Dr Huang Shoou Chyuan is correct when he suggests that private hospitals must be constrained in some way to control runaway hospital bills not through doctors' making (Surgical fee guidelines a good job half done; Nov 23).

Private hospitals are entities owned by faceless shareholders who have overriding pecuniary interests. They can overprice what they think they can get away with, and often do.

To protect themselves from the private medical sector, where the bills can be multiples of what even patients in Class A wards pay in restructured public hospitals, insurers now punitively load the premiums for patients who choose private healthcare.

This is done while encouraging patients towards public healthcare by decreasing their insurance premiums the following year should they choose to address their present problems in a public hospital.

This makes it very unfair for the majority of ethical private surgeons, who charge very reasonably but whose pie has shrunk very dramatically, as patients are driven unwillingly back to the public hospitals which already are overloaded with patients.

Where the combined total private hospital bill inclusive of doctors' fees is comparable with Class A ward charges in restructured hospitals, patients should be given a choice between the two without being discriminated against by their insurers.

This effectively disciplines doctors and hospitals in the private sector to contain costs if they want to regain patients who form the insurance pool.

Yik Keng Yeong (Dr)