Three medical bodies issued a joint letter to their members yesterday to say that in certain circumstances, they consider it acceptable to pay a percentage of doctor’s fees to third-party administrators (TPAs), which takes a position in contradiction to an advisory sent out on Tuesday by the Singapore Medical Council (SMC).

Though the letter did not specifically say so, the criteria under which a percentage of fees would be appropriate would point to general practice (GP) clinics – where fees are lower and there are fewer variations between practices – but not specialists, where bills could vary greatly.

The three parties are the Academy of Medicine, representing specialists, the College of Family Physicians, which speaks for primary care doctors, and the Singapore Medical Association.

The SMC said that under the new Ethical Code and Ethical Guidelines (ECEG), which become effective next month, doctors cannot pay such agents a percentage of the fees they get from patients.

The SMC said the practice “may be construed as a form of fee splitting”, as the work done by third parties does not vary from patient to patient, whatever the fees doctors charge for treatments.

More than 1,000 clinics in the private sector, both GPs and specialists, will be affected by this ruling, as they have patients who are sent to them from TPAs, especially those who represent insurers, and companies that offer medical benefits to employees.

The letter acknowledged that fee-based payment was not a preferred method as it might not reflect work done, and suggested as a solution a multi-tiered fixed fee structure with a cap on fees charged.

But it added: “Nonetheless, we acknowledge that a percentage TPA fee structure may provide a level of administrative convenience, and in very specific and limited circumstances might not be in breach of the ECEG.”

One of the two criteria to be met, they said, is that the fee should represent “a small percentage” of the doctor’s fee, without elaborating.

Currently, it is generally between 10 per cent and 25 per cent.

The other is that more than 80 per cent of bills from the practice should “fall within a narrow range”, which would apply to most GP clinics but not likely to specialists, whose services and fees could vary greatly.

Dr Low Lee Yong, chief executive officer of TPA Make Health Connect, said: “We hope to meet up with SMC for a dialogue on this matter since it affects the livelihood of over 1,200 doctors in our panel.”

He noted that a flat fee might – in contrast to the SMC’s goal – end up pushing up healthcare costs.

“A flat fee of $5 is 25 per cent to the doctor who keeps the healthcare cost low at $20. But it is only 5 per cent for the doctor who charges $100,” he said.

Ms Veronica Allen, chief executive officer of Parkway Shenton which has about 680 specialists and 360 GP clinics under its third-party agreements, said: “We agree that administrative fees charged should primarily reflect the work of the TPA and not be so high as to constitute fee splitting with the doctor.”

The SMC said last night that it “appreciates the support of our professional bodies”, and repeated that fees paid must reflect actual work done by the TPA and be transparent to the patient or payer.

salma@sph.com.sg

This article was first published on December 15, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

Filipinos in Singapore are looking forward to meeting Philippine President Rodrigo Duterte, who arrives here today.

Some have even made special arrangements to leave work early tomorrow, so they can attend an event in which Mr Duterte will meet members of the Filipino community here.

The session, organised by the Philippine Embassy, will be held at the Max Pavilion at the Singapore Expo at 6pm tomorrow.

“I just want to cheer him on and thank him. I support him 100 per cent,” said maid Zeny Lopez Viernes, 45, whose employer has given her leave to attend the event.

“I like the way he wants to wage a war on drugs in the Philippines. It is a problem in our country. I hope he will make the Philippines a great country, just like Singapore,” she said.

Other supporters of Mr Duterte told The Straits Times that they are hopeful his leadership style, while controversial, would improve people’s lives in the Philippines.

IT programmer Ariel Herrera, 33, also registered for the event. He plans to start work earlier and leave the office earlier tomorrow.

“I would like to see him in person,” he said.

“He speaks his mind and he doesn’t beat around the bush. Some people may think he is rash, but I would rather have a rash person who lives up to his promises, than a polite person who does not.”

Registration for the event is now closed, after the number of sign-ups exceeded the venue’s maximum capacity of 6,500 people.

Maid Liliosa Castino, 44, did not register in time, but will still go to the Singapore Expo to try for a glimpse of Mr Duterte in person. Her employers are currently on holiday.

“We have had so many presidents, but the situation in the Philippines has been the same. I think he can make a difference,” she said.

This article was first published on Dec 15, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

Imagine consuming five to six upsized fast food meals a day, tipping the scales at over 120kg, suffering from serious health issues such as high cholesterol, diabetes, and high blood pressure – and being told at the age of 21 that you’re in danger of getting a heart attack.

This was the life of Mr Shaun Lawrence, now 36, for the past 30 years.

Meet him today and you probably will not be able to tell that he was previously obese and battled such serious health issues. That is because he went through a gastric bypass surgery in late 2011 – a form of weight-loss or bariatric surgery effective in reversing diabetes and other associated metabolic disorders. The surgery changes how your stomach and small intestine handle the food you eat.

It divides the stomach into a small upper pouch and a much larger lower ‘remnant’ pouch. The small intestine is then rearranged to connect both.

“In the past, I could only do simple things like walking from my home to the MRT station or crossing over to the coffeeshop. Other than that, I was never able to take part in fun activities I wanted to like football and swimming.

“In fact, I was too ashamed to go swimming because that would mean taking off my clothes in public. I just couldn’t do it.”

On top of that, taking the public transport was a challenge too. Being a big person, Shawn always felt he was occupying too much space, and noticed that people rarely stood next to him.

“Each time this happened, I would think about how it would be nice to lose weight and fit into society, so that I could finally board public transport without worrying about people looking at me differently.”

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121kg man who loved eating loses 50kg after gastric bypass surgery

Source:

Stomp

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Today, Shaun makes it a point to keep himself active by running 5km three times a week as well as swim occasionally.

