Mailbox: Reasons for soaring private health-care costs

Doctors' bills are arguably the most rapidly escalating component of private health-care costs.

I am amazed at how expensive it has become to be treated by doctors in private practice over the past five years. The surgical fee for simple lumbar disc surgery has shot up from $5,000 to as high as $25,000, even when performed by junior doctors.

The free market in health care is among the reasons for the astronomical rise in fees.

An ear, nose and throat surgeon once told me that since the Government abolished guidelines on professional fees, he has been competing actively with his colleagues to see how high his fees can go.

The professional fee system in public hospitals, where foreign patients can be surcharged up to 400 per cent, is a good "training ground" for doctors charging higher fees when the market can bear it.

Then, there is the vicious circle of rising clinic costs and overheads.

Doctors who face escalating rents for clinic space have no choice but to charge more, which in turn attracts more doctors, mostly from public hospitals, to go private. With greater demand for clinic space, rents continue going up.

Another factor is the fee-for-service model, which incentivises doctors to provide more treatments.

I have been in private practice for 24 years and have not encountered any local surgeon operating on a closed collarbone fracture until the past year, when there were three cases. Last year was also the first time I saw a patient undergo an operation for plantar fasciitis, or jogger's heel.

On the other side of the equation are frightened patients who are eager to undergo treatment even if it is not necessary.

For instance, many patients with bulging spinal discs that do not cause any health issues have agreed to surgery after being warned they could become paralysed if they have a fall.

"Pay as charged" insurance policies also encourage doctors to charge higher fees, since these will be covered by insurance. A patient once said that a surgeon told her not to worry about her $55,000 cervical spine surgery as it would be paid by the insurance company.

Singapore patients have good reasons to be afraid.

Letter from Tang Kok Foo (Dr)

This article was first published on August 14, 2014.
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