Ethical guidelines not concrete enough to protect patients' welfare

I am heartened that the medical profession has chosen to address the issue of overcharging in the latest edition of the Ethical Code and Ethical Guidelines (ECEG), but I fear that the move will not go far enough (Protecting patients' welfare while being fair to the doctors; April 27).

Patients are the most extreme example of economic price takers. They are entirely dependent on the good judgment of doctors to make both medical and pricing decisions.

In the throes of disease and the desperation to recover, and lacking full medical knowledge, they are not in a position to remind their caregivers that fees must be "fair and reasonable", or sense that overtreatment is afoot.

Therein lies the main issue - the ECEG is an intangible moral framework that does not provide sufficiently concrete, preventive measures. Nor does it specify means of recourse.

If a dispute regarding overcharging should occur, the outcome is most probably a long and drawn-out legal battle that will exhaust both parties.

Above all, there are both legal and economic limitations to self-regulation because of the inherent conflict of interest in asking any organisation to police itself.

The relevant external authority, the Competition Commission of Singapore, has insisted on adopting the counter-intuitive approach of forbidding concrete fee guidelines, even for medical procedures.

Price-based competition has no place in healthcare, when patients requiring urgent treatment cannot afford to shop around for the cheapest doctor or ask for a less expensive specialist referral.

Given that there is likely to be little variation in overheads between doctors practising in the same discipline and performing the same procedures, it is possible to calculate the range of fees that would be "commensurate with the work actually done".

Variations in "intensity and duration of service" can be accounted for by specific time-based charges.

For matters that, quite literally, concern life and death, certainty in rules is preferable to vagueness.

Paul Chan Poh Hoi

A version of this article appeared in the print edition of The Straits Times on May 01, 2017, with the headline 'Ethical guidelines not concrete enough to protect patients' welfare'. Print Edition | Subscribe