I applaud the Ministry of Health (MOH) for adopting a more proactive approach to rein in doctors who subject patients to unnecessary tests, treatments and hospitalisation (Doctors warned against overcharging, overtreating; March 20).

This is a significant departure from its previous stance that private hospital charges are not under its purview.

Over the past 10 years, after the Singapore Medical Association withdrew its fee guidelines for medical practitioners, there have been no effective regulations to prevent overcharging.

The drive to make Singapore a regional medical hub also provided a pull factor for public-sector doctors to go into private practice.

The lure of private practice lies in the flexibility of doctors to be their own boss, and to determine their own working hours and retirement age. Without any cap on doctors' fees, their bills arguably became the most skyrocketing component of private healthcare costs. The charges levied are also seldom challenged in the absence of fee benchmarks.

Providers of laboratory and radiology services know well that some referring doctors can increase the volume of tests to any point necessary to ensure greater profitability, at the expense of the patient.

There is also a prevailing suspicion over the correlation between sponsorships for doctors' continual medical education programmes by pharmaceutical companies and the prescribing patterns of brand name medication by clinicians. Would drug manufacturers spend so much money on doctors if it does not benefit their bottom line?

Now that the SingaporeMedicine push - a government-industry initiative launched in 2003 to promote Singapore as a world-class healthcare destination - seems to have lost its impetus, the steady inflow of wealthy foreign patients that drove up the income of private-sector specialists has been affected.

If MOH had played an active role in reining in private-sector costs earlier and taking private specialists and hospitals to task for overcharging and over-utilising services, the medical hospitality sector here may not have lost some of its lustre, in the light of lower costs and the growing availability of quality care in neighbouring countries.

Under the current fee-for-service model, which offers unbundled services separately paid for, specialists are given an incentive to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.

Patients seeking treatment in the private sector have reason to be wary of cost.

Edmund Khoo Kim Hock