Angry Doctor

Tuesday, April 03, 2007

How much is that doctor in the window? 2

This little piece of news nearly escaped angry doc's notice:

Singapore Medical Association withdraws guidelines on fees

SINGAPORE : Doctors now have more flexibility to adjust their fees, following a decision by the Singapore Medical Association (SMA) to withdraw its guidelines on fees, as of 1 April.

In a letter to its members on Monday, the SMA said it had been advised by its legal advisors that its fee guidelines contravened the competition act (Sect 34(2) (a) of the Competition Act).

But the SMA has also urged its members not to vary pricing drastically.

This is so that there will not be unnecessary increases in healthcare costs.

The SMA added that charges levied by doctors should be "appropriate and within reasonable limits".

The Association also highlighted that under the "Private Hospitals and Medical Clinics Act and Regulations", doctors would have to advise their patients, before consultation, on charges that were likely to be incurred for consultation, investigation and treatment.

SMA will be conducting a survey later this year to find out the prices of the various charges in primary care clinics.

In and of itself the withdrawal of the guidelines probably isn't a significant event; they are but guidelines and angry doc is not even sure to what extent they are followed by individual clinics and groups.

In fact, since they are not legally binding on any doctor, angry doc has never even thought of them as being a form of 'price-fixing'.

But the law apparently takes a different view.

This article on the Competition Law on the Singapore Academy of Law site specifically states that:

"27.1.6 The term ‘undertaking’ includes professionals such as self-employed lawyers and doctors."


"27.2.4 The term ‘agreement’ in section 34 does not require a formal contract. An informal understanding between parties may constitute an agreement, even though its terms have not been formally set down in a signed document. Likewise, a gentleman’s agreement that has not been signed by the parties and which amounts to a ‘faithful expression of the joint intention of the parties’ can qualify as an agreement for the purposes of section 34."

What more a table issued by the Singapore Medical Association? Little wonder then that the SMA decided to withdraw the guidelines.

Will consultation fees rise or fall after this? Frankly, angry doc has no idea.

However, it does seem that the SMA saw the guidelines as a standard for doctors to agree on to stop them from undercutting each other and prevent them from being divided and conquered by Managed Care Organisations. Now that this is withdrawn, will the fate of local doctors be follow that of those in the US prosecuted by the Federal Trade Commission?

We practise in interesting times...

Added: Dr Huang gives his view on this topic and what it may mean to patients.



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