About bill sizes, doctor exodus...

26 June 2012, The Straits Times

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

Reply from MOH

29 June 2012, The Straits Times

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 (www.moh.gov.sg) 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
Ministry of Health