How Much Is Too Much?

With the recent discussions that have arisen over the withdrawal of the Guideline of Fees for doctors, a couple of questions posed by this writer is certainly a valid one (emphasis mine).

April 16, 2007
How to decide if doc is overcharging?

THE Competition Commission of Singapore's (CCS) response to the recent withdrawal of the Singapore Medical Association's (SMA) guidelines on fees deserves more discussion.

CCS announced that it will work closely with the Consumers Association of Singapore (Case) to handle any complaints of overcharging by doctors.

This is good but it opens up two questions.

The first is will there be a charge levied?

The SMA never levied any charge on members of the public who filed complaints against doctors. But a visit to the Case website reveals that a complainant usually has to join Case as a member. Membership carries an annual subscription of $25 and filing a complaint incurs an administrative charge of $10.

The second question is more fundamental. How will CCS and Case decide on what constitutes overcharging?

The term 'overcharging' carries with it the notion of relativity. Overcharging can exist only if there is an understanding of what is 'normal charging'.

But without benchmarks and guidelines, it is practically impossible to define overcharging. Are CCS and Case going to draw up their own guidelines on what are acceptable and normal prices?

How will CCS and Case decide a doctor is not merely 'expensive' but has transgressed to the point of 'overcharging'?

Do they have the expertise or domain knowledge to know the intricacies and complexities of pricing in the whole spectrum of health care?

And will CCS and Case likewise step up to the plate to handle overcharging complaints when other professional groups withdraw their equivalents of price or fee guidelines?

These are questions that need to be answered clearly and soon.

Christine Chen Siew Mei (Ms)

In response to the first highlighted question, how indeed? What will CASE & CCS use as a benchmark when faced with a complaint from a "consumer" who alleges overcharging? They can't fall back on the now defunct GOF. Will they use results from MOH's planned survey of GPS fees?

More important in my mind is the 2nd question highlighted. Who will provide input to them in deciding whether a doctor has overcharged or not. And HOW would this person (or persons) decide? Can you even put a price on quality of care?

These are tough questions to answer. I am not even sure if doctors themselves would know how to answer them.

I am not even convinced that CCS nor CASE should be the ones handling such complaints in the first place. IMHO, it would "cheapen" healthcare, not literally in terms of dollars & cents, but qualitatively, as I don't think medical care should be considered a consumer product. But sad to say, it certainly looks like it's headed that way.

Addendum (April 17): angrydoc has also commented on this. I guess great minds think alike!