Since the surgery, Shaun has lost 50kg – from a whopping 121kg to 71kg. Impressive, huh?

However, it did take a lot for Shaun to even arrive at the decision of undergoing the surgery in the first place – especially when he loved eating so much.

“I could have gone through the bypass a long time ago, but I refused because I could not say ‘no’ to food,” he says.

During an interview with the Stomp Team, Shaun recalls his poor diet habits prior to the surgery.

“I would get hungry every two to three hours, and despite consuming a full upsized meal from McDonald’s, I would still feel hungry within an hour or so.

“That was when I started snacking, drinking loads of sweet drinks to curb the craving — but of course I was never really hungry, I simply needed something to munch on all the time.

“And of course I did not bother about what I consumed, anything unhealthy was my favourite.”

While refusing to give up food might sound like a lousy reason, it is the reason stopping thousands of patients out there from undergoing the surgery.

According to Shaun, what the surgery does is that it controls the food intake of the person. He says: “They operate it such that only a small portion of your stomach will be in use – mine shrank to the size of a palm!”

This would mean eating much lesser than before, which was exactly what Shaun had feared.

It was not until his doctor informed him of his bad diabetic situation during the last medical checkup before the surgery that he decided to proceed with it.”My doctor told me that there was no other way out. It was either I got hooked on to insulin jabs two to three times a day for the rest of my life, or go for the operation, and so I chose the op.”

However, Shaun emphasizes that going through the operation does not necessarily mean his problems would magically disappear. It would only help reduce them.

He says: “This surgery aids in bringing the high cholesterol, diabetes and blood pressure levels into remission. And as these problems are linked to a person’s weight, the surgery helps to reduce that too.

“So after the operation, as long as I watch my weight, watch my food intake — the chances of diabetes coming back would be very low.”

Though Shaun still does enjoy his fast food meals every once in awhile, he is not able to down upsized meals like before.

“I have to make a choice. It’s either the fries and the drink, or just the burger. I’m not able eat all at once.”

Shaun highly recommends the surgery to those who suffer from similar medical conditions due to poor eating habits.

“I think going for this operation will actually really really change their lives, it did change my life greatly.

“They’ll look at food at from a different perspective like how I look at food now. Now I eat to survive, I don’t eat for the sake of eating anymore.

“It’s definitely a good way to solve your problems if you are worried about your health, or are at risk of getting diabetes – I think this will help a lot.”

With all that being said, is the gastric-bypass surgery really a shortcut to your weight and medical problems? Watch the four-part series below as Shaun shares his experience with the surgery, the mistakes he made, as well as some tips for those considering undergoing the surgery.

Watching 67-year-old Ngai Hin Kwok execute athletic callisthenics could fool one into thinking that the gravity-defying acts are as easy as tying one’s shoelaces.

The semi-retired jeweller makes moves with names like front lever, human flag and muscle-up look like a piece of cake, though in truth they require the strength of one’s core, upper and lower body that even young men and women might not have.

Much of this ease comes from decades of disciplined training and an active interest in sports and fitness.

As a 15-year-old living next to a university in Fujian, China, Mr Ngai and his elder brother were influenced by the students they often saw playing table tennis, lifting weights and doing aerobics. They soon followed suit.

The love for all kinds of exercise grew from there. Even as he moved to Hong Kong and then Singapore for work, with a small family in tow, he found time to work out. In Hong Kong, he walked more than two hours from Xi Wan to Bei Jiao; in Singapore, seven hours from Toa Payoh to Pioneer.

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Check out this 67-year-old’s athletic moves

Source:

The Straits Times

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Now, the grandfather of two boys and a girl brisk-walks 11km every weekend around MacRitchie Reservoir, participates in the 10km run at the annual StanChart Marathon, and does occasional long-distance cycling, covering anywhere between 10km and 100km each time. This is on top of the 80 to 200 push-ups and squats that he does at home daily.

With plenty of time after his retirement six years ago, Mr Ngai actively sought out like-minded fitness enthusiasts to work out with. Reading about the Gym and Strength Interest Group at Cheng San Community Club in the papers a few years ago, he approached them.

When the interest group exercise leaders Ng Bee Kia, 71, and Ng Sui Chi, 58, saw his work on the bars, the three, with fitness enthusiast Robert Ho, 46, decided to form Team Strong Silver to promote active ageing and to counter ageism through callisthenics, a form of athletic training using one’s body weight.

With the team formed in September 2013, Mr Ngai has performed at several public events, including last year’s SEA Games. Sometimes they perform with a group of younger callisthenic practitioners, the Bar Breakers. Since its formation, Team Strong Silver has attracted another four seniors into the group.

Being part of the group has given Mr Ngai more chances to interact with youngsters and further his interest in callisthenics. “When I see youngsters learning new moves, I will try the moves out. If I can do it, I’ll do it. If I can’t, I won’t force myself to. I don’t feel afraid when I am learning new callisthenic moves. Even if I fall, I won’t be injured as I know how to fall. My legs are strong and I am able to control my falls,” he says.

IT consultant Leonard Kwong, 35, a member of Bar Breakers, remembers his first meeting with Mr Ngai. “I was amazed,” he recalls. “I was impressed by his strength.”

He adds: “He sets a very good example with regard to how age is just a number; that, if you work hard enough, you can be as strong as anyone out there. He didn’t get strong overnight. All of us, if we work hard, can achieve great things.”

Mr Ngai, who maintains a simple diet and is proud of his fitness level and health, hopes that he will be able to stay as fit in the coming years and continue doing what he does now.

This article was first published on Dec 15, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.