When doctors' charges cause heartburn

One comment heard in the energetic debate over doctors' excessive charges was that only a small number indulged in the objectionable habit. Whatever the true scale, such conduct contributes to medical fee inflation, as fair-minded doctors have pointed out, to the credit of their profession. Rising health-care costs are common in all of the developed world - the United States is the outlier. Rents, malpractice insurance, diagnostic equipment and improvements in surgery and drug therapy are driving up costs everywhere. Also complicit are the demands of patients, especially those who are endowed with generous medical benefits.

Health-care providers may place a premium on skill but should not gouge. It is unethical if fees are based not on intrinsic worth of the service provided but on what the market can bear. The Singapore regulatory authorities' function is to not only police professional ethics but also help the public make cost-benefit evaluations so medical technology is not used as an excuse to scalp patients.

If overcharging is anywhere near rampant in private hospitals and among specialists in hot disciplines, the Health Ministry would be expected to intervene as a prerogative in promoting patient welfare and to ensure Singapore does not price itself out in the competitive field of medical tourism. Europeans are seeking elective treatments and health screening in India, Thailand and South Korea. Why not Singapore? Wealthy Persian Gulf countries that pay fully or partially for citizens' cancer treatment abroad have a choice of countries now.

It is important to ensure the free-market ethos in health care is not manipulated such that the Government's compact with the people on affordable health care is betrayed. Holes will otherwise be blown in the national health insurance scheme and system of subsidies in public hospitals and private clinics.

Two acts should be undertaken without delay. The more urgent is a review of the use of doctors' fee guidelines to act as a regulatory brake on arbitrary charging. These had once been ruled in breach of the competition code but circumstances have changed. Doctors who weighed in on the matter are in favour of fresh guidelines as a reference point, like the published price comparisons on surgical procedures performed in hospitals.

Next, hospitals' charging protocols for facilities, medicines and consumables should be made more transparent to prevent ruinous runaway inflation. The Health Ministry's move yesterday to publish data on how much operations cost in public hospitals is another welcome step in this direction. Free enterprise in health services differs from goods commerce in that patients leave matters of efficacy and fair recompense to the judgment of the service provider. The implied trust should not be abused.