How much is that doctor in the window? 5

Another article and a letter on the withdrawal of the SMA guidelines of fees in Today today.


How much to see the doc?
Survey results on GP fees to be released within a year but patients face info void now
Tan Hui Leng

WHILE it has withdrawn its fee guideline for doctors' services, the Singapore Medical Association (SMA) will soon release information that should give patients an idea of average charges at General Practitioner (GP) clinics.

The results of the association's survey on primary care clinics, conducted last year, are being analysed and details will be published on the SMA website within a year. The association will also conduct a similar survey among medical specialists this year.

The announcement, made by the SMA at a press conference yesterday to explain the sudden and controversial withdrawal of its Guideline on Fees on Sunday, follows the move by the Ministry of Health (MOH) to publish GP fee schedules online by year's end.

With the withdrawal, the SMA will no longer handle the public's complaints — it receives more than 20 a year — about being overcharged by doctors.

But it is open to exploring a new feedback channel for consumers, in collaboration with the MOH and the Consumers' Association of Singapore — if doing so does not compromise the association's legal position, said SMA president, Dr Wong Chiang Yin.

The SMA move came after extensive discussion with lawyers and the authorities over how the guideline could be viewed as a form of price-fixing, in contravention of the year-old Competition Act.

On talk that doctors had agreed to strike the fee guide so as to mark up their salaries, Dr Wong said: "That is sad because we are doing this with deep regret, great reluctance ... this is 20 years of work by my predecessors, and we are just putting it away? But we don't really have a choice."
First published in 1987 to make private medical charges transparent, the fee guideline has kept price hikes for common procedures, such as basic chest X-rays, to between 10 and 60 per cent — quite a "modest" figure, noted Dr Wong.

But four of the association's five law consultants had believed it to be in breach of competition law. Confirming this with the Competition Commission of Singapore would have cost the non-profit SMA, which had a turnover of $1 million and an operating surplus of $15,000 last year, more than it could afford. Earlier, Dr Wong had told Today the bill could have added up to $200,000, including legal fees.

Clarifying its fees yesterday, the Commission said parties requesting its guidance need only pay an initial fee of $3,000, without incurring legal fees, plus an additional $20,000 for more complex cases. Fees for an actual verdict range from $5,000 to $45,000.

Doctors have been told to remove the SMA fee guideline card from their clinics but are required to display their own pricing information under the Private Hospital and Medical Clinics Act.

The association has also advised its members to set "reasonable" consultation fees. The concern now, said SMA spokesman Dr Tan Sze Wee, is the lack of information for patients. "If you have an urgent need to see a doctor ... you wouldn't have time to call up five GPs to ask for the best quote," Dr Tan said.


If the system is not sick ...
Why withdraw doctors' fee guidelines when healthcare sector is clearly competitive?
Letter from Chua Soo Kiat

I am deeply perplexed by the Singapore Medical Association's (SMA) move to withdraw the guideline of fees for private doctors and their apparent lack of consultation with our Health Ministry, for it seems our Health Minister was equally surprised.

The fee guidelines seemed to have served Singapore pretty well. There have been no statistical data, survey results or any reports to suggest that our current private medical cost structure is uncompetitive, either too high for the average Singaporean or too low for our doctors and specialists to make a decent profit.

The only compelling reason given by the SMA president, Mr Wong Chiang Yin, was that they had "no choice" because SMA may not comply with the Competition Act.

Buying into this logic is very difficult. The SMA seemed to have taken an approach too narrow and inflexible when complying with the Competition Act.

First, as with any other law, compliance with the Competition Act should not take into account just the legal words, but more importantly, the spirit and the intent of the law. A holistic view is needed and public interests have to be carefully weighed given the wide-ranging ramifications.

The first duty spelt out in the Competition Act's Section (6)(1)(a) is to "maintain and enhance efficient market conduct and promote overall productivity, innovation and competitiveness of markets in Singapore".

Singapore has one of the world's most acclaimed healthcare industries, a result of the collective effort by both public and private practitioners. We are on track within the next decade to be an important medical hub attracting thousands of medical tourists from all over the world.

Thus, it is not an overstatement to say that our current medical industry is productive, innovate and competitive by any international benchmark.

Second, when in doubt as to compliance with the Competition Act, the SMA should have sought conclusive legal advice.

It was reported that the total cost incurred may run up to $200,000 and the SMA felt that it was excessive. (Editor's note: The Competition Commission has since clarified that the fees are not of this amount. See page 3.)

How can an association with well paid professionals not be able to fork out $200,000 when making such an important decision? I find this hard to stomach.

Third, besides seeking conclusive legal advice, the SMA should also have approached the relevant Ministry to clarify its doubts.

The Section (8) of the Competition Act explicitly states that "The Minister may give such general directions, not inconsistent with the provisions of this Act, relating to the policy the Commission is to observe in the exercise of its powers, the performance of its functions and the discharge of its duties as the Minister considers necessary, and the Commission shall give effect to any such directions."

To sum it up nicely, our Minister does have the final say.

The SMA should have at least notified our Health Minister rather than surprised him through the public medium.

This sudden move does not appear to be well thought through and I hope both the SMA and the Health Ministry can give more insights into this. There is really no conclusive justification to make a radical change now.

We have done well in recent years containing the rise of medical costs. Let's not shift into a reverse gear.


Mr Chua echoes angry doc's sentiments that SMA might have acted unwisely on this issue. Now that the cost of obtaining a decision from the Competition Commission has been clarified to be lower than the $200,000 expected, perhaps SMA will seek a ruling and review its decision.