Many 'hidden' reasons for rise in healthcare costs

Dr Thomas Lee Hock Seng postulated that the Health Ministry's obligatory requirement for electronic filing of claims by specialist clinics is one of the significant drivers of escalating bills in private hospitals (Higher healthcare costs: Consider less obvious factors too; April 1).

According to the Health Insurance Task Force, the average bill size at private hospitals has spiralled to almost three times that in the public sector.

It is difficult to believe that hiring a few additional staff to do electronic filing has played a substantial part in this phenomenal rise.

If we want to examine less obvious factors for rising healthcare costs, there are many other elements to consider indeed.

Skyrocketing rents for clinics are a contributing factor, driven by an exodus of specialists from public clinics and hospitals into private practice and the institutionalisation of ownership and management of clinic space through private developers, property funds and real estate investment trusts.

Fee splitting between doctors and diagnostic facilities has been an industry norm for years. Laboratories and radiology centres offer schemes for referring clinicians to collect the full charges for tests from their patients - before being billed at a later date - minus the discounts. Fee sharing probably causes patients to fork out more than they should for diagnostic services.

The proliferation of public listings by medical groups and private hospitals has health-cost implications. Conflict of interest, accountability to shareholders and monopolistic practices associated with medical IPOs would inevitably result in higher charges.

Private hospital in-patient bills also contain all manner of costly hidden charges that are not obvious to the layman because of the arbitrary manner in which services and consumables are levied.

Drug manufacturers are aware that market forces in the private sector influence decisions when prescribing medication.

Sponsorships for continual medical education are incentives given to doctors to prescribe their companies' products in larger quantities on a regular basis.

Hence, the escalating cost of healthcare should not be blamed entirely on doctor's fees, even if clinicians remain crucial cost-drivers in any healthcare system.

Edmund Khoo Kim Hock