Monday, April 16, 2007

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!


angry doc said...

Yes. It's scary how we think alike...

nofearSingapore said...

Hi aliendoc:
The competition commission has misunderstood the purpose of the GOF. They think we docs are just like any merchants who will group together and act cartel-like to fix prices and take action against any members who undercut each other.
Far from it, the GOF was initiated by MOH and it is self-regulatory mainly against those who might want to charge the sky.
Enough said- the GOF is gone and the sky is literally the limit.
NO ONE- not even the minister himself can tell any complaining patient if anyone of us are overcharging or not cos there is No benchmark. Caveat emptor/willing buyer willing seller/you are on your own babe is the essence of what's happening.
So I have a clear conscience now. So long as I inform the patient that the surgery is XXXX dollars, and he agrees, no one can say anything.

aliendoc said...

It's too bad that the SMA didn't pursue it further...and that the CCS didn't bother to enquire more into the background of why the GOF was there in the first place. I read the reply letter from CCS to the SMA prez & I was, like, "Huh?" Their reply sounded like they weren't even interested!

monash medical student said...

hi there.

i read with interest your posts on this issue.

if you have time, do leave some comments on another post of mine about consultations in singapore not having any guidelines. and that on how much a doctor should earn.

would like to hear what you think.already contains some links to your site as well.

and something related to our medical tourism as well:

many thanks.

aliendoc said...

hi Jeff,
Unfortunately, I currently live in a country where access to certain websites are blocked due to censorship, & many of these websites are blogs. Sometimes, I can't even see my own blog though I can still put in entries. I would. I can see your entries using a proxy, but entering comments is beyond my technical know-how! Maybe when I am back in the Singapore for the summer I will try again....sorry!