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WHAT’S YOUR BUSINESS? 

An equitable and effective healthcare system must deal with the complexities of relationships amongst providers, healthcare institutions and the funding mechanism. An intrinsic understanding of the role and strength of each player is crucial. This maxim is sacrosanct even in the jungle of the free market. The founder of a famous hamburger chain never went into the business of upstream food processing. He understood that his winning formula was in the assemblage of the final product and resisted the temptation of taking over the whole ’food chain’ even when his turnover was big enough. Entrepreneurs and the few doctors who rationalised unbridled expansion as business savvy should therefore ask themselves what business they are in. Should they stick to the business that they should be in? 

The Singapore healthcare delivery system has undergone market based changes in the last decade. In a healthcare system increasingly polarised by structural and funding conflicts, more than professional inputs are needed to minimise tensions such as that narrated by one doctor in page N6. 

It would therefore be instructive for every doctor to ask himself, ‘What is my business in healthcare beyond the bottom line of numbers? Where is my clinical niche? What is my professional role in the whole healthcare system?’ A psychiatrist spending more time doing skin peeling than psychiatric consultations perhaps on the rationalisation that making the patient look good is in the realm of psychological well-being would find his/her specialist practice become a general practice with interest in psychiatry, albeit temporarily a very lucrative one. 

Apart from individuals, some institutions too, appear to have lost sight that their business is providing healthcare to a particular sector of patients. Institutions which are tertiary centres are expanding their primary care facilities creating ’choke points’ alluded to in the commentary “Be Unchoked” ( Page N 3) of this issue. The proliferation of 24-hour walk-in centres rationalised by institutions as the ‘answer’ to misuse of Accident and Emergency Departments serve only to increase overall walk-in attendance in both private and restructured hospitals. Scheduled attendance in specialists outpatients clinics has also burgeoned despite the almost constant number of hospital beds. Some increase in specialist outpatient clinic (SOC) attendance could be expected in tandem with advances in medical sciences and funding considerations that emphasises short hospital stay. However, system 
 

neglect of encouraging patients to be follow-up by doctors in the polyclinics and general practice will lead to an ever increase of SOCs attendance. 

Prominent advertisements were placed by a hospital a few months ago in our national dailies inviting travellers to the hospital ‘travellers’ clinic’ for routine vaccinations available in any GP clinic. The gazetting of the Advertising guidelines has now 
resulted in some order. 

To return to the hamburger chain, the exhortation of the founding father of the hamburger chain was forgotten recently when under intense competition for the children’s market, the ‘mother of all bargains’ of bundling expensive toys with children hamburgers was marketed. Sales increased beyond all expectations but so did the number of uneaten hamburgers discarded into the bins outside these outlets. The managers suddenly realised that they are in the hamburger business and not the toy business. Similarly, healthcare administrators need to realise that they are in the healthcare business and not in the hospitality business. 

Doctors and institutions need to ask themselves, ‘What’s my business?’ and equally important, ‘What should not be my business?’