2 public hospitals increase fees for emergency services

SGH, KTPH raise charges to cope with rising costs

By Salma Khalik, The Straits Times, 12 Apr 2014

TWO public hospitals have raised emergency department fees in the past four months, with a third set to do the same if the Ministry of Health (MOH) gives the green light.

Singapore General Hospital (SGH) increased its fees by 9 per cent in December from $99 to $108, while charges at Khoo Teck Puat Hospital (KTPH) went from $98 to $103 in February.

While both say this was done to cope with rising costs, the new fees make their emergency departments the costliest in the public sector. Alexandra Hospital is the cheapest at $88 among Singapore's six public general hospitals. MOH declined to reveal which other hospital is looking to charge more.

The fee typically covers basic investigations and procedures, drugs and X-ray services. Patients are charged extra if they need specialised emergency tests or scans.

KTPH and SGH also started charging more for certain classes of beds and consultations.

In February, KTPH raised the cost of its B2 beds from $65 to $70. The hospital has over 90 per cent occupancy rates, which means patients needing a bed often face a long wait.

Consultation fees for subsidised patients at its specialist outpatient clinics went up from $32 to $35 for the first visit, and $30 to $32 for follow-ups. Fees for private patients were not raised.

A spokesman said the increases were "to recover rising operating costs of running the hospital".

SGH, which treats more than one million patients a year, raised both inpatient and outpatient fees in December. Its chief executive officer Ang Chong Lye said SGH is over 30 years old, and needs to expand facilities "to improve patient outcomes and safety".

He added: "Any under-collection of revenue would mean fewer resources available to meet this need. The adjustment to fees can help to recover only a small fraction of rising costs".

SGH and KTPH see more than 300 patients at their emergency departments every day. This can exceed 400 on especially busy days. More than 2,000 people seek emergency treatment at public hospitals daily.

Hospital emergency departments have been struggling to cope with the rise in patient numbers and a shortage of beds.

This has forced hospitals into unique steps, including squeezing three patients into a cubicle for one, setting up an air-conditioned tent outside, or putting patients in beds lined along corridors or in the decontamination area.

While a lack of infrastructure is one problem, it becomes worse when patients who do not really need emergency treatment turn up. This often happens at night when most clinics are closed.

A spokesman for MOH, which has to approve all fee changes, urged people with non-emergency conditions to see a private GP instead - "so that a hospital's emergency department can be focused on those who really need emergency services".

"Public hospitals adjust their charges from time to time to keep pace with rising costs. This is done while bearing in mind the impact on patient affordability."

Standardise subsidised patients' fees at polyclinics, hospitals
By Salma Khalik, The Straits Times, 15 Apr 2014

THE services are essentially the same, but the fees charged by different public hospitals and polyclinics can vary by as much as 50 per cent.

To most patients, this makes little sense. Why should they pay so much more at one hospital compared with another - especially since the Government subsidises much of the cost?

Recently, Singapore General Hospital (SGH) and Khoo Teck Puat Hospital (KTPH) raised their emergency department fees, and some bed and consultation fees.

SGH increased its emergency department fee from $99 to $108 while charges at KTPH went up from $98 to $103.

Alexandra Hospital charges just $88 for emergency services - the lowest among Singapore's six public general hospitals.

Is the $20 more that SGH charges - the highest among public hospitals - because it provides a better level of care? Or because Alexandra Hospital administrators are better at keeping costs down?

SGH chief executive officer Ang Chong Lye explained that the increase in its emergency department charges, along with those for its consultation and ward fees, will help improve facilities which are more than 30 years old.

But if public hospitals are built and maintained by the Government, why should improvements and renovations come from patients' fees?

It may be time the Ministry of Health stepped in to standardise fees - at least those for subsidised patients.

A $20 to $30 difference might not mean much to a hospital administrator, but it can be an extra burden for patients who already rely on health-care subsidies for what are essentially the same services.

Patients cannot be expected to shop around for the cheapest rates - especially when it comes to emergencies. In such cases, the ambulance simply takes the patient to the nearest public hospital - regardless of fees.

And if a Jurong resident needs to see a family physician at a polyclinic for his chronic ailment, that person is unlikely to make the trip to the eastern part of the island, where SingHealth polyclinics charge $22.

But that will not stop him from wondering why the Jurong polyclinic run by the National Healthcare Group charges $29.20.

Similarly, Tan Tock Seng Hospital (TTSH) charges either $75 or $84 for a B2 class bed - depending on whether it has an attached toilet. Again, patients are not given a choice but simply pay the different fee depending on where they are placed.

At Khoo Teck Puat Hospital - where even C-class wards have en suite toilets and bathrooms - a B2 bed costs $70. This means that TTSH charges $14, or 20 per cent, more than KTPH. In fact, even its B2 wards with no en suite facilities cost $5 more.

Is there any logic to such disparate pricing?

While restructured hospitals and polyclinics should be given some leeway in how they run their services and pay their doctors, the ministry should ensure that for subsidised patients, the fees they charge are the same.

This should also apply to subsidised wards in hospitals and to outpatient treatment at specialist clinics, which also vary from one hospital to another.

This can be done either with bigger subsidies where charges are higher, or by insisting that all hospitals and clinics charge the same fees.

If the current system continues, the ministry should explain why it allows such differences in prices. Giving autonomy to public institutions should not be done at the expense of subsidised patients.