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It's final - SMA's medical fee guidelines anti-competitive

View Poll Results: Do you think it is beneficial for the public to have medical fee guidelines?
Yes 2 28.57%
No 2 28.57%
Can't be bothered 3 42.86%
Voters: 7. You may not vote on this poll

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Old 20-08-2010, 11:10 AM   #1
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It's final - SMA's medical fee guidelines anti-competitive

http://www.channelnewsasia.com/stori...075966/1/.html

It's final - SMA's medical fee guidelines anti-competitive
By Claire Huang | Posted: 19 August 2010 1323 hrs

SINGAPORE: The tussle between the Singapore Medical Association (SMA) and Competition Commission of Singapore on guidelines on doctors' fees has finally ended.

After an 18-month review, the Commission concluded that the Guidelines On Fees set by the SMA are anti-competitive.

In February last year, SMA had filed a notification to find out if the guidelines infringe the Competition Act.

In June this year, the Commission issued a provisional statement saying the guidelines are anti-competitive, thereby infringing Section 34 of the Competition Act.

On Thursday, the CCS laid out the grounds for its final decision not to have such guidelines.

It said the guidelines apply to the private healthcare sector only and create a cluster effect.

This means that by setting a fixed fee, doctors who are able to charge less, will have no incentive to do so.

Mr Teo Eng Cheong, Chief Executive of CCS, said: "If you look at the hospital care segment, about 80 per cent is provided by government restructured hospitals and government clinics, and these government hospitals and clinics do not refer to the guidelines on fees that SMA had issued in the past."

Mr Teo also rejected the idea that the remaining 20 per cent of consumers are left to fend for themselves.

He said: "80 per cent of the market do not refer to the GOF (Guidelines on Fees) and are able to function effectively in the absence of the GOF. As for the remaining 20 per cent that chooses to go to the private sector, they can still refer to the costs in the public sector hospitals. If you look at the MOH websites, they've listed out for a number of common diseases the average bill sizes you are expected to incur in the hospital."

Mr Teo added that there are safeguards for patients even without SMA's guidelines.

One example is the Health Ministry's requirement for doctors to display their charges at their clinics.

The Commission's decision comes as no surprise as the government had thrown out the SMA's request for its Guidelines On Fees to be excluded from the Competition Act in June this year.

After consulting the Health Ministry, the Ministry of Trade and Industry (MTI) determined that the guidelines would create anti-competitive behaviour and cannot be excluded from the Competition Act.

The guidelines were introduced in 1987 by SMA and the Association of Private Medical Practitioners of Singapore (APMPS), following the Health Ministry's calls for a guide on medical charges so as to equip patients with pricing information on consultation and surgical fees and to prevent private doctors from overcharging.

In April 2007, the SMA removed the guidelines voluntarily on legal advice that they could contravene the Competition Act.

It then sought to have the guidelines reinstated, but was rejected.

After the guidelines were removed in 2007, there wasn't a significant increase in overcharging complaints to the SMA, said the Commission.

In fact, numbers have gone down from 26 in 2006/2007 to 14 in 2008/2009.

A market study conducted from second quarter last year till first quarter this year found that after accounting for medical inflation, professional fees charged by private doctors actually dropped by 2.6 per cent after the guidelines were removed.

Mr Teo said this further fortifies the fact that the guidelines, which aren't binding in the first place, have no impact on private doctors' fees.

The study, which covers the periods before and after the guidelines were removed, sought the opinions of stakeholders including insurance companies and certain segments of the public.

There may be no guidelines on fees for the private sector but the government is pushing for more transparency in this area, which is why, from early next year, all hospitals making Medisave claims will have to submit basic billing information and this information will be posted on the Health Ministry's website.

Hospitals and doctors are also required to provide financial counselling, said Mr Teo.

He pointed out that in a competitive market, prices are determined by demand and supply.

Minimum or maximum pricing recommendations discourage competition, so the Commission urges all businesses to set their prices independently and not rely on guidelines issued by trade and professional associations.

The Commission explains that its decision is also in line with treatment price recommendations for healthcare in countries like the US, UK and Finland.

On the outcome of the ruling, Dr Chong Yeh Woei, president of SMA said the guidelines have outlived their usefulness.

