Why Stop Doctors from Charging Polyclinic Rate?
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ST forum has published an interesting article on "Why Stop Doctors from Charging Polyclinic Rate" by Leong Sze Hian on April 5.
It has brought up an interesting question:
"Why is it that doctors are not allowed to charge a fee (which is $ eight) that is 55% lower than the SMA recommended fee (which is $ eighteen)?"
If not for this article, I may not have known that there is a clinic in my neighbourhood which is charging at polyclinic rate.
www.clinicsingapore.com
Just when we thought that much have been done to lower our medical cost, infact very much more can still be done.
Why must SMA laid a recommended consultation fee?
Should our polyclinics look into their charges again? -
SMA should seriously revise the rate down
since so many doctors these days don't cure the patient on the
first visit but the second or even third. There are just plenty of
room of abusing patients with the current rate.
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Well this is simply because polyclinics are heavily subsidized by the government, whereas your friendly neighbourhood GP is not. Therefore, polyclinics can afford to charge $8 whereas how in the world is your GP going to survive at those rates, considering that he has to pay for the nurse, the rental, and the drugs?
The SMA ruling acts as a safeguard to prevent doctors from undercutting each other. Sure, the GP can charge polyclinic rates but how is the GP going to ensure that he brings home a decent pay every month? He would probably do that at the expense of the patient lor... Stinge on investigative procedures, give cheaper, less effective drugs etc. Furthermore, if GPs were to charge polyclinic rates, the polyclinic patients will all flock to the GPs and the GP will probably be able to afford spending only 3 minutes per patient. All this will contribute to a decline in the quality of health care in Singapore.
I think the current system works perfectly fine.. for the budget conscious, there is always the polyclinics. For those who want better service (less queue, better drugs, more attention etc), he must be prepared to pay more to see the GP lor. -
If poly clinics have to close down like mediacorps channel "I" because of competition, so be it . Why hold back competitions all over the island when government keeps saying that there should be competitions to renew ourselves. Government should practise what it preaches. If it allows foreign contractors, professionals and workers to come in to compete with citizens for works and jobs, then it should not keep quiet about such medical cartel practices.Originally posted by iamgoondu:ST forum has published an interesting article on "Why Stop Doctors from Charging Polyclinic Rate" by Leong Sze Hian on April 5.
It has brought up an interesting question:
"Why is it that doctors are not allowed to charge a fee (which is $ eight) that is 55% lower than the SMA recommended fee (which is $ eighteen)?"
If not for this article, I may not have known that there is a clinic in my neighbourhood which is charging at polyclinic rate.
www.clinicsingapore.com
Just when we thought that much have been done to lower our medical cost, infact very much more can still be done.
Why must SMA laid a recommended consultation fee?
Should our polyclinics look into their charges again?
The high-cost problem is very serious. There is something seriously wrong with the current system of charging for government services. Land costs and certain fixed equipments are already paid by taxpayers from the public funds and therefore govenment has no moral or legal right to charge for such costs again especially for essential services like medical treatments.
After practising non-welfarism for so many years by jacking up fees and charges to the sky and saying there are no free lunches then the government should not take free lunches in the form of charging doubly for lands, and fixed assets built under taxes by charging such components again as they are already paid by taxpayers. -
I did not see logic in your argument.... y can't they let the doc and the patient determine the rate? If the rate is too low, the doc will go out of business, if the service is not good, the patient will not go to the doc... will also close shop.Originally posted by cornyfish2000:Well this is simply because polyclinics are heavily subsidized by the government, whereas your friendly neighbourhood GP is not. Therefore, polyclinics can afford to charge $8 whereas how in the world is your GP going to survive at those rates, considering that he has to pay for the nurse, the rental, and the drugs?
The SMA ruling acts as a safeguard to prevent doctors from undercutting each other. Sure, the GP can charge polyclinic rates but how is the GP going to ensure that he brings home a decent pay every month? He would probably do that at the expense of the patient lor... Stinge on investigative procedures, give cheaper, less effective drugs etc. Furthermore, if GPs were to charge polyclinic rates, the polyclinic patients will all flock to the GPs and the GP will probably be able to afford spending only 3 minutes per patient. All this will contribute to a decline in the quality of health care in Singapore.
I think the current system works perfectly fine.. for the budget conscious, there is always the polyclinics. For those who want better service (less queue, better drugs, more attention etc), he must be prepared to pay more to see the GP lor.
