Need to reinstate fee guidelines

Rising healthcare costs can be attributed to the absence of concrete fee guidelines from the Singapore Medical Association and high charges from private hospitals (Two quick fixes to rein in healthcare costs; April 13).

Since the removal of fee guidelines in 2007, there has been a meteoric increase in healthcare costs. Rising overheads alone cannot account for this. The vast resources available to insurers give considerable leeway for medical practitioners to raise prices.

In this respect, I am sceptical of the reasoning behind private-sector specialists' fees given by Dr Ernest Wang (Quick fixes don't solve underlying problems in healthcare costs; April 18).

Even though their cost base does include several additional factors, compared with that of doctors in public hospitals, the disparity in pricing is incredible.

A private specialist may charge six times as much as a public hospital for a surgical procedure, such as a balloon angioplasty. No one can seriously claim that the quality of care that the patient receives is somehow several times better.

Above all, the "invisible hand of the market", the main determinant of fair pricing, is conspicuously absent, since patients are not directly voting with their wallets - costs are covered by insurers, which operate on a vastly different calculus and lack immediate negotiating power.

The most fundamental solution would be to reinstate fee guidelines, with prices based on a professional and dispassionate estimation of costs. This will help to correct any imbalance brought about by the insurance factor, and thus remove the main drawback to comprehensive coverage.

Paul Chan Poh Hoi

A version of this article appeared in the print edition of The Sunday Times on April 23, 2017, with the headline 'Need to reinstate fee guidelines'. Print Edition | Subscribe