Thursday, May 11, 2006

The Brunei Health Situation

The Brunei Government spends around $244 million annually to provide medical and health services to the people of Brunei Darussalam. This pays for everything - all the doctors, the nurses, the free hospital care, the free surgery, the free medications, the free trip to Singapore (for the patient and the accompanying family member) - you name it, it's all there. How much does the government get from the public for registration fee and some charges to non-citizens and services charges? Only $5 million - around 2% of the total expenditure. We are one of the luckiest people on the face of this earth. Other people will gladly give an arm and a leg just to be in this country to enjoy all the medical and health benefits.

What do we do? It's free, everything is free, medication is free, consultation is free, so why not use it? Even the littlest headache which can be cured by lying down, people go to the hospital. It's true, it happened at our hospitals. Hmm, tomorrow is a workday, but the next day is not, if I was to go to the A&E tonight to get me an MC, maybe I can get tomorrow off as well. It's true, it happened at our hospitals. Actually I don't really need this medication. All I want is this MC. I will just collect the medication, and I will throw it in the bin later. It's true, it happened at our hospitals. Hey, doctor. Don't give me any aggro, I want the vitamin c tablets. The hospital can give me free, so please put that in my prescriptions. It's true, it happened at our hospitals. I am not worried about eating too much and smoking too much. The hospital will take care of my heart, kidney and lung treatments. It's free, so why worry?

These all happened at the hospitals and the health centers in our country. Medications have been fished out of rubbish bins. People who are not so sick, or pretend to be sick are the bane of the medical officers. If they feel poorly, we'll just give them an MC. What happened as a result? The queues at the hospital and health centres get very very long. Two years ago, I queued up for 2 hours at the Sengkurong Health Center - it was my first and my last trip there. Costs are rising annually, so many people flood the system that no matter how much the government improves its services, there will be more pepole. More improvement, more efficiency, more people, and more costs. Singapore described this as the buffet mentality and with kiasu attitude, nobody wants to lose out. Hey, it's free, if I don't take, the person next to me take. So I take firstlah. (In 2001, 283,000 people went to the hospitals and health centres for outpatient treatment - a number almost equal our population; if you include all visits including ante and post natal, children health care, the total will reach 497,000 - more than the entire population of Brunei went to the hospital in 2001! The figure for 2005, I have been told is equally high.)

Just a thought, what happened if we don't improve the services, do you think people will stop coming? Or maybe the hospital should charge everything? I am not advocating that the government start charging everything. What I am advocating is responsible behaviour from everyone of us including me. Medical costs are rising. Every month another 5 Bruneians will have kidney failures. Their treatments for the rest of their lives will cost the government about a hundred thousand a year. The health authorities need more funding for the more catastrophic illnesses. Shifting in funding has to happen, otherwise costs will just continue to escalate. We have to be ready to bear our share for the small costs or otherwise we have to shoulder all the costs in the future. We have to play our role - take care of our own health - prevention is better than cure - that phrase is truer now than at any other time in the past.

13 comments:

Anonymous said...

Very, very true. There's too much abuse of the benefits which come at little to no cost. We should be more conscious of our health instead of waiting for some poor overworked doctor to save us. And if not overeating+not smoking/drinking= money saved+better quality of life then it's a win/win situation. :)

Maurina said...

Not to forget the millions spent to send students overseas for a minimal eight years- on full scholarships with living allowances. And only a fraction will complete that course.

Sigh. I personally do not mind "partial" privatisation of our hospitals. For example, paying for half of the actual expenses? Or, perhaps free consultation, but paying half of what the medication actually costs.

It might make us think twice about our 'unhealthy' lifestyles, plus God knows how much it will improve the hospitals.

Just a thought.

yas said...

I always wondered why some people go to the hospital for the slightest headaches which would probably go away while they're waiting in line at the hospital.I agree with you on most, if not all, your points. "If I don't take, someone else will take", oh how so very true. If it's free, use it but then again, usage tends to flow to abuse.

You've got a great blog. Keep it up :-)

FlyBoy said...

This situation doesn't just apply to our national health service but also other government services. Have a thought of the free public electricity, roads and other utilities that we use. In most countries citizens pay utility tax for street lighting and garbage disposal.
Sometimes i wonder whether the oil reserves that we have is a blessing or a curse. One day, we won't be a welfare state anymore.We all have to wake up and be responsible and i totally agree with the editor's article. Well said and well done.

SiRTaMBaK said...

Imagine how many malnourished children in Africa could be fed with that money.
Imagine the lives of many crisis hit countries could be saved with that money.

