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02 Feb 2019
Ministry of Health
Negative View - 569
Put a cap on "end of life" treatment

An elderly woman had a heart attack. Her children sent her immediately to a private hospital. The cardiologist carried out a stent and bypass operation. The patient was placed on intensive care (ICU). She passed away five days later. 

The family received a bill for more than $50,000 from the private hospital. This does not include the fees of the cardiologist and other specialists that were called to attend to the patient. It is likely to cost another $100,000 or more.

The family does not know why it was necessary to bring in the other specialists. They got the impression that the cardiologist called his friend to help in the treatment and to add up the bill.

I now wish to give my views about this matter.

This is quite common. It applies to our public hospitals and private hospitals, except that the bill from the private hospital is likely to be more than twice of the public hospital.

In either case, the end of life care is very expensive. It will cost several tens of thousand and sometimes hundred of thousand dollars. To make matter worse, most of the patients died after incurring a large bill. This is classified as "end of life" treatment.

Some people have considered it a "racket" among the medical profession to make the most money from families in their most vulnerable position.

This suspicion should not be applied to honest specialists that put the interest of their patients first, before money. But the high fees can give the impression that money is more important to the medical specialists.

What can patients and family members do to avoid this outcome? In the old days, many old folks instructed their family members NEVER to send them to hospital when they are in the terminal stage. They prefer to die at home.  They felt that they could die with more dignity at home.

The old folks have heard of their friends being sent to hospital and the family had incurred a large bill in a futile attempt to save their lives. They died anyway.

The family of the patient should send their parent to hospital for treatment in the first instance. If the condition is serious and the hope for survival is low, the family should be allowed to discharge the patient to recuperate or die at home.

To make this possible, the government should set a cap on the total bill for  "end of life" treatment. The family member must give specific consent to continue the treatment and incur a larger bill. If this consent is not given, the hospital should be required to facilitate the discharge of the patient.

Some people think that the bill will be covered by private insurance. They will be shocked to learn that, in many cases, the insurance will cover only a part of the total bill, maybe less than half. 

Furthermore, the premium for private insurance will become very expensive at the older ages. They will find the premium to be unaffordable. They should realize that they are paying a high premium to cover the expensive bills of other patients who have to pay the expensive "end of life" treatment. 

We have to stop this burden on families on incurring a large bill for futile "end of life" treatment. 

I call on the minister for health to act now and deal with this problem.

Tan Kin Lian

 


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