Angry Doctor

Friday, April 20, 2007

Confidence Goods 10

Well, well.

CCS and CASE both replied to
Ms Chen's letter today, but they have not answered her most important question.

Watchdog: Give patients fee data to make choices

I REFER to Ms Christine Chen Siew Mei's letter, 'How to decide if doc is overcharging?' (ST, April 16).

The Competition Commission of Singapore (CCS) will not issue guidelines on 'acceptable and normal charges', as this would constitute another form of fee guideline.

It should be noted that the Ministry of Health's guidelines under the Private Hospitals and Medical Clinics Act and Regulations require doctors to display their fees and other relevant charges prominently. Hence patients would know beforehand the fees payable.

CCS would also encourage bodies such as the Singapore Medical Association to collect and make widely available information on the fees charged by doctors, so that the public is aware of the range of fees charged for various medical procedures and treatments.

This would enable the public to know where a particular doctor's fee stands in relation to the fees charged in the market and make informed decisions about which doctor to see.

The CCS will work with the Consumers Association of Singapore to review the complaints that it may receive on doctors' fees. CCS will take action if there is any infringement of the Competition Act.

More information on the Competition Act can be found on our website at (link removed).

Chin Yen Yen (Ms)
Senior Assistant Director (Corporate Communications)
for Chief Executive Competition Commission of Singapore

Free competition will keep prices in check

I REFER to Ms Christine Chen Siew Mei's letter, 'How to decide if doc is overcharging?' (ST, April 16).

The Consumers Association of Singapore (Case) does not always require fees to be paid whenever consumers approach us. Consumers can seek advice via phone, e-mail or walk-in consultation at no charge.

Our officers will advise consumers on a case-by-case basis and highlight the various options of recourse.

Only when consumers request for us to represent them and manage their complaints would they need to join us as members.

As to the writer's concerns about overcharging, we believe that free competition will work against doctors who charge excessively. With free competition, there will always be a range of fees that doctors charge and consumers can choose the doctor that fits their budget.

Doctors who intend to charge a certain level of fee will need good reasons to do so. Doctors who price themselves out of the market may lose their patients to those who charge market rates.

We encourage clinics to practise transparency by displaying prominently the costs of consultation and other medical services at the entrance and at the registration counter. This will ensure that walk-in patients are fully aware of the charges before they seek a consultation and prevent disputes over fees.

Cost-conscious patients should call up a few clinics to enquire about the consultation fees.
We also expect doctors to itemise their charges, so that consumers are able to determine the cost of consultation vis-à-vis the costs of related products and services.

While we believe that fees will not differ significantly after the withdrawal of SMA guidelines, we will continue to monitor the situation and may conduct a survey of medical practitioners' fees in future.

Should members of the public have queries on any consumer issue, they can call 6463-1811 or e-mail (link removed)

Seah Seng Choon
Executive Director
Consumers Association of Singapore

CCS and CASE have both avoided answering the question: Do they have the expertise or domain knowledge to know the intricacies and complexities of pricing in the whole spectrum of health care?

Say you go to a specialist for a surgery, and the fees he quotes you is the top of the range of fees, and several times that of the private rate at restructured hospitals. Is he overcharging you? What if all his other patients who had previously undergone that surgery have paid up without complaints, and felt they had good value for their money?

Say you go to a GP for a problem, and he orders several blood tests, X-rays and scans, and does a biopsy for you, all of which are charged at the middle or lower part of the range. Is he overcharging you? What if many doctors would actually consider the tests he has done for you as redundant?

Without taking quality into account, a "survey of medical practitioners' fees" and "itemised charges" will not allow patients to make informed decisions about their healthcare spending.

Not only have CCS and CASE not answered Ms Chen's questions satisfactorily, their replies in fact raise another question: If CCS believes that free competition will benefit patients, why does it need CASE to monitor the fees?

Or, as Lt Kaffee would ask:

"If you gave an order that Santiago wasn't to be touched, and your orders are always followed, then why would Santiago be in danger?"



  • Angry Dr,

    I started checking on medical costs after I saw a $250K medical bill(unsubsidised, subsided class 'C' bill roughly $70K) from a public hospital. It shattered all my notions about 'affordable' medical care in Singapore.

    What are the implications of "means testings"? A person owning a $500K property has the means to pay for a $200K medical bill?

    I really wonder where we are headed.

    By Blogger Lucky Tan, At April 21, 2007 6:57 am  

  • LuckySingaporean,

    I read your entry. The $250K bill was for "a 2 month stay in ICU+surgery in a govt hospital". For a C-class patient, the bill would be about 20% of that or $70K. For a B2-class patient it would be about 35% of that or $90K.

    From the information I have so far, means testing would be based on monthly per capital household income rather than housing type, but we have to await the final details from MOH.

