Angry Doctor

Tuesday, February 21, 2006

Want it good, want it cheap

I started replying to Oz Bloke on the subject of this letter and decided I might as well just post a new entry altogether.

High prices for common drugs in HDB heartland

MY CHILD was sick, down with a bad cough, sore throat, runny nose and a slight fever on Feb 16. At 9pm, our family doctor had left so we went to another private clinic - 'Street 11 Clinic' at Block 139 Tampines Street 11.

After a brief consultation, she was given these medicines: cough syrup (one bottle, 'Dhasedyl, 90ml'); a packet of 'Danzen' (20 tablets, 5mg) for the throat; 'Telfast D' (10 tablets) for runny nose and antibiotics 'Klacid MR' (five 500mg tablets for throat and nose).

I was astonished when I received the bill. These medicines cost me $80. I am puzzled at the high cost because I believe that my daughter's symptoms were fairly common and she was treated by a locum.

I feel the clinic had either overcharged and jacked up the price of common drugs, or did it give me unnecessarily expensive drugs for a common illness?

I asked the receptionist for a breakdown of the cost of the various medicines. To my surprise, the staff informed me that the five antibiotic tablets alone cost $37.

I believe Health Minister Khaw Boon Wan had mentioned that affordable medicines be provided for patients at reasonable prices. Yet the clinic in our heartlands is charging drugs such as 'Klacid MR' at an exorbitant price. This is a worrying problem which I hope can be addressed to benefit the masses.

Gan Siok Wah (Mdm)

Not too bad as complaint letters go - the author sticks mainly to the point about drug costs, although she could not help casting doubt on the doctor's professionalism ('a locum'), or appealing to authority in her last paragraph.

I don't think it is my place to judge if the drugs were unnecessary (or unnecessarily expensive?) or 'jacked up' in price. Certainly it is a fair question.

What I am curious to know, however, is this: what do you think is the right price for your daughter's medical care when you were obviously worried enough by her illness that you took her to a private clinic at night instead of just giving her some OTC drugs and waiting till the next day (Feb 17 is not a Sunday) to go to a polyclinic?

Is $80 really unaffordable, or just an expense one would rather not incur?

(People complain about the cost of healthcare, yet for the vast majority of working adults and children, a year's healthcare expenditure would not exceed the cost of that year-end trip to Australia or Korea?)

While I agree with the idea of clinics not dispensing drugs, I think the patients too may need to consider a paradigm change and start to look at sick expenses as part of their necessary budget and not an unexpected loss.



  • We should be like restaurant and if our customers can't afford it, they can go elsewhere.
    This is good for our customers but bad for our business.

    Publishing our charges and sticking to it is what GP should do and ig GP are jacking up prices for medicines, it simply means that consultation fees are inadequate.

    After reading about other healthcare system, I come out with the following solution.

    1. raise GP consultation fees to a suitable one and allow pharmacy to sell medicine instead.

    Problem: may raise healthcost but pressure is on drug company and pharmacy not on the poor GP whose rent is killing him. 15k a month is ridiculous

    2. govt subsidise GP as they are selling a common good

    Problem: lawyer are selling a common good too, people will complain about preferential tx to GP which could work in the past when doctors were respected

    3. have a national organisation that provide medical equipment and drugs to GP

    Problem: drug companies profit drop
    lots of admin staff but cheaper heathcosts

    Futute Medical Administrator

    By Anonymous Anonymous, At February 22, 2006 12:19 am  

  • or provide an alternative to the patients : choice of ethical drugs at high price or generic drugs at lower price.

    some GP clinics in malaysia do that. u want branded drugs (aka designer labels) then one must be prepared to pay. if the patient is worried about overcharging then ask for a prescription then get the drugs at the pharmacy.

    By Anonymous Anonymous, At February 22, 2006 9:04 am  

  • One of my medical school classmates said this when we were final year medical students.

    He said he went to see his family doctor and came away with a bill for $20.

    If he remembered correctly, when he was a small boy of 8, the bill for seeing the doctor with meds was $20. There he was a man of 22 and the bill after seeing the dr with meds was STILL $20. So after 14 years the price of seeing a doctor was the same!

    I think that's what the public wants. They want the price of healthcare to remain stagnant. They want better medicines. Newer drugs. More medicine. Better doctors. But they want to pay the same as it was in the 80s.

    I read about how some people were saying why GPs don't give Tamiflu!

    How much is a course of Tamiflu? Haha

    By Blogger Dr Oz bloke, At February 22, 2006 9:14 am  

  • wah, reply from a soon-to-be HO. good that you're aware of the social issues surrounding healthcare.

    to come back to the point of private healthcare costs.

    i think, unlike luxury goods, most people treat cheap (and good) healthcare as a birthright. think of it this way: nobody bats an eyelid queueing 3 hours for bak kwa during chinese new year while a 1 hour wait for consultation at a GP's clinic is not acceptable. Again, spending $200 for bak kwa is acceptable to some while anything over $50 for a simple-case consult + meds is deemed expensive.

    so how? cough + colds = get OTC drugs from Guardian Pharmacy? Cost of decongestant nasal spray + paracetamol < $80

    i really don't know. should GP charges be capped? who pays the dear doctor's rent then?

