The issue of doctors charging twice the market price for drugs ("Guidelines on drug pricing needed" by Dr Gil Simon Schneider; Dec 21) is just the tip of the iceberg.

The mark-up at clinics here is nothing when compared with the mark-up in hospitals, particularly private hospitals.

In my letter ("Huge mark-ups for basic medication and supplies"; Aug 21, 2014), I gave examples of how the private Mount Elizabeth Orchard hospital charged almost five times what a specialist clinic did for some drugs, for example, the antibiotic augmentin.

In addition, the mark-up for common supplies such as safety pins and foam cups, both at close to $5 per piece, is easily 30 times that of the market price.

There may be some justification for some mark-up in the prices of drugs, which have an expiry date and have to be stored under certain conditions, and for which proper records have to be kept.

But there is no reason for the high mark-ups for non-perishable supplies such as safety pins and foam cups.

There were also suggestions last year on reducing drug costs, for example, by having the Government buy drugs on behalf of all patients and setting recommended prices within a range.

More than a year after the discussion, there seems to have been no change to the authorities' answer - that "private hospital charges do not fall under the Ministry of Health's purview" ("Private hospital charges not under MOH's purview" by the Ministry of Health; Aug 26, 2014).

There has been no report of anything done to address the high mark-up in the prices of drugs, particularly in a tertiary setting where the mark-up is easily in the double-digit multiples of retail prices, rather than just double in the case of clinics.

With the implementation of MediShield Life last month, I hope to see more concrete steps taken to address the cost issue to prevent an escalation of the premium amounts.

Charis Mun (Mrs)