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高效率如何衡量?

Emotions ran high when Senior Minister Lee Kuan Yew, who returned to Singapore from London last week, spoke on Sunday about the ordeal of his wife suffering a stroke there. The voice of the usually stoic Mr Lee cracked and the deep affection he has for his wife is clear.

  When I was a journalist in the 80s, I had covered many overseas trips by Mr Lee who was then the Prime Minister. Mrs Lee, a role-model wife who always accompanied Mr Lee on such visits, would take meticulous care of Mr Lee's daily needs.

  The anxiety felt by the 80-year-old Mr Lee is understandable when, during an overseas trip, he suddenly found himself having to attend to his wife who has always been by his side to take care of him. Fortunately, Mrs Lee has returned home for treatment and is now recovering.

  Many people will testify to the torment of waiting for treatment in a long queue in an emergency as everyone hopes to receive immediate attention from doctors and nurses. The truth is, even in Singapore which boasts a fairly efficient health-care system, this is still a tall order.

  It is not uncommon to hear the man in the street gripe about hospital services. Just imagine, even Mr Lee, given his status and prestige, was “neglected” at a public hospital in London. What would happen to an ordinary Singaporean?

  However, Mrs Lee did get a CT scan earlier and the location of the blood clot was identified. On this account, we should still be thankful to the British side. The fact that the scan was carried out in the early hours shows that even though the health-care system in Britain faces serious structural problems - the result of an over-emphasis on welfare over the years - it can still mobilise resources to meet urgent needs.

  In our case, this ability to marshal resources in an emergency is shown in swift reaction by hospitals here and SIA. In just 48 hours, a plane was turned into an “airborne hospital” and flown to London to bring Mrs Lee home for treatment.

  This is, however, not a good assessment of the efficiency of our health-care system and we can't say with certainty that Singapore is well-equipped to respond to an emergency.

  The litmus test of our health-care system lies in its ability to react quickly to a sudden “attack”。 How we handled the Sars outbreak in March this year would, I think, be a better gauge.

  Every country will accord its leaders or other key members special treatment. This should not surprise anyone. For a true measure of the efficiency of a country's health-care system, what is more crucial is what kind of treatment the ordinary people get.

  We should, of course, draw lessons from the dire straits welfare states find themselves in. A son of a friend of mine, who graduated from medicine from a British university and did his internship in a specialist hospital there, also noted that the former empire has lost its glory - its hospital equipment is not even comparable to ours.

  The biggest problem is the shortage of funds, a result of the heavy burden of free health-care services on the nation. This observation is consistent with Mr Lee's.

  Going beyond the limit is as bad as falling short. European nations, including Britain, have perhaps gone overboard in providing its citizens with free medical care, something which they now find impossible to reverse.

  Singaporeans have no wish of seeing Singapore go down the wrong path. But they do often feel that the government has not done enough and can be more generous with its budget for health care.

  Some measures were announced recently by Acting Health Minister Khaw Boon Wan to get public hospitals to cut costs and ensure costs remain affordable. The efforts are commendable and I truly hope our health-care system will work towards becoming more and more people-centred and efficient.
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  上周刚从伦敦回来的李光耀资政,谈起夫人突然中风的痛苦经历,禁不住哽咽,让人看到这位铁汉的柔情,也充分流露资政伉俪的鹣鲽情深。

  笔者在80年代当记者的时候,曾多次随团采访资政(当时为总理)的出国访问,深知李夫人每次随行,对总理的起居和健康总是关怀备至,是典型的贤妻良母。

  这回,年届八十的资政在出国中途,突然需要回头照顾形影相随数十年的老伴,那种情绪上的震撼是可想而知的。所幸李夫人已无大碍,并正在康复中。

  紧急求医,排队久等的煎熬,是许多人都有过的经验。任何人遇上紧急情况,都会希望医院和医生能立即施救,不过,即使在医疗系统效率颇高的新加坡,这也还是个很崇高的理想。

  因此,我们也不时可以听到许多民众对医院的不满和投诉。试想,以李资政的地位和威望,在伦敦尚且受到公共医院的“怠慢”,换成是一个普通新加坡人,结果又会是如何?

  不过,李夫人终能提前接受脑部扫描,确定血块所在。对此,我们还是应该向英方说谢谢的。这件在三更半夜发生的事故却也说明,英方是有能力调动当地医疗体系的资源应急的,尽管他们的整个医疗系统正面对严重的结构性问题,也就是长期实行过度医疗福利所带来的后遗症。

  这种紧急调动资源的能力,也犹如新加坡的医院和新航在接到通知后,火速行动,在48小时内就安排好“空中医院”飞到伦敦把李夫人接回国一样。    因此,这不是衡量新加坡医疗体系效率的好标准。我们也无法因此断言新加坡具备了应付紧急状况的能力。

  新加坡医疗系统的真正考验是面对突如其来的“袭击”时,是否能迅速回应。从这个角度来看,今年三四月间沙斯的爆发,应是更好的试金石。

  每一个国家都会给它的领导人或其他重要人物特别的照顾,这是不足为奇的。真正的差别,在于一般老百姓所能得到是怎样的待遇。这才是一个国家的医疗系统的效率高低的试金石。

  不过,我们的确也应吸取福利国当前面对困境的教训。笔者的一个朋友的孩子,毕业于英国某大学医科,在当地专科医院实习过,也观察到旧帝国已失去往昔的光芒,医院里的设备还不如新加坡。

  个中最大的原因就是财政拮据,免费医疗对国家的负荷实在太大了。这同资政的观察是完全相符的。

  然而,所谓过犹不及,包括英国在内的欧洲国家,或许在给国民的医疗福利上的确都做过头了,因此形成了积重难返之势。新加坡人不期望我们这个小国步上它们的后尘,但总觉得政府还做得不够,还可以在医疗开支预算方面稍微慷慨些。

  最近,新任卫生部代部长许文远亮出了一些新的招数,要公共医院尽量降低成本,减轻百姓的医疗费负担,这种亲民的做法是绝对值得称许的。希望我们的医疗体系能不断朝这种亲民和高效率的方向迈进。

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