Angry Doctor

Wednesday, April 04, 2007

How much is that doctor in the window? 4

Dr Oz Bloke tells us more about the SMA guidelines, and aliendoc gives us her view on what its withdrawal may mean to patients.



  • I support the release from the guidelines as doctors should be given more autonomy to the fees they charge <--- after all they are ethically bounded by the prices they set right?

    It's odd that the general public want their children to become doctors and lawyers when they try to bargain the price down for the services rendered. But then, when they enter a Tung Luk restaurant or any fancy restaurant, they quietly fork out money for the meal without any word - lidat hor, why not all the kids become restauranteurs?

    Another potential problem is doctor hopping - fees for various procedures may vary - imagine if you go to see one doctor for regular consultation and was prescribed warfarin and you decide to undergo day surgery in another clinic because it is cheaper - the patient may end up in a hospital with a higher bill. There is a need to stick to the same doctor (unless he/she is seriously not suited for the patient) in order to keep everything in view and in check

    Fees to services rendered by healthcare professionals always seem to be more of a hassle than a sign of blessing that they are being treat for a medical condition.

    So far, the local pharmacists in community practice are not charging fees for dispensing and consultation yet - but I think if that happens suddenly, public uproar is imminent.

    Just want to seek a working doc's opinion - one of my medical friends who hails from Germany, made this comment, "The oath of Hippocrates has become, in time, hippocritical." Comment <-- sounds very GP essay.

    By Blogger OJ - Da UNlicensed Pharmacist, At April 05, 2007 7:51 am  

  • Hi oj, just to clarify something. Even with the guidelines in place, doctors WERE given autonomy to charge what they wanted.

    Which is why you have clinics that charge $8 (inclusive of medicines and consultation) out there.

    As far as GPs are concerned, most of the overcharging claims had nothing to do with overcharging on consultation fees. Propietary medicines cost a lot. This is set by the pharmaceutical companies.

    Clinics that dispensed propietary medicines for the patients instead of cheap generics were accused of fleecing them. I remember angry doc had blogged about a situation where a clinic that was named in the ST Forums had done something like that and the patient cried foul.

    So what does this tell you? Singaporeans are ignorant and stingy when it comes to healthcare. (I had an interesting discussion with my TCM professor who also agreed on this point even from a TCM practice point of view)

    Singaporeans want everything cheap cheap and good. Propietary drugs are high priced. This is decided by the pharmaceutical companies and has nothing to do with doctors. On the other hand if the doctor uses generics to keep bills low, then he is accused of using inferior medicines.

    Frankly I think Singaporeans can be rather unrealistic. Already a $10 consult with the GP is far lower than the charges you get in other first world countries. I wonder if aliendoc can share with us what GP consult fees are like in China.

    By Blogger Dr Oz bloke, At April 05, 2007 10:01 am  

  • This may come as a surprise to some, but overcharging is not against medical ethics per se.

    Check the SMC Ethical Code and the Hippocratic Oath - neither prohibits overcharging.

    As long as the fee is agreeable to both parties, and it is not an emergency situation, there really is no definition for overcharging here.

    By Blogger angry doc, At April 05, 2007 12:41 pm  

  • It's always the black sheep that always stand out from the crowd. you just need 1 to contaminate a white sheet. I've nothing against docs as I've to work with you guys to make patients heal faster and their health better. I'm more concerned with the patients.

    Prices by drug companies are usually Recommended very much like the recommendations of consultation fees. Healthcare professions and institutions have the autonomy to vary the prices.

    The pricing is not rigid.

    Not many GPs I know dispenses brand/proprietary meds. Most of them will dispense bioequivalent generics. These are mainly for the acute diseases and their prices are not available in the case website.

    However, for chronic diseases and some brand medications, the prices are now more transparent. And more often than not, it is the private specialist clinics that dispense (newer) branded meds as the patent is still valid.

    Refer to:

    Even the prices of the branded meds vary - evidence of autonomy in price determination.

    It is also interesting that a recent survey show that the average drug spending per capita here is about only 10% of total healthcare cost.

    By Blogger OJ - Da UNlicensed Pharmacist, At April 05, 2007 2:48 pm  

  • All I can say is that in a GP clinic consult charges usually account for about 30% of the bill total.

    You can work it out. Most GPs would charge from $5-$15 for consultation.

    What's the bill size with propietary medicines? Usually at least $30-$40.

    Of course the doctor profits from the drug sales but that's also because patients are very very adamant that they do not wish to pay anything more for consultation.

    Hence my assertion that GPs make a living mostly by being drug retailers rather than being paid for their professional work. (this is not by their own choice but how the public choose would be willing to pay more for medicines and zero for consult)

    Market forces at work.

    By Blogger Dr Oz bloke, At April 05, 2007 4:40 pm  

  • I'm afraid I haven't had much experience with the local GPs here in China yet (touch wood!) But I do know that a consultation with a GP for your run of the mill URTI at a hospital catering to foreigners can be very costly. Including medication, it could cost as much as US$75 (from hearsay, no personal experience) if you don't have medical insurance.
    Bottomline is, medical care is NOT CHEAP. Someone has to pay for good quality care. WHO that someone is, is probably the main issue with Singaporeans :).

    By Blogger aliendoc, At April 06, 2007 12:50 pm  

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