Monday, April 09, 2007

Dollars & Sense & Non-sense

And so it continues in today's ST Forum (April 9, 2007)...

First, a lone voice of reason...

Most GPs charge less than recommended fees

I REFER to the recent announcement that the Singapore Medical Association (SMA) had scrapped the medical fee guidelines and the resultant knee-jerk reactions.

The adverse feedback in the papers and on radio programmes seemed to be directed at the general practitioners (GPs). I think critics are pointing their arrows in the wrong direction.
The public should think about the family doctors who have been servicing them all these years. Think about the charges for simple medical ailments that did not need expensive medicine or investigations. Most of the time, the charges would range between $12 and $24 (inclusive of medicine).

Now look at the recommended charges that were recently scrapped by the SMA. It does not take a mathematics genius to calculate that if the consultation charges recommended were indeed followed, there would be no way that the total charges paid by patients could be within the range we have been accustomed to paying.

The conclusion must be that not many GPs follow the guidelines. They in fact charge much less than what was recommended.

One GP interviewed said that there was competition between the clinics. So it was unlikely that medical charges would increase.

It is not uncommon to see a number of clinics within a few blocks of HDB flats. Market forces would have ensured that none of the clinics would want to price itself out of the market.

Not too long ago, there was a report on the plight of some neighbourhood clinics which faced decreasing takings. Are we so illogical as to assume that these clinics would raise their charges overnight just because the guidelines were removed, when they have been undercharging all this while when the guidelines were around?

One chooses one's family doctor based on a number of factors, such as his medical competence, bedside manners, empathy and trustworthiness. Cost would be a factor, obviously, but if the charges were too high, the GP would not have been our family doctor in the first place.

As we have been told, we should stick with the same family doctor, who would be familiar with our medical conditions. Hence, it was with great surprise when I read that our Health Minister advised the public to vote with their feet when consultation charges are not displayed.

I am sure the issue of exorbitant increase in medical charges would not apply to the majority of clinics here.

Most of our humble family doctors slog hard to open their clinics. Please do not react adversely without first giving the issue a logical think-through.

Gabriel Koh Liat Choon

Not surprising, since I think Gabriel Koh is also a GP.

Then this one...

With no more fee guidelines, will 'bargain' clinics still match polyclinic rates?

I REFER to the editorial 'Beware spike in docs' fees' and the article 'Dropping of SMA's fee guidelines: Other professional groups relooking fee guidelines' (ST, April 5).

In April 2005, 22 clinics that were willing to charge the same $8 fee as polyclinics were told by the Singapore Medical Association (SMA) that they could not list this information on a medical services website, because it infringed the SMA's advertising guidelines ('Does' ads allowed, so why not discount scheme?'; ST, April 13, 2005, and 'Why stop doctors from charging polyclinic rate?'; ST, April 5, 2005). As a result, all 22 clinics stopped offering the $8 fee.

Now the fee guidelines have been withdrawn, will these 22 or more clinics offer the same fee as polyclinics again?

By the way, since polyclinic fees were increased last month to $8.80, it may soon be cheaper to go to a private clinic at $8.

Leong Sze Hian

I wonder if Mr Leong even realises that polyclinics are highly subsidised by the government while private GPs are not? These very pertinent facts seem to be conveniently forgotten. One would think that Singaporeans, in all their great wisdom (sarcasm meant), would take that into account when comparing polyclinic prices with private clinics.

And then there is this one who takes the cake (emphasis mine)...

SMA announcement sure to mean more overcharging

I AM uncomfortable with the latest announcement by the Singapore Medical Association (SMA) to deregulate fees charged by doctors ('Think doc has overcharged you? Turning to Case only recourse now' (ST, April 5).

Already with guidelines, general practitioners (GPs) have overcharged patients. Only recently, letters in the Forum page have reported cases of GPs overcharging patients seeking treatment, especially during the holiday season. Quoted fees of $60 to $100 were commonly seen.

I am sure not many GPs make their fees known to paying patients before they see them. This is unlikely to change now the SMA has withdrawn its guidelines as most GPs also see their profession as a business that needs to stay financially viable.

Many patients will not seek help from the Consumers Association of Singapore (Case) as the amount is not large enough to warrant the hassle of getting back tens of dollars.

Nevertheless, most GPs currently charge between $30 and $40 for general flu and fever cases. Some friends who have seen the same GP for many years say they are charged only $25 per session. Office workers tend to have medical coverage by group medical insurance and may not feel the impact of any fee increase.

More worrying, however, is the retirees group who have no proper income and no medical coverage. Their visits to the GP will also be more regular due to ageing medical issues. My mother was charged $60 last month for a consultation visit to a GP due to some skin problem. She was also not told how much she would be charged before consultation.

I dread to think of the time I was in Australia when each consultation session with the doctor for simple flu and fever was in the region of $150 to $180. No wonder most Australians self-medicate and visit the pharmacist for simple flu and cough.

This may be a viable consideration in Singapore if pharmacists can provide professional advice on common flu and cough illnesses. Nevertheless, as over-the-counter pharmacists cannot issue medical certificates for those who need to rest, the practice of seeing pharmacists may not work here.