The market forces will determine the best price/quality of service... no need to regulate everything on earth. -
Well of course they can let the doc and the patient determine the rate, in fact that's what they are doing now. Only that what we have now is a minimum charge of $18 per consultation to ensure that even if GPs were to charge that rate, he would still be able to afford to give a reasonable standard of care to his patients.Originally posted by diggo:I did not see logic in your argument.... y can't they let the doc and the patient determine the rate? If the rate is too low, the doc will go out of business, if the service is not good, the patient will not go to the doc... will also close shop.
The market forces will determine the best price/quality of service... no need to regulate everything on earth.
Without the minimum limit, the GPs will start to undercut each other to ridiculously low prices. Say, if the GP were to charge only $8 a person, he will certainly not be able to do blood tests, urine tests, give the newest and most effective drug that he thinks is best and yet remain viable right? Considering the high overheads (rental etc) that he has to factor in as well. Also, he will have to see three times his usual number of patients in the same amount of time to earn back his salary. So how long do u think the doc can afford to spend per patient?
Then u say if thats the case the docs will go out of business, and GPs will close shop etc etc.. ok, then where will that leave us? Everyone will have to cross the island and queue 5 hours to see the few GPs who still manage to survive in Singapore. We wanna pay rock bottom prices yet demand a high level of medical care.
Medical care is different from say goods and other services. We can tolerate poor service from a restaurant which is trying to cut cost but we cannot have the doctor compromise his level of professional medical care by cutting costs. Human lives are at stake here, right?
So our system now is such that there is a minimum charge for GPs ( $18 ), and then it's up to the GP himself to decide if he wants to charge the minimum or higher (up to $45 i think). So in a sense market forces still come into play, but at the same time we are ensuring a minimum standard of professional care on the part of the doctors.
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How does charging $18 ensure quality of health care? Or charging $100 for that matter?Originally posted by cornyfish2000:Well of course they can let the doc and the patient determine the rate, in fact that's what they are doing now. Only that what we have now is a minimum charge of $18 per consultation to ensure that even if GPs were to charge that rate, he would still be able to afford to give a reasonable standard of care to his patients.
, he will certainly not be able to do blood tests, urine tests, give the newest and most effective drug that he thinks is best and yet remain viable right?
Then u say if thats the case the docs will go out of business, and GPs will close shop etc etc.. ok, then where will that leave us? Everyone will have to cross the island and queue 5 hours to see the few GPs who still manage to survive in Singapore. We wanna pay rock bottom prices yet demand a high level of medical care.
So our system now is such that there is a minimum charge for GPs ( $18 ), and then it's up to the GP himself to decide if he wants to charge the minimum or higher (up to $45 i think). So in a sense market forces still come into play, but at the same time we are ensuring a minimum standard of professional care on the part of the doctors.
I have been to Snr Consultant that charges $78 per session that leave much to be desired.... whereas some neigbourhood GPs has become firm amily doctors.
BTW, the amount stated is for basic consultation and medication onli and does not inlcude additional test. Same as in Polyclinic where they will charge for additional items done.
Overall, I feel that the health care cost in SGP is too high. -
it seems unfair that the doctor is not allowed to lower this prices. after all, the doctor can always rise this prices later.
this seems like a unfair cartel practice. if a price war results from all the doctors undercutting each other and the standard of care drops, then we can have laws and guidelines to ensure that this is remedied. -
basically speaking, its the same ideas behind the reasons for our minsters' high pay
high pay= less corruption less competent
low pay = more corruption more competent? not really
it is said, "when you pay peanuts, you get monkeys"
but somehow in sg, no matter what you pay. you still get monkeys -
Guys, please refer to the reply in today's Straits Times Forum page for a response from a practising family doctor.
i'm not a doctor myself and of course i would love to pay as little as possible and yet enjoy the benefits of excellent health care. But do u think it will be fair for us to expect good medical service when we don't even pay the docs enough to cover their operating costs? As i've mentioned in my earlier posts, a decline in medical service standards would be inevitable. We have to bear in mind that the neighbourhood clinics aren't charitable organizations.. the doctors have families to feed too. More importantly, unlike polyclinics, GPs are not subsidized by the govt.
