Saturday 30 June 2012

Private versus Public Hospitals

About bill sizes, doctor exodus...

DR GERARD Chee agreed that private hospital charges are higher than those in public hospitals ('Bill comparisons may not reflect true cost differences'; Tuesday).

However, he suggests that the cost comparisons may not be wholly accurate because the report did not reflect all private and public hospital bills. He further concludes that the private-public hospital cost differentials are due more to public-sector doctors being grossly underpaid.

The Ministry of Health has been publishing bill size data for the top 70 medical conditions in public hospitals on our website ( since 2003.

With effect from last year, all private hospitals have also submitted their bill size data for the same medical conditions for publication on our website.

The published bill sizes include inpatient and day surgery cases, and reflect hospital charges as well as doctors' professional fees.

Inpatient and day surgery cases were chosen because patients would usually incur larger expenses for hospitalisation as compared to outpatient treatments.

The public can refer to the published data on the ministry's website to form their own conclusions on the inpatient and day surgery cost comparisons between public and private hospitals.

While the attrition rate of public-sector doctors has remained stable for the past three years, we are mindful that pay must be fair and competitive in order to recognise the good work of our doctors in the public health-care system.

As announced by the Health Minister in March, a new and more competitive pay framework is being introduced to better recognise the contributions of our doctors in clinical care, education, research, leadership and administration in the public health-care sector.

Doctors who leave the public sector do so for various reasons, of which pay could be one.

It would, however, be disrespectful and unfair to the many dedicated and professional doctors in the public sector to suggest that they, too, will leave eventually in search of better pay and cause their patients to suffer a 'decline' in the quality of care.

Many public-sector doctors are motivated by a sense of mission and the satisfaction of being in public service, contributing to the care of patients, the furtherance of medical knowledge and the nurturing of future generations of doctors. As members of a respected profession, doctors aspire to do their best, regardless of where they choose to practise.

Bey Mui Leng (Ms)
Director, Corporate Communications
ST Forum, 29 Jun 2012

Doctors leave public sector for reasons other than money

DR GERARD Chee's most obvious conclusion from the report ('Private versus public hospitals: More than twice as costly'; last Friday) was 'how poorly paid public hospital doctors are', as reflected in the lower cost of public health care ('Bill comparisons may not reflect true cost differences'; Tuesday).

This seems inappropriate. To put things into perspective:
- The medical profession, both in the private and public sectors, is among the most respected and well-paid here. We should be cognisant of and grateful for this privilege. 
- The relatively lower cost of public health care is a reflection of government subsidies, and does not mean that doctors in this sector are poorly paid. 
- Doctors in the public sector are amply paid for the duties and responsibilities they assume and the time spent doing so. But their salaries have far less correlation with what patients pay than what the Government thinks they are inherently worth - which is a lot.
Within 10 years of public service, most doctors can earn six-figure annual salaries - not exactly a pittance for performing mostly unspectacular routines.

Doctors leaving the public sector cite work-life balance, administrative hassle, office politics and poor leadership as the main reasons for doing so.

So Dr Chee is wrong to ascribe pecuniary reasons solely for the exodus of doctors from public hospitals to the private sector.

Dr Yik Keng Yeong
ST Forum, 28 Jun 2012

Bill comparisons may not reflect true cost differences

I CONCEDE that costs in private hospitals are higher than those in public hospitals for private patients ('Private versus public hospitals: More than twice as costly'; last Friday).

However, there were a few omissions in the report:

- Singapore General Hospital (SGH) was not mentioned in the bill size comparisons for public hospitals.
Bill sizes vary between public hospitals, and SGH is known to be more expensive than, say, Tan Tock Seng Hospital (TTSH) or Changi General Hospital (CGH).

Also, other private hospitals such as Mount Alvernia Hospital were not mentioned.

The comparisons were limited mostly to Mount Elizabeth Hospital, which is known to be the 'premium' private hospital, and TTSH and CGH, the more 'affordable' public hospitals.

Comparing the bill sizes of the 'most expensive' private hospital and those of the 'cheaper' public hospitals may not give the true reflection of the issue.
- As an ear, nose and throat surgeon, I find the median bill of $11,066 for the removal of tonsils and/or adenoids rather high. This reflects the wide variation in doctors' fees rather than the cost of having the procedure done at a private or a public hospital. 
- The perception of costs should not be limited to surgical procedures and hospital stays.

Most patients seeking private health care require only outpatient treatment (about 90 per cent of my services are provided on an outpatient basis).

