How much should an orthopaedic surgeon charge for a simple knee replacement? In the private sector today, one in four charges more than $13,215, and a similar number peg fees at less than $7,747.
This is just the surgeon's fee and does not include the cost of the artificial knee, use of the facility or what the anaesthetist is paid. Is a surgeon whose fee is double that of another doubly good? Is he charging what the market can bear? Or does his fee depend on whether a patient has an "insurance rider", which means the patient's insurance pays his full medical bill with no co-payment on his part?
A third of people here have such riders, which is seen as a major driver of rising insurance claims because patients are not bothered by high fees.
The private medical sector is like a cowboy town, with doctors free to charge what they like. Ethically, they are obliged not to overcharge. But it is difficult to ascertain what constitutes overcharging when there is no yardstick to measure against. Hence, the many calls over the years for some form of guideline.
The Ministry of Health (MOH) has held out for a decade, believing the market would find the correct level. Last year, MOH published the actual fees charged by private sector doctors, but this has not been useful, given the huge variation in fees charged.
MOH's announcement that it will come up with benchmarks next year is long overdue. While doctors need not follow such benchmarks, they will help patients, doctors, insurers and third-party administrators know if the fee is a gross overcharge.
The benchmarks for fees would also give the Singapore Medical Council the "norm" against which to compare a doctor's fee in the event of complaints.
The Health Insurance Task Force's report last year said fee guidelines in countries that have them "are a cornerstone to achieving quality healthcare at an affordable cost". Hopefully, the MOH benchmarks would do that here and slow down the spiralling cost of healthcare that has many worried that it may no longer be affordable for the majority in the future.