    Certainly $250 (or for that matter $70K) is a lot of money, but I think it should be seen in the context of what it paid for. There is no detail of the reason for admission and the type of surgery and course of recovery in this case, but a 2-month ICU stay plus surgery sounds like it would consume a lot of resources. Those resources need to be paid for.

    As it is tax payers pay for 80% of that bill. We can of course extend it to 90%, 95%, or even 100%, but it does mean that tax payers will have to pay more. Are we prepared to do that? Are we prepared to pay 90%, 95%, or even 100% of the medical bill for patients whose total come up to a few thousand dollars? A few hundred dollars?

    Another question is: how much of that $70K did the patient end up paying?

    How much of it was paid for using Medisave? How much did the patient have to pay out of his own pocket? If he could not afford it, was Medifund used to pay for the remainder, or did he receive other forms of financial aid from the hospital, CDC, or other organisations?

    I don't think we can look at incomplete information from isolated cases and conclude that healthcare in Singapore is not affordable. We accept that there are cases where the bill becomes very high and patients cannot afford it, but then there is help in the form of Medifund and other financial assistant schemes.

    By Blogger angry doc, At April 21, 2007 5:54 pm  

  • My wife is currently pregnant. 25 weeks gestation at the moment.

    She had premature contractions.

    We went to KKH.

    Thoughts ran through my head about what would happen if our 25 week old baby were to be delivered.

    Mortality is high. Morbidity is high. A several month stay in Neonatal ICU would cost a lot of money if we were not in C class.

    These issues are real. Even for a doctor myself earning a comfortable income, a several hundred thousand dollar hospital bill followed by having to bring up a child with possible disabilities is a very sobering thought.

    Luckily for us, no premature delivery occurred.

    I hate to say this to you angry doc, but perhaps you need to have a loved one close to you be struck down with illness and then have the government tell you that you can't go to C class because you do not earn <$1000 a month and then later on be saddled with debt of several hundreds of thousands of dollars.

    I know someone has to pay for it. But I am still happier paying higher taxes so that all of us do not have to worry so much about the cost of saving our loved ones.

    To be frank at one stage I was thinking, it might be better if my soon to be born permature son die swiftly rather than for KKH's neonatologists try to save him.

    Certainly isn't a good thought but it did cross my mind. :(

    By Anonymous Anonymous, At April 22, 2007 9:49 pm  

  • Angry Dr & Anon,

    Means testing has no cap on what the person pays. Say after you go through means testing and they say you don't qualify for class 'C....your bill can be $5K or $200K. A person may be able to afford a $5K bill but $200K?

    It just does not make sense, that the means testing is suppose to determine what a person can afford without putting a cap on a final bill. Alot of people will fail the means testing and NOT be able to pay the final bill.

    The 'case study' I put forward, the parents were required to pay in full the $70K bill. After the Medisave(which is their own money anyawy) is emptied, they were put on an instalment scheme outsourced to a professional debt collector. They don't qualify for CDC, Medifund, or any other organisations.

    As for whether it should be 90%, 80%, 70%...etc, it boils down to affordability. Medical care is something people need especially those who end up in ICU. Should it be 80%? What happen if the bill is $1M, the middle income family is still ladden with debts of $200K...does it help them? In the USA, the medical care cost is horrendous but you can cover for almost everything by buying insurance. I'm saying lets look at all the cracks, that result in very heavy burdens for families and work out schemes - either govt pay all(95%) or insurance or ?. For that we have to establish certain 'maximum bills', either the govt absorb it or create an insurance for such cases.

    Nowadays $150K-$200K bills are not uncommon. I would like to buy an insurance that limits my liability to say $20K...and if there is no insurance possible, can the govt take care of it? ...Like for the loop hole involving babies with congenital effects.

    If the govt choose to do nothing, then don't go telling its citizens that health care is affordable. They should warn people of the cracks, the rising costs and possibilities of $100K bill so that people don't get shocked and at least prepare for these things.

    Congenital defect cases we are talking about 3%-5% of all babies where there is no insurance coverage. We cannot take comfort in that 95% chance that a baby is alright and let 5% of parents fall through the cracks. Singapore is not a poor country we spend $10.5B on defense alone every year and our govt has enough money to invest billions overseas. I find it unconscionable that they turn around and tell us, they have no money to help these babies.

    It is precisely these 'isolated' cases that demand the most attention. Since it is 'isolated' (not many) it is well within our means to do something about it. What good is a system if it tells you that you're 95% alright...we have the means to make it 100%.

    Thanks to anon@9:49 for sharing his experience. You'relucky not to have a pre-mature baby. Some parents are not so lucky, I've met one who chalked up $110K(class C!!) in medical bills as the child had to be in the incubator for 5 months and needed 2 corrective surgery. It is already painful enough for the parents to go through this without the financial burden.

    By Blogger Lucky Tan, At April 30, 2007 3:54 pm  

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