How much is that doctor in the window? 8

A very pertinent question was raised in the ST Forum today:


How to decide if doc is overcharging?

THE Competition Commission of Singapore's (CCS) response to the recent withdrawal of the Singapore Medical Association's (SMA) guidelines on fees deserves more discussion.

CCS announced that it will work closely with the Consumers Association of Singapore (Case) to handle any complaints of overcharging by doctors.

This is good but it opens up two questions.

The first is will there be a charge levied?

The SMA never levied any charge on members of the public who filed complaints against doctors. But a visit to the Case website reveals that a complainant usually has to join Case as a member. Membership carries an annual subscription of $25 and filing a complaint incurs an administrative charge of $10.

The second question is more fundamental. How will CCS and Case decide on what constitutes overcharging?

The term 'overcharging' carries with it the notion of relativity. Overcharging can exist only if there is an understanding of what is 'normal charging'.

But without benchmarks and guidelines, it is practically impossible to define overcharging. Are CCS and Case going to draw up their own guidelines on what are acceptable and normal prices?

How will CCS and Case decide a doctor is not merely 'expensive' but has transgressed to the point of 'overcharging'?

Do they have the expertise or domain knowledge to know the intricacies and complexities of pricing in the whole spectrum of health care?

And will CCS and Case likewise step up to the plate to handle overcharging complaints when other professional groups withdraw their equivalents of price or fee guidelines?

These are questions that need to be answered clearly and soon.

Christine Chen Siew Mei (Ms)


How indeed.

As angry doc has mentioned in a comment in a previous post, overcharging is not against medical ethics per se. Neither the Hippocratic Oath nor the SMC Ethical Code forbids overcharging.

As long as the fee is agreed upon, and it is not an emergency situation, there really isn't a definition for overcharging. Doctors charge, and are paid, what 'the market will bear'.

One can perhaps stipulate a 'normal price' for a particular treatment or procedure by a particular grade of doctor, but it will not reflect the reality of the private healthcare sector, where sought-after specialists command a premium and still have a steady flow of patients.

On the other hand, having a fixed or 'normal' price for particular treatment or procedures may result in over-servicing, where a doctor recommends and performs treatment, investigations and procedures which are not strictly necessary or beneficial to the patient. But then again, this is already the reality in healthcare systems where physicians are reimbursed for services and procedures rather than result or outcomes.

Of course, one may also over-service and overcharge patients.

Like Ms Chen, angry doc is not yet convinced that CCS or CASE have the required knowledge or experience to tell when a patient has been overcharged or over-serviced.

angry doc is not even sure doctors can be sure all the time, but if he had to be hauled up for allegations of overcharging a patient, he would rather be facing people who knew what treating a patient entailed.