ABOUT half of the 20 general practitioners in a Straits Times survey have ignored a new guideline that requires them to give patients an itemised bill.

The detailed breakdown, which became compulsory in April, separates items like consultation fees and medication and is designed to help patients understand exactly what they are paying for.

While most specialists appear to comply, many GPs still give patients a lump-sum bill. A Straits Times check found that, while 10 out of 10 specialist clinics offered itemised receipts, nine out of 20 GP clinics did not. Three did not issue a bill at all and one even refused a patient an itemised bill.

One industry insider said some doctors charge above market rates for drugs and are wary about losing out on the margins, a major part of their business.

At a clinic in Dover Road, a patient who wanted to be known only as Miss Koh, said she was recently refused an itemised bill.

'I know from experience the cost of a drug can vary quite a bit between doctors, so I always try to get a breakdown for comparison,' said the 31-year-old.

Already, some patients have benefited from the transparency guideline and saved money on drugs. Pharmacist Tan Soo Tong said up to a dozen patients come to his Unity Pharmacy in Thomson Plaza daily with prescriptions.
'Most of them come because medication is cheaper (than in a GP's clinic),' he said.

Dr K.K. Chong, a GP at a clinic in Bukit Purmei, was one of nine in the Straits Times check who did not offer a detailed price breakdown to patients. When contacted, he said his clinic provides an itemised bill to those who ask. He said itemisation drives up the cost of visiting a GP.

'Doctors have always been trying to keep costs down for needy patients by subsidising consultation fees and margins of medication,' said Dr Chong. 'But with itemisation, the fee has to be broken down and it will be difficult for costs to be capped.'

Some doctors cited the cost of computerising their system as one hurdle. But the Singapore Medical Association (SMA), which represents most doctors here, said bills can still be handwritten.

For those who have gone digital, like Dr Ong Kian Chung, a respiratory physician at Mount Elizabeth Medical Centre, the transition has not been a major problem. He spent $4,000 to computerise his system in 2005 and has itemised his bills since.

'Patients are able to look at the items and see what exactly they are being charged for,' said Dr Ong.

Before the April 1 deadline, the SMA heard concerns from doctors about the transparency of charges and how the bill should be broken down, said its vice-president, Dr Chong Yeh Woei. It issued an advisory in February to members which included a sample copy of a bill, he added.

Madam Halimah Yacob, head of the Government Parliamentary Committee for Health, said itemised billing is unlikely to have a major impact on most practices.

'Not many, in my view, would want to change doctors just for a few dollars less, especially if they are satisfied with their doctor's service,' she said.

Itemised billing is practised by other businesses, from supermarkets to law firms, and doctors should not be an exception, she added.

jessicaj@sph.com.sg

This story was first published in The Straits Times on June 2, 2008.