Forum: How rising healthcare costs can be dampened

As a health professional in the private sector, I read with interest Mr Wong Boon Hong's letter on rising healthcare costs (Focus on root cause of rising healthcare costs; Oct 3).

Mr Wong mentioned three possible issues for the authorities to address: defensive medicine, abuse of hospitalisation and mark-up of medical bills.

With respect to the issue of defensive medicine, patients and members of the public need to understand that modern medicine employs a probabilistic approach, not absolutes. Frequently, diagnoses are not immediately known at the first consultation. Doctors need to integrate information from the patient's history, clinical findings, test results and investigations to form a coherent picture of the diagnosis and formulate a treatment plan. This often takes time.

The first, often preliminary, tests cover a wide range of possible diagnoses, which are narrowed down sequentially as common conditions are excluded. Less common causes of a patient's symptoms and signs require additional, sometimes unique and specialised, tests.

Unless every available test is performed, there is a possibility of a missed diagnosis and liability for the doctor. Given the current litigious climate, doctors are apt to practise defensive medicine.

One way to address this issue would be for the public to accept the possibility that a minority of patients would have their diagnoses missed or delayed if the multitude of tests are not performed. These individuals with missed or delayed diagnoses should abstain from taking legal action. Greater litigation and indemnity expenditure leads to a vicious circle of increased healthcare costs.

Mr Wong also correctly states that there are patients who abuse hospitalisation. This situation is encouraged by the structure of insurance policies that require hospitalisations for claims.

Since patient autonomy is revered, doctors are hesitant to deny them hospitalisation even though outpatient care is possible, fearing a complaint for refusing to respect patient autonomy.

Mr Wong's last comment needs to be qualified. Benchmarks for professional fees have been set, but there are no corresponding benchmarks for hospitalisation fees and charges for medications and investigations.

I urge Mr Wong as a member of the public, and therefore one without conflict of interest, to champion a non-litigious society, to act to change the medico-legal tenet of patient autonomy and lobby for hospitalisation fee benchmarks, which, in combination, are likely to bring down healthcare costs.

Mona Tan (Dr)

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