New committee to set doctors' fee benchmarks for greater transparency

BY next year, there will be more clarity as to what doctors' actual charges are for common surgical procedures as the government sets in motion efforts to roll out fee benchmarks.

As part of wider efforts to ensure that healthcare costs are sustainable, Health Minister Gan Kim Yong says a new independent committee with the expertise will be appointed in early 2018.

It will look into 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 benchmarks comprise a range of fees and will be reviewed periodically to serve as a reference for doctors.

"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, over time, this will help us to manage healthcare costs," says Mr Gan.

He says the committee will "have the flexibility to appoint sub-committees or task force" to look at "special procedures" given the numerous specialities.

And if a doctor's fees are above the benchmarks, it does not mean there is overcharging as "it all depends on the complexity of the case, the experience, the skills and circumstances", stresses Mr Gan, who adds: "If you as a (medical) profession accept that this is the right fee that you charge, then you have to defend it."

The benchmarks will also benefit patients who can then decide if they want to continue to seek treatment from a particular doctor who may cost more, but is well-regarded.

Over time, the scope of procedures will "evolve and expand" as more data is collected, the minister says.

He adds that the competition watchdog's concern has been about service providers banding together to set fees or guidelines. In this instance, the fee benchmarks are set by the ministry so they will not be anti-competitive.

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 fast rising healthcare costs here.

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

Singapore Medical Association's (SMA) president Wong Tien Hua tells The Business Times that SMA supports the government's move, but prefers more stronger measures.

"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."

Dr Wong adds that besides the new fee guide, there are other "equally important initiatives" including reviewing hospital charges, educating the public, and insurance product redesign.

Consultancy firm Oliver Wyman's partner Jeremy Lim says if executed well, the gauges will be a "game-changer" although how effective they will be hinges on the selection of committee members "through to the way consultations are conducted to decision-making by the committee and subsequent reviews".

That said, he is unsure how these experts, who will likely be practicing doctors, are truly independent.

"What all this means for doctors is most likely to be a narrowing of the variation in fee setting. Yes, some of those on the low end or even below the fee benchmark ranges will undoubtedly up their prices, whilst others will have to reduce theirs to keep patients and payers (insurers and employers). Ultimately though, we should strive to provide patients and payers corresponding measures of quality so that true 'value' as defined by quality or outcomes over price can be determined," Dr Lim points out.

On a wider 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.