Ultimately, medical insurance is desirable. But the devil is in the details of its implementation.

It is true that limits set by insurers tie doctors' and patients' hands ("Limits set by insurers tie doctors', patients' hands" by Dr Chong Jin Long; last Friday).

Insurers offering a total package to whole companies for complete coverage of all conditions do offer inadequate and below-market compensation to doctors.

For example, insurers can offer $20 for a general practitioner consultation, including medicine, before taking a further cut of $2 for their administrative trouble.

At these rates, medical care is at its bare basic, which is unsatisfactory to all parties, except the insurer.

Even then, insurers sometimes pay up to six months after being billed.

On the other hand, it is indubitable that some doctors will charge maximally for patients who have full private medical insurance, since the fees are already covered.

Well-meaning listings of operation fees, medications or operations, and random audits just won't do.

Anti-competitive or not, the medical profession needs stringent, enforceable and reasonable caps on all procedures and consultations, or else prices will run riot.

Doctors must be recognised for what they are - highly trained professionals offering an essential service, and deserving of a fair fee.

The Community Health Assist Scheme and Pioneer Generation subsidies for the needy and the elderly strike the balance well.

Fair remuneration caps, mandatory co-payments and stringent enforcement are good steps, going forward.

Even when no one seems to pay, ultimately, all Singaporeans in the insurance pool do.

Yik Keng Yeong (Dr)