A comparison of costs in private and public hospitals should include outpatient treatment costs as well.

Nevertheless, the one obvious conclusion I gathered from the report is not how much more expensive private hospitals are compared to public hospitals. It is how poorly paid public hospital doctors are, as reflected in the lower cost of public health care.

This explains the exodus of doctors from public hospitals to the private sector.

Until the authorities realise this, the public sector will continue to lose good and dedicated doctors to the private sector. Waiting times will increase, quality of care will decline, and regardless of whether private hospitals are more expensive than public hospitals, more patients will choose to seek private health care.

Dr Gerard Chee
Consultant, Ear Nose Throat Surgeon
G Chee Ear Nose Throat Sinus & Dizziness Centre
Mount Elizabeth Medical Centre
ST Forum, 26 Jun 2012

More than twice as costly
Still some prefer private hospitals due to perception of better care, says don

By Salma Khalik, The Straits Times, 22 Jun 2012

PATIENTS in private hospitals could find themselves with bills that are two - even more than three - times that of full-paying patients in public hospitals.

Take the removal of a breast lump, a procedure usually done as day surgery. The median bill for this at the privately run Raffles Hospital last year was $5,764, which means half the patients paid more than this amount, and the other half, less.

At the National Cancer Centre, the median bill among full-paying patients for breast lump removal was $2,397. Changi General Hospital (CGH) had the lowest median bill for full-paying patients undergoing this procedure, at $1,736.

Compare these figures with the median bill for subsidised patients: It ranged from $595 at CGH to $1,311 at the National Cancer Centre. These figures for last year are based on real bills featured on the Ministry of Health (MOH) website.

At Mount Elizabeth Hospital, the median bill for breast lump removal was $5,044 - lower than at Raffles Hospital - but the top 10 per cent of heftiest bills for this operation shot past $9,000.

Despite that, 15 per cent of the more than 3,000 women needing breast lump removal had it done there.

Professor Euston Quah, who heads the department of economics at the Nanyang Technological University, put this down to the perception that private hospitals give better care; waiting times are shorter, and they stock a wider range of more expensive drugs.

Public hospitals, on the other hand, cater mainly to subsidised patients; they treat a lot more patients and stock the cheaper generic drugs.

Prof Quah said: 'Health and medical care is a very important aspect of life, if not the most important to people, and they are willing to pay.'

As to why private sector prices are so much higher, he said: 'They have to strive to provide the best to survive and make surpluses, unlike public hospitals.'

Mount Elizabeth, Gleneagles and Raffles hospitals from the private sector and the National Heart Centre (NHC) from the public sector are the most expensive in terms of average bill sizes.

While Raffles operates like a public hospital in that it has specialists on its payroll, Mount Elizabeth is different: It provides the facilities and nursing care, but its specialists are independent operators - and there could be a huge variation in the fees they charge.

A 'brand name' doctor in private practice could easily command a fee several times that of less well-known doctors.

Room rates also vary, with public hospitals charging between $300 and $428 a night for a single-bedded room. In the private sector, room rates range from $435 to $578; suites could cost thousands of dollars a night.

But for Mr David Utama, who heads a multinational corporation here, cost is immaterial. He and every member of his extended family are self-confessed 'staunch believers' in the Mount Elizabeth quality of care, following his father-in-law's illness last year. His father-in-law, aged 81, was unconscious and doctors in Jakarta had given up hope on him. The family wanted him brought here, but could not get hold of an available charter flight.

One call to Mount Elizabeth by Mr Utama at 9am was all it took. The hospital arranged everything, and by 6pm, his father-in-law, who had hada stroke, kidney impairment and pneumonia, was in intensive care there.

He pulled through and is on his feet now, although he needs a cane to get about, said Mr Utama, who said stories circulate about how private hospitals 'rip off' patients. His father-in-law's bill, inclusive of the emergency evacuation, was under $100,000.

Mr Utama said: 'We never felt that they took advantage of us. The good care and outcome is why we all believe so much in Mount Elizabeth.'

Dr Lim Suet Wun, the executive vice-president of Singapore operations for hospital owner Parkway Pantai, said: 'Our price shows the value patients put on the quality, efficiency and outcomes of care that Mount Elizabeth, Gleneagles and Parkway East hospitals give.'

Prof Quah suggested that a study be done on the actual difference in quality between hospitals. Such a study should factor in patient survival, length of stay and success of treatment.


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