s better that way” he said, “minute you step into the hospital the meter really kicks in”.

My wife went on to have consultations with two very senior specialists, professors in cardiology and respitory  medicine respectively. They were very thorough, took their time and the bill was just S$138 (US$100) per visit.

As I say, I was impressed with how it was all handled. It’s not often you can say that a hospital visit was a relaxed, almost pleasant experience.

It seems to me that the Singaporeans, along with the French, and possibly the Germans and Scandinavians, have got their act together when it comes to handling their health systems. My perception was that Singapore was an expensive place to be treated and I was, broadly speaking, right. It is, if you aren’t a Singaporean. In which case you, or your insurance, will be paying the full commercial international rate. But, that’s not the case when it comes to diagnostics. Here you pay what any Singaporean would. That seems to me to make sense. It’s good business isn’t it? A medical loss leader you could say.

The Singaporean approach to public health is emminently practical and effective, as becomes a nanny state. If you are a rich Singaporean or a foreigner you will get the Rolls Royce treatment with all the trimmings but – will pay through the nose for it. If you are a middle class Singaporean, fewer trimmings but the cost of treatment is heavily subsidised. If you are poor you may well have to wait for treatment, unless it is an emergency, and certainly few trimmings, but – you will be treated in the same way medically as everyone else and not have to pay for it.

The  mark of a civilised nation is how it cares for the health of its citizens. There is place for private medicine to be sure, but that place is as a junior partner in a mixed economy. Not running away with a  gamethat is rigged by the pharmaceutical majors, private or quasi ‘non-profit’ hospitals, cliques of lucre-driven doctors and researchers, in a stitch-up with the insurance companies.

For profit hospitals should be for those who can afford them or the insurance premiums that allows them to be treated  there. Their owners and shareholders cannot reasonably expect to benefit by skewing the market their way by attacking public medicine politically and seeking to privatise it or starve it of funding. Little kudos if any should be given to those engaged in private medicine solely for profit. Let them be satisfied with the money. The honours, if not wealth, that  rightly accrue to great doctors should go to those that treat all people equally whatever their station.

Apart from the difference in cost one of the other things I noticed in Singapore that I did not in Hong Kong, at least not to the same degree, was the willingness to provide important information to the patient that can either save or cost a life.

The Hippocratic oath tells physicians ”first do no harm”. If you knowingly withold information that could save your patient’s life I’d say that was doing harm. What I saw in Hong Kong at senior levels was a clique-ridden medical closed shop split between UK and US post graduate trained physicians none too happy to collaborate with doctors outside their group, quick to stand on their dignity and who, no matter how good they were as doctors, let money and concern for their standing get in the way of patient well being.

To cite an incidence: I know a woman who has pulmonary and cardiac problems. Test shows that she had mild aortic stenosis. Her cardiologist  indicated that there was nothing to worry about just keep a watch on it. Within a year that woman’s aortic stenosis had become so severe that she was advised she required an immediate replacement of the aortic valve at a cost of some US$100,000, failing which she would drown from the liquid accumulated in her lungs.

That same woman was also told by her pulmonary specialist that the fluid in her lungs could not be aspirated from the right lung because of its location.

It was only when she consulted a cardiologist and pulmonary specialist in Singapore that she was told  she needed an immediate aortic valve replacement to survive and that the liquid in her lungs could easily have been removed under CT guidance.

How come these very able doctors in Hong Kong did not tell this woman the facts of her situation? Was it because the equipment or the expertise was lacking? In which case it was all about money. She could have gone elsewhere – had she known.

My fear is that some very qualified doctors merely manage what becomes the terminal decline of a patient because a life-preserving remedy lies outside their area of competence for one reason or another.Whatever the reason, that’s bad medicine.

Alternative Voice


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