    By Blogger andrew, At February 22, 2006 9:16 am  

  • wa the customer must appear quite rich hahah.

    Actually $80 is quite expensive for a simple cold and flu unless the situation warrants the prescription of klacid. I doubt most doctor will prescribe klacid the first time. Of course there are many unknowns in that simple presention in the news. eg how severe is the patients condition, Drug allergy etc. The retail price from pharmacy would probably cost about$50 plus sixty plus consultation it is probably around 70 something to 80 dollars.

    The question really is the choice of drug. I find it funny for him to prescribe telfast and klacid. :) Just a personal opinion and of course there are many variable I don't know.

    Of course there are the sale rep who load the doctors with their medicine. It is hard for docs not to try to clear them :)

    Doc usually wouldn't write prescription unless they don't have the drug.

    By Anonymous Anonymous, At February 22, 2006 2:54 pm  

  • Yeah you said it right. Telfast D? Klacid MR?

    Man these are pretty expensive drugs!

    So little wonder why the bill was $80.

    I wonder whether the mother objected ot receiving Fedac and generic Clarithromycin instead? Or it's just that the clinic uses those high powered non-generics on a regular basis?

    By Blogger Dr Oz bloke, At February 22, 2006 3:53 pm  

  • I had blogged about this matter too and one of my readers drew my attention to your post. Drop by, if you're interested.

    By Blogger Gilbert Koh aka Mr Wang, At February 22, 2006 6:10 pm  

  • "Is $80 really unaffordable, or just an expense one would rather not incur?"

    It is not a question of being unaffordable. I believe it is a perceived overcharging that prompted that lady to write to the press. For example if I buy an apple at $1 usually and then I went to another place and bought a similiar apple and this time it cost $8. They send me the bill after I ate the apple which I assumed would be around $1. I would naturally be quite puzzled how can the dicrepancy be that great. It is not a matter of whether I put aside money for healthy fruits in my diet, but is the price justified.

    By Anonymous Anonymous, At February 22, 2006 11:29 pm  

  • One thing which you can't get from the pharmacies without prescription is the antibiotic. Thing is, though $80 might appear too steep a price to pay but in my perception at least, that's the price of private GPs in singapore generally. GEneric medications are overpriced and consultation fees are jacked up too. As for those rather common medications, frankly speaking, the patient wouldn't have any slightest inclination that she need to get that for her child. It was only after the doctor's diagnosis then she realised that she's been 'overcharged' as she could have gotten them easily from the pharmacies.

    Maybe she should opt for self medication in the future, or at least on a temporary basis and visit the polyclinics on the next day. I dun think this is a problem that can be 'resolved' anywhere in the near future. LEt's face it, it's costly to visit a private GP in our currently settings. but in the course of being irked by that fact, we gotta admit that we too, have cheaper alternatives.

    in a way, those private GPs have to earn too.

    By Anonymous Anonymous, At February 23, 2006 2:43 am  

  • In all this fiasco, has anyone thought that perhaps the doctor did not communicate, in the truest meaning of the word, to the patient's parent, the necessity of the expensive drug in treating her child. Perhaps if he had, the mother would have accepted the cost as well as the need for the Klacid.

    Very often, we hear of patients complaining about how dour and uncommunicative their doctor is. I agree. Not everyone is like Dr. OZ, oozing with enthusiasm for his job. But having said that, most of the docs. I have dealings with are very chatty with me. Probably, I think it's a two way traffic. Some patients can be very uncommunicative too!

    I wonder whether "communications with patients" is part of the medical student's curriculum.

    By Blogger uglybaldie, At February 23, 2006 7:55 am  

  • "It is not a question of being unaffordable."

    Actually, you are right - it's not about it being unaffordable. But then neither is it about overcharging.

    She only questioned the fees after finding out it was $80, and really her complaint was that it cost her $80 - whether it was due to marking up or just the 'true' cost of the drug was irrelevant to her. She wanted 'affordable medicines... at reasonable prices'.

    I wonder if 3-cent tablets marked up to $12 would be acceptable to her. Maybe she wouldn't even have asked for a bill-breakdown then?

    By Blogger angry doc, At February 23, 2006 8:32 am  

  • "I wonder if 3-cent tablets marked up to $12 would be acceptable to her. Maybe she wouldn't even have asked for a bill-breakdown then?"

    Ah! That's one of the options I put up at my blog.

    Has anyone seen those Special Japanese God-Knows-How-They-Grow-Them type apples and fruits at Isetan Shaw Centre? If I remember an Apple cost about $80-$100!!!!!

