Doctor's charges: How high is too high?

SINGAPORE - Doctors have revealed which factors they use to determine the size of their bills, in the wake of the Susan Lim overcharging case.

Public sector fees, insurance payouts and peer pressure all help them to gauge the "ethical limit" on how much specific services should cost.

Eight doctors spoke to The Straits Times following Dr Lim's failure to overturn her professional misconduct conviction.

The 58-year-old surgeon had appealed against her three-year suspension and $10,000 fine for charging $24 million to treat a royal patient from Brunei.

But the Court of Three Judges upheld the verdict, saying medical fees have an "ethical limit" - regardless of market forces or contracts signed by the patient.

While this limit is not fixed, fellow doctors and patients play a large role in pricing policies in the private sector.

Medical oncologist Wong Seng Weng, who runs practices at Paragon and Mount Elizabeth Novena Specialist Centre, said these factors give doctors a sense of where the average price hovers.

"Most people who have been practising for quite some time will know roughly how much a service costs from speaking to peers or to patients who may doctor-hop." Dr Tony Tan, who heads the Obstetrical & Gynaecological Society of Singapore, said peer pressure and criticism will probably keep up to 90 per cent of doctors in check. "Doctors are the worst critics of one another," he added.

Liver specialist Desmond Wai, who practises at Gleneagles Medical Centre, said one way to gauge how much to charge is to look at prices at public hospitals, which are available on the Health Ministry's website. Patients' insurance policies also help as there are fixed sums that can be claimed for specific procedures.

But others believe clearer benchmarks will help prevent cases such as Dr Lim's from happening again.

Fee structures are "necessary to prevent exploitation", said one primary care doctor who did not want to be named. He added that medicine "cannot be treated like any other business, subject to the same commercial considerations or anti-competition laws".

The Singapore Medical Association published guidelines in 1987, but they were scrapped six years ago due to the Competition Act, which aims to stamp out anti-competitive practices.

Dr Jeremy Lim, an expert in health systems, said: "In the absence of specific guidelines, it will be near impossible to know where the lines are drawn."

Meanwhile, lawyers told The Straits Times they are also subject to ethical limits. "Overcharging is not allowed," said lawyer Nicholas Narayanan.

But like doctors, the legal profession does not have written price guidelines. To minimise fee disputes, lawyers say they generally enter into written agreements with clients right from the start.

Architects told The Straits Times they do not have ethical limits as their industry is client-driven. When a tender is called, it is in their interest to submit a competitive price.

"If you mark up your costs too high, you'll lose out," said architect Amy Heng, 27.

Meanwhile, the Health Ministry yesterday described the decision to turn down Dr Lim's appeal as "necessary in order to preserve the relationship of trust and confidence between the medical profession and the public".

The Straits Times understands that the surgeon may still be able to practise overseas, even while suspended, if she can obtain the necessary medical registration in that country.

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