Mailbox: Health-care costs can't keep rising

My letter ("Reasons for soaring private health-care costs"; last Thursday) has stirred a hornet's nest. The most vocal critics are doctors who think the party can go on indefinitely - that patients would choose to pay more every year, or insurers would take ever rising claims in their stride.

They should be thankful I have warned of the impending train crash for privately funded health care. Foreign patients have already started to vote with their feet.

Yet other doctors have called me to tell me about even worse abuses of the free market system for doctors' fees.

Dr George Wong Seow Choon ("Medical advances come at a cost"; last Saturday) is correct in many aspects, and it also illustrates how easy it is to be seduced by those who claim that technological advances have changed the practice of medicine.

New and expensive technology still has to be carefully selected for the appropriate clinical circumstance. Video laparoscopic surgery and robotic surgery, including the da Vinci system, have improved outcomes in some instances. Yet unscrupulous doctors can use technology to their advantage.

Several years ago, a very rich patient had a small breast lump removed by the da Vinci robotic system and was billed $70,000 for the surgeon's fee alone. Conventional open surgery would have taken one-third the time at less than one-fourteenth of the price.

Some doctors have claimed I have not kept up with advances in medicine, and that up to 5 per cent of patients with plantar fasciitis will require surgery. The patient I described had open surgery after three days of heel pain and was never offered any alternative treatment.

Honest and ethical medical practice and putting the patient's interest first have not gone out of fashion. These remain elements of an equitable civic society.

It is time for the Health Ministry to seriously monitor and control rapidly rising health-care costs.

The Monetary Authority of Singapore has far greater powers than the Singapore Medical Council, while transport providers are overseen by the Public Transport Council. The Ministry of National Development has even decided that housing should not be left to the free market.

Last year, a visiting Health Manpower Development Programme expert from the United States warned that health-care costs in America could not possibly continue on their present trajectory. Isn't this also true for Singapore?

Tang Kok Foo (Dr)

This article was first published on Aug 19, 2014.
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