Fee guidelines force doctors to exercise self-restraint

I agree with Mr Alfie Lim Si En that actual transacted surgical charges of public and private hospitals published by the Ministry of Health (MOH) are a reliable guide ("Be cautious about prescriptive guidelines"; Oct 20).

However, such data covers only a selection of day surgery procedures or straightforward operations for inpatients. A large number of surgical cases carried out in private hospitals are complicated.

Formal fee guidelines for consultations and outpatient treatments do empower patients to make more informed choices when considering their personal needs and preferences in selecting the best option.

Prescriptive guidelines in healthcare have their origins in issues such as rising healthcare costs fuelled by increased demand for care, more expensive technologies, variations in service delivery among providers, and the presumption that at least some of this variation stems from either overtreatment or overcharging.

Dr Wong Chiang Yin, who was the president of the Singapore Medical Association (SMA) when its fee guidelines were withdrawn, warned of the grave consequences of abolishing those points of reference.

He likened the SMA fee guidelines to speed limits on our expressways ("Fee guidelines are like speed limits"; Aug 21, 2014): Some drivers will automatically travel below the limit, while a few have a tendency to go well above the limit.

The majority will drive near the speed limit, but exceed it without a care once this limit is abolished.

Unfortunately, those who already tend to speed will test the limits of how fast they can travel once speeding is no longer unlawful.

Opponents against the issuing of fee guidelines argue that this may encourage doctors to charge at the upper end.

However, patients and insurers will notice straightaway that these doctors are more expensive, but are also assured that they are forced to exercise some self-restraint.

A reintroduction of the SMA guidelines, using its fee range as a point of reference, with inflation taken into account, will increase the transparency of medical charges.

Edmund Khoo Kim Hock

A version of this article appeared in the print edition of The Straits Times on November 04, 2016, with the headline 'Fee guidelines force doctors to exercise self-restraint'. Print Edition | Subscribe