Private docs can set own fees as SMA drops guidelines

PRIVATE doctors here are free to set their own fees from now, instead of referring to guidelines drawn up by the Singapore Medical Association (SMA).

The SMA agreed to withdraw the guidelines during its annual general meeting on Sunday after receiving word that the guide could be in contravention of the recently- enacted competition code.

SMA President Wong Chiang Yin told The Straits Times yesterday that it would be contacting its 4,800 members this week to alert them to the surprise change.

It is not known how the move will affect the fees doctors charge, but Dr Wong suggested that doctors refrain from making 'drastic changes in the short-term' to avoid worrying patients and escalating health-care costs.

To help patients make fee comparisons, he added that the SMA will survey private doctors on their fees and publish the results online.

The fee guide, started in 1987 for both general practitioners (GPs) and specialists, was intended to inject some transparency into private medical charges.

It was mooted by the Government to prevent cases of rampant overcharging. It said it would legislate fees if the medical fraternity did not take things in hand.

In response, the SMA came out with a guide giving a range of charges for various services, including what doctors can charge on weekends and public holidays, and even for issuing a death certificate.

For instance, it lists the charge for a 10-minute consultation with a GP at between $10 and $20. For a similar consultation with a specialist, the recommended charge was between $60 and $100.

Although doctors did not need to abide by the benchmark, they had to inform patients of their charges before seeing them.

If they did not, patients could have complained to the SMA. It would then refer to the guide to enforce refunds.

However, since the Competition Act was enacted last year, the SMA has been grappling with the legality of the guidelines.

It consulted its lawyers and was told the guidelines could be illegal.

However, the SMA had several misgivings about withdrawing them. One concern was whether patients with small claims would have an avenue for redress if the guidelines were withdrawn,

Dr Wong also argued that patients, especially those who need specialist treatment, are not like other consumers who 'shop around' for better value for money.

The association then decided to write to the Competition Commission for clarification.

However, the commission reiterated a section of the Act stating that 'recommendations of a trade association in relation to price...may be considered to be price-fixing, regardless of the form it takes'.

When contacted yesterday, the chairman of the Government Parliamentary Committee for Health Halimah Yacob expressed dismay at the change and said: 'Health care is an important public good that should be exempted from the competition code.'

The 'greatest casualty', she said, will be transparency.

But the executive director of the Consumer's Association of Singapore Seah Seng Choon felt that the withdrawal is 'good in principle as it endorses the concept of free competition'.

He said doctors should display their fees clearly in their clinics so patients know the charges before they decide to seek treatment.

The commission was unable to respond to queries yesterday.

The Health Ministry told The Straits Times yesterday that under its guidelines for private hospitals and medical clinics, doctors are encouraged to publish their consultation charges before seeing patients.

A separate law under the Private Hospitals and Medical Clinics Regulations also requires hospital managers to inform patients before or on admission the estimated total charges for their stay.

It said it will continue to publish pricing data and historical price trends on its website.