Private hospital operation fees to be included on Ministry of Health's website

Listing of op fees at private hospitals helps patients
Move increases fee transparency and allows patients to make informed decisions: MOH
By Salma Khalik, Senior Health Correspondent, The Straits Times, 6 Oct 2016

Patients can now have an idea of how much private sector surgeons charge for their services, and perhaps even negotiate a better rate.

The Ministry of Health (MOH) has started publishing private hospitals' operation fees. It gives a breakdown of the bill for various procedures - the surgeon's fee, the anaesthetist's charge and the cost of the facility such as use of the operating theatre.

The ministry yesterday said making the information public will increase fee transparency and help patients make informed decisions.

The move sheds some light on what is currently an opaque area.

There are no fee guidelines for doctors. Many private specialists fix their own fees, which could differ greatly between two surgeons operating in the same hospital. In general, half the cost paid by patients goes to the surgeon.

As a result, there have been cases of doctors overcharging, the most prominent being surgeon Susan Lim's bill for seven months of cancer treatment in 2007 for a member of the Bruneian royalty, amounting to $24.8 million.

The fees put up by MOH are based on data submitted by hospitals between July 1, 2014 and Dec 31 last year. They are a range, with the lower amount reflecting the 25th percentile charged and the higher amount, the 75th percentile. This means a quarter of patients pay less than the lower amount, and an equal proportion pay more than the higher rate.

So, for instance, to remove the appendix, half the patients in the private sector pay $9,928 to $13,128, with the surgeon pocketing $4,500 to $6,420 of this sum.

So a patient who pays his surgeon more than $6,420 for this procedure will know that the price falls in the top 25 per cent range.

The move by MOH was welcomed by Dr Chia Shi-Lu, head of the Government Parliamentary Committee for Health, who has raised the issue in Parliament.

Dr Chia, an orthopaedic surgeon at Singapore General Hospital, said it would help both patients and doctors in financial discussions.

If the doctor is charging a lot more than the range given, then he will have to explain the reason to the patient, he said. It could be because of the doctor's greater experience, or because the case is more complex.

The ministry said: "Such information will enable patients who are considering treatment at private hospitals to estimate the fees charged by the doctors and the hospital for the various listed procedures."

The list of common procedures for which the ministry publishes operation fees has also been increased from 65 to 141. The data will be updated annually on its website.

The MOH started publishing bill sizes in 2003, beginning with only public sector facilities.

More transparent fees 'a positive step'
Observers say listing of private surgery fees helps patients but may have limited impact on prices
By Salma Khalik, Senior Health Correspondent, The Straits Times, 6 Oct 2016

With the move to provide a breakdown of private sector operation fees, the hope is that surgeons will be more mindful about how much they charge their patients.

Ms Tin Pei Ling, who is on the Government Parliamentary Committee for Health, said: "It does not mean that surgeons cannot charge above the norm, but then they will have to give patients a full and proper explanation."

The public can now see how much private sector surgeons charge for a range of common procedures.

Dr Lee Hung Ming, a private ophthalmologist, said making fees more transparent is the right step forward. He said: "It provides not only local patients but also foreign patients with sufficient data and information on the range of fees charged by the majority of surgeons and hospitals in Singapore for commonly performed operations.

"This transparency... will help enhance Singapore's reputation as a regional medical hub."

But making the information public has its limits in keeping prices down, said those interviewed.

For one thing, the data given is just a broad range.

Mrs P.K. Sandhu, 49, a mother of three, said it was good to know how much doctors are charging but it might not be that useful.

Knowing the range of fees surgeons charge does not help in finding a particular one whose fees are reasonable, she said. She added that if she trusted a surgeon, she would be willing to pay a bit more: "If his fees are way higher than the range given, I would ask for an explanation. If he gives me a good answer, I would stay with him."

The Singapore Medical Association (SMA) said it has always advocated more transparency on charges, but added: "It is too early to tell if this will have any impact on healthcare costs."

It noted that the data is based on actual fees charged and is not a guideline. SMA had previously offered guidelines but later removed them due to anti-competition issues.

The association added yesterday that there are individual variations in disease severity as well as other factors that may add to the complexity of a case and, thus, the fees charged. "In addition, patients must take into account the experience and expertise of the treating doctor," it said. "MOH (Ministry of Health) should monitor the situation carefully over the next few months before we think of publishing other data."

Ms Tin said the initiative was "a positive step in the right direction in helping patients make more informed decisions", and is useful to people who do not have a particular surgeon in mind and are not "super rich", but who want to opt for surgery in a private hospital, she said.

"Looking ahead, one suggestion is to have the list of medical conditions expanded, potentially including non-surgical types."

Related
MOH Publication of 'Total Operation Fees' to include fees in Private Hospitals
Total Operation Fees - By Procedure
Total Hospital Bills - By condition/procedure