He said: "We just hope that the ministry will be able to improve the regulation such that there will be transparency of fees. We're particularly concerned about the minority who use the private sector and the medical tourists."

"Patients will look at doctors as doctors, whether they're from public sector or private sector. So the downside risk of this is that the trust between the doctor and the patient will be eroded," added Dr Chong.

SMA said it will continue to publish data on specialists' fees to give patients some information on pricing in the private medical sector.

SMA has two months to appeal against the Commission's ruling.
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Old 20-08-2010, 11:17 AM   #2
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it is final... people really do not bother to read a damn sticky thread.

my personal opinion is that clinics should list all items and their charges but a guideline on prices is not the way to go.
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Old 21-08-2010, 05:33 PM   #3
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Please follow the article quoting format as indicated in the sticky thread.

Please include the source of the article. Outside the quotes, please express your clear opinion.

Please put the article contents within quotes like this:
*article contents*
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Old 21-08-2010, 10:17 PM   #4
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it is final... people really do not bother to read a damn sticky thread.
of cos. The accumulated opinion of the internet say so... look at all the threads here...


my personal opinion is that clinics should list all items and their charges but a guideline on prices is not the way to go.
No... Medical charges are on an essentials goods (your health). Even if the doc charges to the limit of your wealth, you have no choice but to accept. Without a guideline that is reasonable, docs are free to "overcharge". We are going to have higher medical cost with this change...
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Old 22-08-2010, 12:23 AM   #5
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of cos. The accumulated opinion of the internet say so... look at all the threads here...



No... Medical charges are on an essentials goods (your health). Even if the doc charges to the limit of your wealth, you have no choice but to accept. Without a guideline that is reasonable, docs are free to "overcharge". We are going to have higher medical cost with this change...
you do realise that when the CCS told them to stop using the guideline, average prices went down by 2.6 percent??

medical inflation may mean an increase on prices of meds and equipment. but if all items that is chargeable to me is listed, the patient can understand where the charges are and if compared with another place is found to be much higher an complaint can be raised.

that is where the competition lies. if the doctors who can link up with more clinics and order drugs in bigger batches amounting to a higher discount they can either charge at lower prices or collectively jack up to gain higher profit.

thing is with the non-guideline there might be other clinic networks out there that will charge lower.

if the guideline is still around and says 6 dollars for a swab then all clinics will use 6 dollars. I do not think at any point in time was the guideline meant to reduce prices but to provide so called "uniform" pricing instead.
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Old 22-08-2010, 09:38 PM   #6
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As long as there are sufficient players in the market which operate in a fair fashion and pass on savings to the consumer, the market should be relatively healthy. In this case, as long as the healthcare provider is mandated by law to list down all costs and have price transparency, I believe information asymmetry will continue to be low.

There is no perfect solution. - there is always the possibility of corruption and excessive greed with all the players come together to screw us, just like with the health insurance sector in America rallying together to screw Obama's public healthcare plans.
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Old 22-08-2010, 10:42 PM   #7
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you do realise that when the CCS told them to stop using the guideline, average prices went down by 2.6 percent??
Once the major chains start charging higher due to "higher cost", the smaller ones will follow.


medical inflation may mean an increase on prices of meds and equipment. but if all items that is chargeable to me is listed, the patient can understand where the charges are and if compared with another place is found to be much higher an complaint can be raised.
patients see the charges only when making payment. Plus, how do we know if the doctor's assertion that some test/procedure is necessary are really so???


that is where the competition lies. if the doctors who can link up with more clinics and order drugs in bigger batches amounting to a higher discount they can either charge at lower prices or collectively jack up to gain higher profit.
That is the ideal situation. But the bigger chains do not charge a lower price. The smaller clinics do.


thing is with the non-guideline there might be other clinic networks out there that will charge lower.
The guideline do not prevent other clinics to charge lower.


if the guideline is still around and says 6 dollars for a swab then all clinics will use 6 dollars. I do not think at any point in time was the guideline meant to reduce prices but to provide so called "uniform" pricing instead.
Are you sure? There were differences in pricing even then. Just that patients during those times knows what is the expected fair price for a test/procedure if they bother to check. Now? Patients have no way of knowing if they are overcharged...
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Old 23-08-2010, 08:21 AM   #8
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I think that if your family doctor wants to do a blood test for you and does not suggest that you go to the polyclinic (so that you can be subsidized) then that family doctor might not be worth going to.