Gilbert Goh Keow Wah

What's eating Gilbert Goh? He seems to have brushed off explanations on why consultation charges were higher during the holiday season. Apparently, Mr Goh thinks that doctors should not raise their charges come hell or high water.

He seems to be reasonably well-traveled, & a fairly intelligent fellow when he writes that GPs see their professions as a "business that needs to stay financially viable." I wonder how he thinks GPs are able to stay financially viable if they don't charge enough to cover cost...Oh! I get it now! GPs are supposed to earn just enough to cover cost. No need extra money for kid's education and maid salary (since doctors' spouses will probably need to also work in order to earn money for things like food in the house & utility bills) or car. Forget about luxuries like a TV or a PC at home too, or even the occasional holiday to Desaru.

He even knows that consultation charges in Australia are sky high compared to those in Singapore, and yet, $30 - $40 is still too high for him(although this is only about 20 - 30% of the Aussie charges).

He has the right idea about self-medicating for simple ailments. That's what many do in places like Australia & the USA. The issue about MC's is something that will have to be dealt with by the HR people.

Sigh...I have a feeling that many Singaporeans feel the same way as Mr Goh.


m1 student said...

This is just very sad. Doctors can complain and complain for all they want but it's not going to change anything. Singaporeans still want $8 consult+med. They still think that the Hippocratic Oath is a like a vow of priesthood of sort. I wonder how the market would be like when i graduate. Perhaps, we'll be charging less than the barbers. Then it'll make sense to hang up our stethoscopes to cut hair. After all, that pays the bills.

aliendoc said...

$40 for a hair cut in some salons, maybe even more for "directors"! Not a bad idea!
Anyway, in the olden times, the "art of surgery" actually started with the barbers, so it's a full circle moment!

m1 student said...

Very much like herbal medicines etc. But i would imagine that our colleagues practicing the art of surgery wouldn't have to drop their scalpels to cut hair for a living.

Dr Oz bloke said...

So what's new aliendoc?

We all knew all this before it was written in the papers anyway.

Things will just go from bad to worse. Why? Because fees will NEVER EVER go up from now on. It will remain this $8 all inclusive for years to come while everything else goes up in price. Mark my words.

aliendoc said...

I guess a teenyweeny little part of me was hoping that perhaps, PERHAPS, Singaporeans would be smarter than what they appear to be. A futile hope, eh?

angry doc said...

Gilbert Koh strikes again in today's Forum page. I am surprised they publish the same guy on two consecutive days.

aliendoc said...

Yeah, I saw that. Don't forget, it's the Straits Times...doesn't exactly have a great track record of making doctors look good!

Anonymous said...

"But talent retention is a continual challenge. It is not just about money. Medical service in the public sector is a noble career choice, a calling. While we should pay our doctors well, we must not chase the market. Whatever we decide to pay in the public sector sets the floor for the industry. It is fruitless to think we can close the gap." This is what Mr. Khaw said sometime in 2005 to our dearest 140th media.

if you change a few words...

"But talent retention is a continual challenge. It is not just about money. Civil service in the public sector is a noble career choice, a calling. While we should pay our minsters well, we must not chase the market. Whatever we decide to pay in the public sector sets the floor for the industry. It is fruitless to think we can close the gap.

yeah right

Anonymous said...

I think a lot of people think like Mr Koh. I am appalled at this statement actually.

"General practitioners (GPs) are also not doing too badly with average income of around $5,000 to $6,000 monthly."

Come on, doctors also work damn hard. we studied like crap to drag our asses through medical school. the least we deserve is to be paid commensurate amounts. I think it's only uniquely Singapore. The other countries' medical associations won't stand for their doctors being treated like crap. kicked around and spit upon.

aliendoc said...

anon 11:27 - it's funny you should mention that, cuz I was thinking the same thing about the recent civil service pay rise & what the response would be like if doctors use the same justification for increasing fees that the govt has been using!

Anonymous said...

Oh no. That would be so wrong. We're supposed to be holiest of holiest. Surviving only pure passion and the love of humanity. Money? That'll degrade the sanctity of our art.

I think. Mr Khaw will just brush it off. We're the bad guys. The guys who are trying to fleece the people. Earning more than 6k is a no-no. It's okay for our dear minister to be taking home 2.2million and at the same time, introducing means testing and god knows what's up his sleeves.

anon 11:27

monash medical student said...

maybe all the doctors should call a forum and unaminously agree to charge a certain amount, say 50 bucks. ALL DOCTORS. so they have no where else to run. since they can';t complain to anyone, anymore.

just the evil side of me. ha

Anonymous said...

that'd be great if it was true. but it's anticompetitive, so you're breaking a law.

Dr Oz bloke said...

You can't do that. Simply because there already IS A PRICE WATCHDOG.

It's called the Polyclinic.

It is a bit like how NTUC keeps prices low and keeps us from the mercy of Carrefour, Cold Storage and Giant.

Anonymous said...

Gilbert Goh is infamous for his frequent letters to the newspaper forums, usually suggesting economically unsound policies, which is probably due to a lack of education in basic economics. It'd be best to ignore his forum letters until he learns otherwise.