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.
Comments
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.
You've got a great blog. Keep it up :-)
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.
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.
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.
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)
"The alternative lifestyle"
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.