for procedures and test done at private clinics, I would say unless it is really required. Do them at a polyclinic. The subsequent referral to a hospital if required will also be cheaper.
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Old 23-08-2010, 08:45 AM   #9
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I think that if your family doctor wants to do a blood test for you and does not suggest that you go to the polyclinic (so that you can be subsidized) then that family doctor might not be worth going to.
There could be a million and one reason to do a test in the GP clinic.


for procedures and test done at private clinics, I would say unless it is really required. Do them at a polyclinic. The subsequent referral to a hospital if required will also be cheaper.
Who are we to say if it is requried or not? the bulk of the population is not educated enough to question the doctor's wisdom or lack of. If the GP say it is a necessary test, how do we really know if it is not?
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Old 23-08-2010, 09:24 AM   #10
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even though I am not a doctor I still ask all sorts of questions when I visit my doctor.

there is really nothing wrong asking what is wrong when speaking to your doctor.

now unless you are unconsious, bleeding or in severe pain. Not much is going to be so critical that you need it done right there right now. a good doctor in my eyes will tell you, "ok we could this here and that will make you feel better in like 30 minutes but I still want you to get yourself to a polyclinic."

I get your point though, not many people get the whole "ask my doctor what this is for" thing.
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Old 23-08-2010, 12:07 PM   #11
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Voted no. I want transparency (ie they all publish all their fees so that we can compare and choose), not guideline (which all of them stick to the pricing ie no competition between them).

guideline is not transparency.
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Old 23-08-2010, 12:12 PM   #12
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the regulations have been changed to list all items on the bill.

family clinics may not really follow it to the letter but at least dental clinics and the hospitals do.

dental wise, the charges are still a little sketchy but at least you know if your teeth are in good condition then when you go for maintenance it will cost less. Not that you skip it but it will cost less. And also give you less problems which will cost a bomb... a root canal is really the bomb...
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Old 05-12-2012, 12:22 AM   #13
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Smile Appalled by clinic's charges

It's final - SMA's medical fee guidelines anti-competitive - Channel NewsAsia
It's final - SMA's medical fee guidelines anti-competitive
By Claire Huang | Posted: 19 August 2010 1323 hrs
SINGAPORE: The tussle between the Singapore Medical Association (SMA) and Competition Commission of Singapore on guidelines on doctors' fees has finally ended.
After an 18-month review, the Commission concluded that the Guidelines On Fees set by the SMA are anti-competitive.....
The Straits Times; Published on Dec 04, 2012
Appalled by clinic's charges
RECENTLY, I fell and suffered a small cut at the arch of my foot. The wound was promptly dressed, but there was still some bleeding the next day.
My grandparents noticed and insisted I consult a doctor. They brought me to Peach Family Clinic in Ang Mo Kio where one Dr Wong was on duty. He looked at the wound and said that my mum had done a good job cleaning it and that I need not have consulted him. He proceeded to treat it anyway, applying antiseptic and redressing the wound with a plaster. I was in and out of the clinic in five minutes.
But the bill surprised me: $20 for the consultation, $20 for the procedure and $7.29 for medication and GST - totalling $47.29. I was appalled.
Cheryl Ng (Ms)
Appalled by clinic's charges
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Old 05-12-2012, 11:55 AM   #14
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The Straits Times; Published on Dec 04, 2012
Appalled by clinic's charges
RECENTLY, I fell and suffered a small cut at the arch of my foot. The wound was promptly dressed, but there was still some bleeding the next day.
My grandparents noticed and insisted I consult a doctor. They brought me to Peach Family Clinic in Ang Mo Kio where one Dr Wong was on duty. He looked at the wound and said that my mum had done a good job cleaning it and that I need not have consulted him. He proceeded to treat it anyway, applying antiseptic and redressing the wound with a plaster. I was in and out of the clinic in five minutes.
But the bill surprised me: $20 for the consultation, $20 for the procedure and $7.29 for medication and GST - totalling $47.29. I was appalled.
Cheryl Ng (Ms)
Appalled by clinic's charges
Cherry, it is unbecoming of you to dig up a two-year old thread.....with a cut-paste.
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