Recently, a world-class foreign institution announced that it is setting up a facility within a local tertiary hospital. I personally welcome this at face value. After all, if Singapore did not take up this offer, someone else certainly would and then we would lose this golden opportunity to be tied up with a prestigious institution.

Certainly, there is much that the entire medical profession can learn from a good foreign institution. And I hope that such a foreign institution can conduct a meaningful technology and skill transfer; not just to the institution hosting them, but to the entire healthcare milieu they are in.

But nothing comes for free. An association with a famous name can be costly. What is there in it for them? Pure altruism? Will they provide the advanced care here in Singapore so that we can learn from them or will patients be transferred to the "mother" institution back home for treatment, thereby reducing its local facility into a "transit" lounge or a referral "funnel"? This is possible, given the good air-links Singapore enjoys with the rest of the world.

Other questions that need answering include: Will Medisave, Medishield and Medifund as well as subvention be made available when the public goes for these top-notch quaternary services? Will there be safeguards and checks in place to monitor if these services are as cost-effective as the lesser or less than quaternary services currently offered? The key term is "cost-effective", and not just "effective". And since there is no competition for these quaternary services to be offered (as so claimed), what will happen if a monopoly is created? Will local manpower such as bonded Medical Officers and Registrars etc be deployed in such facilities whereby there is obviously a foreign interest? And what experts will be sent here? Yesterday’s "experts" now in the sunset of their careers, young consultants who happen to work in a world-class institution or real world-class "current" experts? How long will they be here? Years? Months? Or just weeks or even days? And finally, who pays for the buildings, fixtures i.e. development costs?