SINGAPORE: Patients who opt to do surgical procedures at private hospitals will now be able to get a better sense of their medical bills beforehand, with benchmarks on professional fees being made available from Tuesday (Nov 13).



The benchmark fees for 222 common surgical procedures, including Caesarean section, heart bypass and knee replacement, are published on the Ministry of Health (MOH) website. They make up more than 85 per cent of surgical procedures done in private hospitals on Singaporeans in 2017.





Making the announcement, the ministry said this is part of measures to improve transparency and tackle rising healthcare costs.



Private healthcare costs rose 9 per cent year-on-year from 2007 to 2017, almost double the increase in public healthcare costs, the Fee Benchmarks Advisory Committee said.

Healthcare inflation was 2.6 per cent and hospitalisation inflation was 3.8 per cent from 2007 to 2017, both higher than general inflation of 2.3 per cent during the period, it added.





FEES ABOVE BENCHMARK DON’T MEAN OVERCHARGING



The committee which developed the benchmarks was appointed by MOH in January this year and includes representatives from the medical community and the insurance industry.



Apart from looking at fees charged by private doctors for more than 200 surgical procedures in 2017, committee chairman Dr Lim Yean Teng said other indicators such as inflation were also taken into consideration.

To ensure that the benchmarks reflect a fair range of professional fees for the procedure, the committee also considered other factors such as the complexity of the procedure and the time, effort and expertise required of the doctor for typical cases, MOH said.



As an example, the professional fee for a single knee replacement surgery ranges from S$8,250 to S$10,700. But that doesn't mean that a doctor is necessarily overcharging if the fees are above the benchmark, Dr Lim said.



“The doctor may have a good reason to quote a higher fee for the particular surgery for the patient,” he said. He gave the example of a patient with an underlying kidney failure or heart disease.



“You have to do extra monitoring. The surgery may have to be done under certain conditions that are more complicated than the usual surgery.”



Interventional cardiologist Associate Professor Abdul Razakjr Omar said that in his practice, more than 90 per cent of procedures are not complex.

"(A) sick person often has neither the time nor inclination to shop around to determine what a reasonable price should be ... (the) fee benchmark is the right way forward," said Dr Razakjr, who is also the deputy medical director at Raffles Hospital.

Doctors who charge above the benchmarks would have to explain their reasons for doing so when asked, the committee said.



CONSULTATION FEES AND ANAESTHETIST FEES MAY BE REVIEWED NEXT



The committee was tasked by the MOH to focus on fees charged for common surgical procedures by doctors in the private sector for a start, as they are typically one of the "sizeable components" of total hospital bills, Dr Lim said.

Such fees usually make up about 30 per cent of the bill, MOH said.



Senior Minister of State for Health Dr Lam Pin Min told reporters on Monday that the committee may look into consultation fees and anaesthetist fees next.



“We will also gather feedback from the ground, from various stakeholders to see what other areas the review committee should be looking at before deciding on the actual scope of the work,” he said, adding that the hope is that the committee will decide on the scope for review in the next one to two years.



Dr Lim said that ultimately, the effectiveness of the fee benchmarks depends on how well it is accepted and utilised.



“We believe that as long as all the stakeholders involved collectively and consistently make use of it, it can help to limit the rapidly rising healthcare cost.”



MOH said that patients are encouraged to use the benchmarks to have a conversation with their doctor on their treatment, the complexity of their condition and the fees charged.



The benchmarks also support insurers in taking an active approach to their claims assessment, product design and selection of preferred healthcare providers for their panel, the ministry added.



INSURERS, CASE WELCOME BENCHMARKS



The Life Insurance Association (LIA) said on Wednesday that it supports the benchmarks, one of the initiatives to slow down healthcare inflation recommended by the Health Insurance Task Force in 2016



They are “paramount to improving the transparency of medical costs in Singapore”, it said.



“It will help bridge the information asymmetry gap which currently exists between healthcare providers and consumers, and help patients receive appropriate care at fair and reasonable costs."



It will also help “mitigate cases of over-charging by providers and empower insurers to detect inflated claims and take an active approach towards claims adjudication,” the industry body added.



Consumers Association of Singapore (CASE) executive director Loy York Jiun said the benchmarks are a good step towards making surgical fees more public and transparent for consumers, allowing them to make a more informed decision.



“It will also help to limit excessive markups in surgical fees by setting an upper limit,” he said.



“We would also like to encourage surgeons to display the corresponding MOH fee benchmarks for their procedures to allow consumers to make a more informed choice,” he added.