Last year I had the opportunity to meet three young brothers from Kenya, Zambia and Nigeria when I was invited to attend the Commonwealth Youth Forum in Malta. They spoke of funding from developed countries to help their countries.

Not a plea but for a worthy cause. They approached me asking me how is life in Brunei? Medical cost? Oil prices? Education? Standard of Living?

And I say Thank You to the Government of his Majesty the Sultan for looking after his people and bless our country for having oil, for that is all I could afford to say.

The struggles that they go through everyday are nothing compared to what minscule dilemmas we encounter day to day.

Therefore, in this matter the people have to 'change'. Some how they just seem to take things for granted and I really wonder what 'chaos' will erupt when just a little change takes place.

LSM said...

This reminds me of my university days. Healthcare at the uni clinic was free and students took advantage of it. I've personally heard of students who woke up late and missed an exam so to save their behinds they fake a sickness (like a headache, something that doctors can't really disprove), get the exonerating Medical Certificate, dump the medicines and all was well for them.

On a seemingly unrelated note, I once signed up for a magic class and the teaching magician explained why he charged a nominal fee (very cheap, actually) for his classes. In his own words, we value what we pay for.

I'm with flyboy on this one. The Brunei government has been so kind to provide public services free-of-charge for so many years. Within the last decade, they've started charging for some of them (healthcare, Jerudong Park) but I think the damage has already been done: people have learned to take the facilities for granted.

To expect Bruneians to suddenly act in a responsible fashion with regards to healthcare and other heavily subsidised government services is a pipe dream. But to spur this change, I actually advocate charging a slightly higher price for public services because I agree with what my magician teacher says: we value what we pay for.

Anonymous said...

Bruneians will value things if they pay for it. For an instance the recent electricity bills. Suddenly there is a n urge to pay the bills where its priority was probably in the last of monthly expenditure of a family before enforement to 'cut' the service if a person failed to pay. If the Government ask the people to pay for medical services, people will appreciate them more and more and less MCs will be taken by abusers. I know the price of medicine that is given to patients is not cheap. Imagine a 7 day medicines cost hundred of dollars per pack which are usually given to patients for consumption of 3 months. Imagine that we have to pay for it. I bet some people will opted not to have that medicine if he/she cant afford it. A Singaporean told me the other day that he rather commit suicide rather than pay his medical bills if he suddenly got a stroke.

Anonymous said...

Just a thought, what happened if we don't improve the services, do you think people will stop coming?

People cant stop going because its the only hospital in the country. JPMC cant be realiable coz after certain hours, they dont operate. Saturday and Sunday are off days so you still have to be rushed to the dreaded A&E at RIPAS.

Bruneians always argue, that they are poor hence their only chance of getting medical health care is the government's service.

In order to reduce cost, Singapore hospitals are already outsourcing things such as x-rays processing to India... so when will Brunei's? At least in the singapore case, efficiency is the top priority and the x-ray result can be received in less than an hour, if im not mistaken (Straits times article several weeks or months ago)

her said...

Yup.. its true.. *nodding* I did wait for long hours at RIPAS hospital.. *sigh*.

LSM said...

If local healthcare gets too expensive or too lousy then the resident 'bomoh' will have an influx of patients ;)

Maurina said...

Hahaha LSM.

"The alternative lifestyle"

Anonymous said...

Ministers, Deputy Minister, Perm Sec and Deputy Perm Sec of the Health Ministry should all once in a blue moon, drop by the A&E section, especially around 9.50-10pm to see if the counter staff are available to serve the customers...

Anonymous said...

As a doctor working in the outpatient department, I see a lot of unneccessary 'illnesses', i`ve seen people faked their way through just to gte an MC, and i`ve had complaints for not giving MC when I feel and judged that the patient was not ill. Working in the clinic is total pressure, pressure of seeing 60-80 patients per day, trying to rush consultations just so patients do not complain about the waiting time and most of the time I feel like i`ve been fooled, particularly where it concerns minor illnesses esp coughs and colds. Honestly speaking the only cure for self limiting viral illnesses is time and healthy behaviour and practices. I do not understand why patients demand every single drug for every single symptom and I get complaints from staff even where I don't prescribe anything at all (where the patient was perfectly fine and asymptomatic). These kind of people are the ones crowding our clinics. At times where I`ve tried advising a patient about health and lifestyle I get cut me by the famous statement "ani nada MC kah ni???". I`ve never been so astounded by the amount of minor stuff that turns up in my clinic and I`ve tried to restrain telling patients 'you came here and waited all this time for THAT?' (a small mosquito bite)
My years of training in medical school down the drain.
We need structured health promotion and education to empower our people to self-manage and be confident about their health practices and behaviour. And eating nasi katok and tamu fried foods is not one of them.