Senior health correspondent Salma Khalik rightly pointed out that compulsory co-payment is only one facet of the solution to reducing escalating healthcare costs (Stopping full riders just one part of solution to soaring medical bills; March 9).

One missing piece of the puzzle is the role of family doctors as gatekeepers in the healthcare system.

In Singapore today, in order to facilitate a full insurance claim, a patient with, say, a simple skin lesion that may be removed at the family clinic will likely request to be referred to a specialist for in-patient excision at a hospital.

The proper way to handle this situation is to incentivise both the patient and doctor to manage the skin lesion at the primary-care level.

The incentives could be a reduction in yearly premiums for the patient and reasonable payments for the family doctor for his work.

Overseas studies have proven the cost-effectiveness of leveraging the primary-care system to prevent indiscriminate use of the healthcare system.

Insurers should set up a family doctors' panel to manage medical conditions at the primary-care level instead of having patients admitted to hospitals.

This could save thousands of dollars for each case and, in the long run, could reduce the patient's healthcare cost.

Tan Eng Chun (Dr)