Thursday, July 04, 2013

Need for Guideline on Medical Fees : Aftermath of Dr Susan Lim case

Dear Friends
The letter below was published in the Straits Times Forum page (4th July 2013).

Revisit need for Fee Guideline

THE verdict of the Court of Three Judges, in dismissing an appeal by Dr Susan Lim against her professional misconduct conviction by the Singapore Medical Council (SMC), brings about a welcome closure to a contentious issue that had split the medical fraternity into two opposing factions (“Surgeon Susan Lim loses appeal”; Tuesday). Click here for background.

(Until the verdict was finally made known, no one had any inkling on which side of the fence the ruling would fall. Anyone who said “ I told you so” either had inside information or is a liar.)

 The “free market” proponents have no qualms about charging what they think is the “market rate” as, to them, medicine is just another means of making a living, and as patients come to them of their own volition.

“Caveat emptor” (let the buyer beware) being a dictum that is repeated ad nauseum, they think it must be permissible to charge what the market can bear. After all, in materialistic Singapore, is not wealth the main measure of a doctor’s true worth?

 The opposing faction is made up of the “traditionalists” whose most conservative members frown upon all forms of advertising. To them, medicine is a noble calling that is different from other professions, and it is crass to even promote one’s practice.

 Patients will find them by word of mouth, hence advertising is superfluous at best and a tool for false representation at worst.

 The appellate court has decided that “a doctor cannot rely solely on the morals of the marketplace” and that there is “an objective ethical limit” on medical fees, in both private and public health care, that operates outside of contractual and market forces.

 Doctors, especially in private practice, now face a very real problem. What is this proverbial “ethical limit” that has been bandied about? What may seem like a reasonable fee to one might appear to be “fleecing” to another, thereby leading to unnecessary complaints to the SMC.

There used to be a fee guideline published by the Singapore Medical Association (SMA), but this was scrapped in 2007 as it was deemed anti-competitive by the Competition Commission of Singapore.

(The GOF was mooted in the early 1980s when the Ministry of Health, the SMA and the Association of Private Medical Practitioners of Singapore felt a need to publish a fee schedule to provide greater transparency for patients. )

 It is surely timely to revisit the need for such a guideline.

 The Academy of Medicine, SMA and the Health Ministry should also come together to provide answers to the perplexing question of what the “ethical limit” is.

Huang Shoou Chyuan (Dr)

PS: Edited out parts in (brackets)
I had blogged on this issue several times and had some letters published in both Straits Times and Today
1.Click here
2. Here

1 comment:

Paulinelhg said...

Thanks for this post, it is of my opinion, that market forces did not drive medical cost down.

The common complaint I hear from older folks is the high and unreasonable cost of medical care, which they unfortunately do need very much, but couldn't afford

While I do see many who could (because they have assets or insurance to pay for it), enjoy their peace of mind

And many old folks end up spending their time queuing half a day at polyclinic to see a doctor and getting their medication. If they need a referral to see a specialist in government restructured hospital, the wait could be 2 weeks to 2 months. Then they see a specialist, who verify the medical condition, and if need be scheduled further test, this may be 2 weeks to 1 month. Thereafter, be scheduled to see the specialist to review what is medically necessary, with further waiting time. Some may decide not to sell further treatment due to cost or other life challenges.

In a private clinic/ hospital , a patient can see the specialist, go for diagnostic test, review with same specialist, all in 1 day. Just make an appointment, choose any doctor of your choice, on that day, turn up. The difference is money. And yes they will go for the second opinion! Is only 1 day for private practice, while those seeking second opinion in public medical service may take ???

Pls do continue to write about this issue and I hope this will being back medical fee guidelines, which will benefit the residents of Singapore. Thanks