The issue, which has generated spirited exchanges between the medical fraternity and the Competition Commission of Singapore (CCS), may finally be settled in a matter of months.

The commission is expected to embark next month on a six-month study of the matter.

A CCS spokesman told The Straits Times that it had decided to look at how the medical sector is structured and its practices here and in other countries, following the 'public interest' generated over the fee guideline issue.

In April 2007, under advice from its lawyers, the Singapore Medical Association (SMA) had scrapped its fee guidelines for fear that the commission would deem them anti-competitive price-fixing.

This was shortly after the Competition Act came into effect in 2006 to prohibit practices which prevent, restrict or distort competition.

But the association still feels doctors should be exempt from such rules, saying it is unrealistic to expect patients to shop around and compare prices.

There are statutory bodies which are exempt, such as the Law Society, which is allowed to keep its recommended charges for conveyancing work by lawyers.

In contrast, the Institute of Estate Agents was told to remove its recommendations on commissions for property transactions last year.

The SMA guidelines recommended fees for consultation, doctor's charges for different procedures, and other items such as medical reports.

Since the scrapping of the guidelines, private doctors have been free to set their own rates, but they must let their patients know how much they are charging before treating them. They must also give patients an itemised bill.

A survey carried out by the SMA last year on fees charged by 78 specialists showed only a minimal increase in some of the charges since the guidelines were removed.

Although the CCS has not taken any official position on fee guidelines for doctors, commission officials had said in the past that such guidelines, even if not mandatory, could become a signal to market players and result in prices clustered around a narrow range.

The SMA, on the other hand, has argued that fee guidelines actually help patients to make informed choices.

In the early 1980s, the Ministry of Health, the SMA and the Association of Private Medical Practitioners of Singapore agreed on the need to publish a fee schedule to give patients greater transparency.

Some doctors have even argued that medical fees cannot be determined by free market forces and the removal of guidelines has led to overcharging and eroded the competitiveness of the private specialist sector.

A check with the Consumers Association of Singapore found that complaints against doctors and dentists regarding overcharging and fee-related disputes averaged 30 cases annually in the last five years.

There were 26 cases in 2007. Last year, there were 45.

Fee guidelines are followed in some countries such as the United Kingdom and Malaysia.

Private hospitals in Malaysia have to set prices according to a schedule of fees, failing which they face severe fines and penalties.

Madam Halimah Yacob, who chairs the Government Parliamentary Committee for Health, said guidelines could be useful in signalling to patients if they have been charged exorbitantly.

She added that regular surveys can be done on the fees for medical services, to determine the necessity of keeping the guidelines.

Also in favour of the guidelines was health economist Phua Kai Hong from the Lee Kuan Yew School of Public Policy. He said that it provided a visible range for bottom-end and top-end prices.

Doctors do not have to stick to one price and hence there is no price-fixing involved.

'Fee guidelines provide a moral restraint and patients are able to check the fees they have to pay,' he said.

'Otherwise there might be some unethical doctors who do a wallet biopsy and size the patients up and charge accordingly.'

jessicaj@sph.com.sg