More clarity in doctors' fees by next year

Singapore

BY next year, Singaporeans will have a better sense of actual charges for common surgical procedures as the government pushes past a gridlock to tackle the thorny issue of doctors' fees.

As part of wider efforts to ensure healthcare costs are sustainable, a new independent committee will be appointed by early 2018 to determine benchmarks comprising a range of doctors' fees for the various surgeries.

Health Minister Gan Kim Yong told the media that its members would assess actual transacted fees, distribution of fees and the nature of the procedures before deciding what is a reasonable fee range for each of the surgeries.

The yardsticks would be reviewed periodically and serve as reference on what are fair charges.

"I think we also hope that by publishing this benchmark we can help doctors decide what is a reasonable fee because some of the doctors may not know what other people are charging and they're also confidential so they won't tell others how much they are charging. So with this data, then they can know what most people are charging. That also helps them to keep their fees more reasonable. Hopefully, overtime, this will help us to manage healthcare costs," said Mr Gan.

He said the committee would "have the flexibility to appoint sub-committees or task force" to look at "special procedures" given the numerous specialties.

So what happens if a doctor's fee is above the benchmark?

Well, Mr Gan stressed that this does not mean the doctor is overcharging as "it all depends on the complexity of the case, the experience, the skills and circumstances". "If you as a (medical) profession accept that this is the right fee that you charge, then you have to defend it."

Patients would benefit from the improved transparency as they could then decide if they wanted to continue seeking treatment from a doctor who might cost more but is well-regarded.

Over time, the benchmarks' coverage would evolve and expand as the government collects more data.

The development comes a year after the Health Insurance Task Force (HITF) recommended that medical fee benchmarks be introduced as one of the ways to help keep a lid on growing healthcare costs here.

Higher healthcare costs are not unique to Singapore and they have been driven up by many factors, including a rapidly ageing population, advancements in medical technology, higher doctors' fees, as well as greater access to healthcare and in turn, higher consumption.

The push to have greater clarity in doctors' fees has been a long-drawn one.

In 1987, the Singapore Medical Association (SMA) and the Association of Private Medical Practitioners of Singapore (APMPS) introduced fee guidelines following calls by the Ministry of Health (MOH) for a guide on medical charges. MOH had wanted patients to be more informed about pricing on consultation and surgical fees, as well as to deter private doctors from overcharging.

But in April 2007, SMA voluntarily removed the guidelines as they were deemed anti-competitive.

In June 2010, SMA's request for the guidelines to be excluded from the Competition Act was thrown out. In August that year, the Competition Commission of Singapore (CCS) concluded that the fee guidelines breached the Competition Act as they only applied to the private healthcare sector and created a cluster effect.

Asked about this, Mr Gan said the competition watchdog's key concern was about service providers coming together to set fees or guidelines, which would not apply in this instance since the new benchmarks would be set by MOH.

In recent years, MOH has been publishing historical transacted hospital bill sizes for common medical procedures and the publication has been expanded to include fees for various bill components, such as surgeon's fees.

When contacted, SMA's president, Wong Tien Hua, said the association supports MOH's move but prefers a stronger approach. "We appreciate that benchmarks may not be exhaustive although they would at the least cover the common procedures. The data collected must be robust. In this regard, SMA would prefer guidelines to benchmarks."

To ensure sustainability, Dr Wong noted there are other "equally important initiatives" including reviewing hospital charges, educating the public, and insurance product redesign.

On a national scale, the government has embarked on measures to ensure long-term healthcare needs are met in a sustainable way through the "Three Beyonds". The first is beyond healthcare to health - investing in disease prevention and health promotion to help Singaporeans keep healthy; the second is beyond hospital to the community - to shift care from resource-intensive acute hospitals to the community; and the third is beyond quality to value by delivering value-based and evidence-based care that match a patient's need.