I share the concerns about rising healthcare costs and agree that all efforts must be made to control these costs ("National insurance will escalate healthcare costs" by Dr Yik Keng Yeong; Forum Online, and "Rising healthcare costs: Don't let genie out of bottle" by Mr David F. Grant; both published last Wednesday).

But I beg to differ on the assumption that universal insurance will lead to an escalation of healthcare inflation.

Healthcare inflation was already high in the United States even before Obamacare was implemented. So it is safe to presume that there are many other factors which can lead to this.

Dr Yik is right to be concerned that patients will demand more as the cost of treatments and investigations come within reach.

But is it really a bad thing? We do hear stories of people who refuse even basic treatment because they are not able to afford it, or wait till the problem becomes an emergency before seeking care.

As investigations become more affordable, doctors and healthcare providers will have to work a little harder to explain to the patient the appropriate treatment options rather than go for the costliest ones, which may not necessarily be better.

There are some initiatives in the US to educate the public about the appropriate treatment options, the most prominent of which is the Choosing Wisely programme.

A similar effort locally will go a long way towards equipping both the providers and patients with the appropriate knowledge to reach an informed and evidence-based decision.

Another reason for healthcare inflation is the fee-for-service (FFS) model of payment, which encourages excessive investigation and over-treatment.

Singapore does not need to blindly follow the FFS model. We can use a combination of capitation, where a set amount is paid to healthcare providers over a fixed period regardless of treatment, and FFS to achieve the optimal outcomes.

The last but most important reason for healthcare inflation is the reliance on tertiary care institutions and less emphasis on population health and public health, including primary care.

It is always cheaper to keep people healthy rather than to treat them when they become sick, and I applaud the various efforts of the Ministry of Health and Health Promotion Board in this regard.

Kunwar Bir Singh (Dr)