Administering Different Drugs and Treatment for Same Medical Conditions

Mr K Karthikeyan asked the Minister for Health whether hospitals administer different drugs and treatment for the same medical conditions based on private or subsidised wards and, if so, whether the Ministry conducts checks on hospitals for such practices.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): In our public hospitals, care is provided based on the patients' clinical condition, rather than their subsidy status. Doctors and the healthcare team administer drugs and treatments appropriate to each patient's clinical needs. Where clinically appropriate to do so, generic drugs are used for both subsidised and private patients. However, as each patient has his own risk factors, clinical presentations and associated diseases, there may be differences in the treatment and drugs used for different patients, even for the same condition.

Some of the drugs or treatments thus prescribed could be non-subsidised as there are more cost effective alternatives available. Nonetheless, where non-subsidised drugs or treatments are assessed to be clinically required and cannot be replaced by subsidised alternatives, patients from lower-income households are provided assistance to help them access these drugs or treatments.

Public hospitals have various governance frameworks in place to ensure that patients receive care appropriate to their clinical needs. This includes accreditation committees to ensure appropriate use of new technologies and procedures and that procedures are performed by properly trained doctors. The Pharmacy and Therapeutic (P&T) and Medical Device (MDC) committees ensure clinically appropriate use of drugs and medical devices/implants respectively. There are also pre-operations conferences for peer review of elective surgeries to ensure that they are appropriate, safe and not unnecessary.

I had a recent case with my union member who went to a hospital to do a stomach operation. There is a range of painkillers. The nurse

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gave him Panadol. He said, "I just did a stomach operation. Is there any way I can get an injection?" The doctor and the nurse were talking and he overheard the conversation: "C Class ward; Panadol is enough." This gave him a feeling that you would get subsidised treatment when you are in a C Class ward. Is there any way we can talk to the hospitals and see how they communicate and how they make things straight? That is my only concern.

First, let me thank the Member for raising this Parliamentary Question (PQ), as well as for sharing this example. It is important for us to explain and clarify. Let me reassure the Member that hospitals do not differentiate the treatment routes based on the subsidy status of the patients, as long as the treatment route is required and necessary.

In this instance, it is, indeed, unfortunate that there is this perception. We need to get more details to better understand the case. Let me briefly elaborate.

There are clinical guidelines for pain management in different clinical conditions, which provide clinical guidance on the choice of pain relief drugs, and these are in line with international practices.

Typically, for pain management, as the Member has highlighted, clinical guidelines may give guidance to provide baseline pain management; further pain drugs may be added, if required; as well as to start with the least invasive drugs. This approach is quite typical across the different clinical conditions. The patient may, first, be prescribed oral Panadol. This could progress to stronger, more potent drugs, through injections, for instance. These are not without side effects.

Basically, throughout the spectrum of drugs required for pain management, you can find subsidised drugs. So, the patient does not really have to pay more for these subsidised drugs. There is no Panadol injection, but as the Member has mentioned, there are morphine, pethidine, nico injections which are in the Standard Drugs List. As I have said, these are stronger painkillers and may not be without their side effects. So, we need to ascertain if the patient's conditions will warrant these and if these are suitable for the patient. We would need further details to better understand the case.

What I would like to reiterate is that the drug and treatment prescribed are what the doctor and the healthcare team deem as clinically appropriate, based on the patient's conditions and not based on the subsidy status of the patient.

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