Support for move to have medical fee benchmarks

SMA head says they are useful for doctors and public; insurers hail greater transparency

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The Ministry of Health will be coming up with government-backed fee benchmarks for different medical procedures for Singaporeans to see if they are being charged reasonably. PHOTO: ST FILE

Singaporeans will be able to refer to government-backed fee benchmarks for different medical procedures from next year, to see if they are being charged reasonably.

Another version of medical fee guidelines, put out by a doctors' body, was dropped a decade back as it was deemed anti-competitive.

Since then, there have been calls to have guidelines reinstated in some form to help doctors and patients get a sense of what is a reasonable fee for treatment. It was also a key recommendation of the Health Insurance Task Force report last year.

Now, the Ministry of Health (MOH) has taken it upon itself to come up with such benchmarks - a move that was widely welcomed.

Health Minister Gan Kim Yong told local media this week that he hopes the professional fee benchmarks "over time will help us manage healthcare costs".

Dr Wong Tien Hua, president of the Singapore Medical Association (SMA), said: "Our position has always been that a fee guideline is useful for both doctors and the public."

The SMA introduced fee guides in 1987 and expanded them to cover 1,500 procedures by the time they had to be withdrawn in April 2007, when told these contravened the Competition Act. That is because it was seen as doctors themselves giving an indication of what they should be charging.

Benchmarks from the ministry will not face similar problems.

Mr Gan explained: "The main concern is about service providers coming together to set fees or guidelines. SMA was the doctors themselves. This benchmark will be set by the MOH, which will be independent of the service providers."

Doctors, however, would give their input.

"It is not MOH deciding unilaterally what a reasonable fee should be," said Mr Gan. He added that doctors are not compelled to follow the recommendations, but may set their own fees.

But the benchmarks can help doctors peg their fees. Patients could also ask for an explanation if they are charged much more than the benchmark.

The Life Insurance Association (LIA) of Singapore, to which all six insurers of integrated plans with MediShield Life for private healthcare belong, welcomed the move. "This is a key step to enhance the transparency of medical costs in Singapore."

The health insurers have been faced with soaring claims, especially for treatments in the private sector by patients who have "riders" that cover the entire cost of their bills. Said the LIA: "By providing a baseline for assessing what are reasonable charges, the market will be able to operate with greater effectiveness."

The ministry already publishes real fees for different procedures, which highlight only the huge differences in the market. Some private doctors charge two to three times what their peers do.

Even when the SMA guidelines were around, there were huge differences in what doctors thought was a reasonable charge.

For example, surgeon Susan Lim had told her Bruneian royal patient that the cost of the intensive treatment she wanted would amount to $100,000 to $200,000 a day. During the High Court hearing of the case in 2011 , three expert witnesses quoted three different "reasonable" daily charges that ranged from $1,000 to $300,000.

SMA's Dr Wong said that while the benchmarks may not be exhaustive, they "must be robust". He added: "Other equally important initiatives would include reviewing hospital charges, educating the public and insurance product redesign."

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A version of this article appeared in the print edition of The Straits Times on December 01, 2017, with the headline Support for move to have medical fee benchmarks. Subscribe