As long as healthcare is a business and private hospitals are run by publicly listed companies that are responsible to shareholders, charges will continue to rise ("Keeping a lid on healthcare costs"; Tuesday).

Private hospitals offer referral fees or rebates which may encourage some doctors to carry out unnecessary laboratory and radiology tests to generate income.

Private medical groups also charge high prices for specialists to rent clinics in their medical centres and to use operating theatres and other facilities.

These costs are inevitably passed on to patients.

Since the Ministry of Health (MOH) has stated that private hospital charges are not under its purview, these facilities have a free hand to determine prices for both medicine and supplies.

A routine check on in-patient bills will show that hospital fees amount to anywhere between 50 per cent and 80 per cent of the total charges. The pharmacy category alone may consist of 40 per cent of the bill.

The mark-up on medication, laboratory and imaging tests, as well as consumables (items such as tissue paper and diapers) can be as much as 200 per cent.

Patients must insist on a detailed bill upon discharge, and scrutinise it carefully; hidden charges are routinely embedded, or patients may be charged multiple times for the same service under "ward fees", "nursing fees" and "miscellaneous fees".

But when patients ask about items in the bill, cashiers are often reluctant to check or explain these in detail.

It is hard to define overcharging in the absence of fee guidelines. Is it any wonder, then, that private hospital bills have doubled over the past 10 to 20 years?

The MOH must intervene sooner rather than later to protect the welfare of patients, as well as Singapore's reputation as a medical tourism destination ("More transparent fees 'a positive step'"; Oct 6, and "Medical tourism ambitions under threat"; Monday).

Many foreign patients have voted with their feet, and more Singaporeans are following suit by seeking cheaper treatment in Malaysia, Thailand and India.

Perhaps the heightened competition will bring prices in Singapore down in the medium to long term.

Edmund Khoo Kim Hock