ABSTRACT
Introduction: The rising cost of healthcare in Singapore has resulted in calls for greater price transparency. With the GP (General Practitioner's) fees surveys done in 1996 and 2006, we undertook a similar survey in 2013 to investigate the change in GP fees and GP operating costs over the years. Methods: The 2013 GP Fee Survey involved 992 GPs and solo clinic practitioners. Results from the 2013 GP Fee Survey were compared against the 1996 and 2006 GP Fees Surveys. Compound Annual Growth Rate (CAGR) was used to reflect the change in price data over the years and compared against the CAGR of the Consumer Price Index (CPI) and CPI-Health over the same periods. Results: 113 participants (11.5%) responded. Between 1996 and 2013, the CAGR for CPI was 1.84% and CPI-Health was 2.97%. In comparison, the CAGR for the median patient fee was 3.12%; staff salary was 1.95%; property cost was 2.47%; and total monthly practice cost was 9.21%. Conclusion: Between 1996 and 2013, the rise in the patient fee matched the rise in CPI-Health but the rise in practice cost outpaced CPI-Health by more than three-fold. However, the low response rate limits the generalizability of the data.
ABSTRACT
BACKGROUND: We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income. METHODS: Chronic pain was defined as pain ≥ 3 months. From 2009−2014, residents aged 40−60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves. RESULTS: In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36−3.27, P < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25−3.39, P = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18−4.40, P = 0.014), cervical cancer (aOR = 2.65, CI = 1.34−5.23, P = 0.005) and breast cancer (aOR = 3.52, CI = 1.94−6.41, P < 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of “major illness”; screening as a search for answers to pain; and labelling pain as an end in itself. CONCLUSIONS: Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.