LettersOPINION

Letter: Budgeting in unprecedented times 

I’m no health economist, nor do I have access to the national health expenditure budget and data, but it was somewhat surprising that many health services are facing significant budget cuts. 

I do know that budgets are usually made based on previous years’ spending, and it would be odd if a budget cut is being made despite significant usage. However, I don’t have that data, so I don’t know.

I do know that many elective services were disrupted during this pandemic. I believe that this would mean the budget allocated for these services would not have been used, and with the rising COVID-19 expense, they probably would have been allocated to that instead. I hope this fact was not overlooked when the budget was made, because those disrupted services are still wanted and needed by many, and we have to provide them, just at a later time.

Budgeting in unprecedented times is no easy feat. There is no recommendation or previous year template to adapt from. It also doesn’t make sense to follow the pattern of spending of earlier years because COVID-19 has messed up our expenses, and we need to acknowledge and adapt to that. 

Nephrology service seems to have received a massive 78% budget cut. That just sounds crazy since the prevalence of renal failure did not miraculously drop this year. COVID-19 didn’t end up curing diseased kidneys. 

However, something else in the budget caught my attention. The allocation for peritoneal dialysis is increased. This I think is quite brilliant and reflects the new normal.

For hemodialysis (HD), patients would need to travel to the hospital or centre every other day for their dialysis. If I’m not mistaken, there were even a few COVID-19 clusters that broke out from dialysis centres during the second wave. On the other hand, peritoneal dialysis (PD) is done at home. People don’t have to travel to centres to get it done. One reason people don’t like doing PD as compared to HD is that PD has to be done three times a day whereas HD is done three times a week, ergo more convenient and more comfortable to take up jobs. 

But then COVID-19 came, and our lives changed. Many of us are now working from home. We face travel restrictions. If the COVID-19 and lockdown continue, it makes sense for more patients to be doing PD than HD. This is probably what “new normal” means. Kudos to whoever thought of this farsighted notion. I don’t know if this was your intention, but I’m impressed. 

Alas, my being “impressed” didn’t last long. One point very evident in the budget is how much importance has been given in addressing the issues with short term measures. Quick wins. The low hanging fruits. There isn’t much evidence of long term measures.

One major asset that the MOH possesses is its people. Healthcare collapses without its providers. In this budget, the frontliners are getting a one-off bonus. Yay. But what happens after that? The fact that we need more healthcare workers is not a fairy tale. Healthcare workers are not cheap. Their training is costly, and they too end up being high maintenance. So I guess, keeping them happy with a chocolate bar and a pat on the back is more comfortable and more economical. Please do the right thing and focus on reinforcing and building up the healthcare asset.

I find it rather difficult to argue or refute this budget because these are unprecedented times, and we can’t predict how our future is going to be. We reckon a vaccine might curb COVID-19, but we have no idea still if the vaccine that’s going to be made is the real deal or a dud. It might not be wise to put all our eggs in this basket just yet. 

I trust that the people who made the budget know what they’re talking about, but I also hope that the service providers will not shy away from asking for more money when the need comes. If you don’t ask, you don’t get. Please advocate strongly for your cause.

 

Warmest regards,
Dr Vikkineshwaran Siva Subramaniam

Vikkineshwaran Siva Subramaniam thinks medicine and healthcare are fascinating and strives to learn more about it. He is neither a health economist nor a public health expert but he has medical knowledge, some common sense and general knowledge. Please take his opinions with a pinch of salt. 

 

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