    Now they look really nice apples, but undeniably apples. If I served it to you cut, you would think they are just apples too. Then comes the bill.

    The point here is that Klacid MR is NOT I repeat NOT NOT NOT NOT a usual antibiotic that you get prescribed at most clinics in Singapore most of the time!!!!

    I'm just thinking whether Mdm Gan has been used to getting Klacid MR at all? If so then there's something wrong with the way her usual GP practices in the first place.

    It's like saying I eat those super-grown Japan Apples all the time and they cost me $1 but when I went to Isetan it cost me $80!

    Get the idea everyone?

    Next time when you go visit your doctor, try asking for Klacid MR and Telfast D and see what the bill is going to be. I can almost guarantee you that it won't be $20. If it is, please tell me which clinic it is, I want to buy stock of Klacid MR from him (assuming it isn't counterfeit of course)

    By Blogger Dr Oz bloke, At February 23, 2006 9:14 am  

  • I have posted a comprehensive blog entry about flu and cold and antibiotics over at my blog.

    I'm quite sure it will enlighten the general public in Singapore out there.

    By Blogger Dr Oz bloke, At February 23, 2006 10:16 am  

  • I wanted to send you this via email but I couldn't find it. Anyways,

    See this

    By Anonymous Anonymous, At February 23, 2006 5:15 pm  

  • An unpublished letter to strait times

    Doctors at fault? That's not always the case

    CUSTOMER service is a two-way traffic. I refer to a clinic in Holland Road's vicinity which closes at midnight. Apparently, late patients were turned away and they complained.

    Put yourself in the clinic assistants' shoes. If the patients come at the last minute and each patient takes 15-20 minutes from registration to dispensing and issuing receipts, the clinic's staff and doctor will go home very late every day. It is not as if patients suddenly became sick at midnight. More often, it's because Singaporeans like to put off doing things until the last minute.

    One reader complained that her father was turned away at a clinic in Serangoon because its rules stipulate that only regular patients, and no new patients unless brought in by a regular, will be attended to on holidays.

    From the clinic's view, opening the clinic on public holidays is a service to loyal patients of the doctor. They are loath to accept patients who see their competitor doctors but take advantage of their clinic's services only when their regular clinics are closed.

    Another reader complained she was charged $80 for simple flu medicine. The doctor had prescribed Klacid MR, which is very expensive.

    The patient can always tell the clinic that he cannot afford such branded, expensive medicine. A face-saving way is to pay the consultation fee and ask for a prescription to buy the drugs at a pharmacy instead.

    There are doctors who charge a premium for using branded, expensive drugs and not generics, so the mark-up and consultation fees go up stratospherically.

    The message is: If you want good, strong medicine to cure you at one go without having to go back two or three times to the doctor, be prepared to pay for premium drugs.

    The range of fees for simple flu medicines can be from $17 in a common HDB clinic to $80 in 'high-class' GP outfits. It always pays to ask first. It's like this: You can have your hair cut at $8 by the neighbourhood's Indian barber or pay $100 at a high brow hair saloon.

    Lim Boon Hee

    By Anonymous Anonymous, At February 24, 2006 10:50 am  

  • we should follow French system example... medicine is reimbursed by the government there, therefore it is in the interest of authorities to promote generic drugs and fight acquaintances between doctors and laboratories (people generally ignore how shameful is the laboratories lobbying at this point)

    By Anonymous Anonymous, At March 16, 2008 6:31 pm  

  • I just had a similar encounter. I am going to file a complaint to Singapore Medical Council against the doctor. The total bill I've got for a flu/common cold is $90.90!

    By Anonymous Anonymous, At January 04, 2011 10:30 pm  

  • I just brought my boy to a gp in a hdb for a mild cough in the morning...short consultation like less than 10mins and only prescribed fedac...bill $45! Consultation fees range stated $20-$50. For such a short and simple consultation and a common drug I too felt I'm overcharged. Another reason why I felt so was previously my boy was given fedac & chlormine for flu by another hdb gp but the bill was only $30+. Do I have a stand to lodge a complain? Not that I want to get back any money but I hope to highlight undesirable overcharging practices.

    By Blogger Unknown, At July 02, 2015 3:31 pm  

  • Today i go to tekka clinic get bill 70 dollar.some medicine cost very too much...15 days before i go to shifa clinic the medicine ..each 1dollar..but tekka clinic each 3 dollar ..i said i don't want the medicine give back money ..he say can't ..i do what?

    By Anonymous Anonymous, At December 06, 2015 11:25 pm  

  • MR Klacid now costs - 7.90 And the doctor gave the maximum course of 14 days for a simple ear infection. I too was shocked when I saw the amount $110/- only for one medicine. Live healthy or just die. Should never fall sick..

    By Blogger S R Sai, At March 09, 2016 10:01 pm  

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