I received excellent treatment from my physiotherapist for my upper back pain and was able to complete the hot 168km Bike Rally 2010.  Physiotherapists in Singapore are like physical therapists in the U.S., however they are not yet licensed professionals though acupuncturists are. They are working with the government to change their status. 

My physiotherapist, Sylvia Ho, co-founder of Core Concepts Physiotherapy Centre, was trained in Australia where she earned both her bachelor’s and master’s degrees.  She prefers to use manipulative therapy and massage to ultrasound or electrical stimulation machines. She believes my discomfort came from a major change in my ergonomics related to my daily use of 2 computers at new desks and subsequent poor posture. My upper back and neck pain improved more with each visit, exercises she recommended I do at home, and changing my computer posture.  

Core Concepts charges about $56 for each therapy session that lasts about 30 minutes and consists of intensive manipulation and massage.   Physiotherapists employ hands-on techniques that try to remove blockages, loosen and stretch muscles and joints, and improve posture. 

After my first visit, I submitted the bill to my Singapore insurer, which I have through my employer.  Soon thereafter, I received an email asking me for the original copy of my written referral.  This was news to me.  For my U.S. insurer, no written referral is required, so it had not occurred to me that I would need one in Singapore. That was a mistaken assumption and I should have known better.

I told the insurance company the truth: that my physician told me to see a physiotherapist. They responded that they still needed the original written referral.  So I contacted the physician via email. He did not respond. One week later, I called his office. They said they would email me the referral. They did not. I called a week later and tried again. This third attempt proved successful. They emailed me a scanned copy of the handwritten referral from the doctor and I received the original in the mail a few days later. However, I did notice one potential problem: there was no date on the referral. 

Nonetheless, I filled out the on-line medical claim submission forms and submitted the “certified original” referral and bills. I was told they pay about $35 maximum for each physiotherapy visit.

I should hear within a few weeks.

Meanwhile, I tried to learn more about the “Sixth Best System in the World.”  Keep in mind: No system is perfect.

I was interested to learn that at least some of Singapore’s hospitals publish their bed charges and the Ministry of Health publishes the mean costs for certain diagnoses at some hospitals.

For example, at Singapore General Hospital, there are 7 types of “wards.”  I list them below with the costs per day (in approximate US$) and some amenities:

Standard Ward Class C - $21-      9 bedded room, natural ventilation

Standard Ward Class B2 - $56 -   6 bedded room, individual ceiling fans, semi-automatic  bed

Standard Ward Class B2+ -$84 -  5 bedded room, air-conditioned, attached bath and toilet

Standard Ward Class B1 - $130 - 4 bedded room, all of above, TV, phone, choice of meals

Standard Ward Class A1 - $215 - Single room, all of above, toiletries, fully automated bed, optional sleeper unit

Upgraded Ward Class A1+ = $243- All of above, plus mini-safe, fridge

The charges listed above are what the patient will pay out-of-pocket for their beds exclusive of any care. “Out-of-pocket,” however means that the patient can use a Flexible Spending Account or a Medical Savings Account (Medisave), into which their employer and/or they are required to put a minimum amount.  As of December 2008, the average Singaporean had about $10,000 in their Medisave account.  They can also use the accounts of the close relatives and dependents in some circumstances. 

While this seems complicated to me, most Singaporeans seem to understand how it works. They also have to pay “out-of-pocket” for some expensive therapies including chemotherapy and HIV drugs.  How much? I’ll find out and report on it in Part III. 

Alexander Zehnder is the Scientific Director of the Alberta Water Research Institute in Edmonton, Canada. A few weeks ago, he gave a lecture entitled “Water for Life, For How Many?”  at Nanyang Technological University in Singapore where I am currently Visiting Associate Professor. 

Zehnder listed 6 major challenges facing the world regarding water:

Good water for a growing population

Water induced disasters protection

3)   The water infrastructure for distribution and collection

4)   The distribution of water between humans and ecosystems

5)   Solutions for water conflicts and fair water share for all

6)   Enough food for all

There are 3 kinds of water, according to Zehnder: blue water, which lands in rivers and places from which we drink; green water, which lands on green spaces and vegetation, which uses it to grow and eventually evaporates or just sits there; and virtual water, which is the water that is turned into food that is traded and sold across communities and national borders.

Virtual water is very interesting and important since the vast majority of countries import it (in the form of food).   There are 5 countries on the planet that are by far the largest exporters of virtual water: USA, Australia, Argentina, France, and Canada.  These countries, according to Zehnder, feed the world.  Most countries of the world are food importers (including China and India) and this disparity will only increase as the populations of these countries also increase. Africa may suffer the most because of enormous population growth and world trade and financing policies that favor richer exporting countries.

The demand for water is increasing further as more Chinese and others move into middle class and are interested in eating more meat. The production of meat requires about 10 times more water than the production of non-meats. If we all became vegetarians, according the Zehnder’s data, we would have enough water to meet the growing demands. However, he is not advocating universal vegetarianism.  He loves a good steak.

Since water and food are so inexorably connected, Zehnder believes that efforts at turning millions of acres of corn or sugar into fuel is “the dumbest idea ever.” Instead, we need to use the water for food and solve our fuel problems with other strategies.

Since he did not specifically address conflicts over water during his talk, I decided to ask him about it when the floor was opened up for questions. He said that even though some are claiming that water will be the cause of future (if not present) global conflicts, he disagrees. In the short run, there are conflicts over water. However, over the long run, countries realize the interdependence of their water needs and that water will actually bring people closer together.  That may be hopeful but examples from Turkey and Egypt seem to confirm his hypothesis and the current water issues in Southeast Asia (between China, Vietnam, Laos, and Cambodia) may be a test of his theory.

In the end, Zehnder himself concludes four things: 1) The growing economic and political dependence on virtual water must be addressed, 2) Virtual water should be part of all water management decisions, 3) Economic power of the poor countries must be strengthened to cope with water instability, and this is a not just a responsibility of richer (water exporting) countries, but it is also in their own interests, and 4) geopolitical efforts are needed to abandon the myth of national food self-sufficiency.

So water should be used for people and food, not for fuel.