As for how a min charge of $18 will ensure medical service standards are kept.. well, i'm not sure how SMA came up with this figure in the first place. But my guess is that this figure was probably based on the average no. of patients that a GP sees everyday, such that after deducting the operating costs, the doctor will be able to bring home a decent salary. Hence with this min. charge, the doctor will be able to do whatever he thinks is best for the patient, afford to spend time with each patient without having to worry about cutting costs to ensure that he still brings home a reasonable salary.
Hence this $18 min charge acts to prevent unhealthy price wars and cost-cutting among the GPs, and if any GP were to compromise medical service standards even with this min. charge in place, we can hold him fully accountable since he will no longer have any reason to cut back on his services.
However, if we do not have this in place, a GP price war will start, and service standards will drop. We then accuse the GP for poor medical service, but will that be fair for the doc? He's only trying to make sure that he brings home enough to send his kids to school, and is doing this in response to what every other GP is doing! We then legislate as someone suggested to ensure that medical service standards are kept (and how is the legislation going to be worded by the way.. medical service standards is such an intangible entity that is affected by many other factors as well) and voila! it will probably turn out that to ensure this, the GP will have to charge at least $18... and we'll be back to square 1.
As for whether the $18 minimum charge will ensure quality of medical care, my answer is that it doesn't. This min. charge simply makes it inexcusable for doctors to cut costs at the expense of the quality of health care. Whether or not a doctor is a good one depends largely on his knowledge, experience and character. I'm sorry to hear about your experience with the senior consultant. I'm sure your dissatisfaction with his services was not because he was trying to cut costs but because of his attitude, or lack of efficacy in the treatment he prescribed right? That could be due to the nature of your disease, or that he simply did not have enough experience in treating your disease. Of course, such intangible factors are beyond the control of even the SMA. But what we are concerned here is that doctors will sacrifice their professionalism if they are faced with dire financial difficulties, as will probably occur if the minimum charge of $18 is lifted and a price war ensues.(believe me, GP practices are everywhere and are very competitive)
Personally, i would rather pay $18 and be assured that my doc is doing his best and isn't cutting corners than to pay $8 for an ineffective and thoroughly unsatisfying consultation.. and probably having to visit the doc twice more for the same disease as i'm not getting any better. What do u guys think? -
This is the reason we do not need to set a min cost. The competitive market corrects itself, allowing only the most efficient to survive.Originally posted by cornyfish2000:Personally, i would rather pay $18 and be assured that my doc is doing his best and isn't cutting corners than to pay $8 for an ineffective and thoroughly unsatisfying consultation.. and probably having to visit the doc twice more for the same disease as i'm not getting any better. What do u guys think? -
Here's an article in SMA website, show me the money.
http://www.sma.org.sg/sma_news/3703/junior_TL.pdf
How does our Health Ministry compute the health subsidy? Could one of the components in health subsidy be:
The difference in consultation charges charged by private and public professionals? That is there is a $10 ($18-$subsidy per patients for consultation? And based on the numbers of patients seeking medical attention in Singhealth/NHG polyclinics, Singhealth/NHG may reimbursed the $10 x X patients from our Health Ministries?
Why SMA proposed $18? Why are the components that constitute the GP consultation charges?
Here's the recommended charges by SDA (Singapore dental association):
http://www.sda.org.sg/sda_content/faq/GuidelineofFees.pdfHuman lives are at stake here, right?
So human lives are at stake too while extracting tooth.
Are there any recommended consultations charges imposed by Singapore Lawyer's Associations?
Why there is no recommended consultation charges imposed for IT professionals? I hate to be an IT professional. -
Yes, but as i mentioned, are we prepared to do so at the expense of health care quality? Assuming that $18 is the min average charge for a satisfactory consultation and any lower than that quality will be compromised. Thus the min $18 rule is needed to prevent the price from dropping below $18 which can well occur if free market forces were to come in and competition to lower prices heats up.Originally posted by lwflee:This is the reason we do not need to set a min cost. The competitive market corrects itself, allowing only the most efficient to survive.
This is the only reason i can think of to explain how SMA came up with this min $18 charge. -
Yes, human lives are at stake too while extracting tooth, that's why SDA has a recommended min charge for their various dental procedures too.Originally posted by iamgoondu:Here's the recommended charges by SDA (Singapore dental association):
http://www.sda.org.sg/sda_content/faq/GuidelineofFees.pdf
So human lives are at stake too while extracting tooth.
Are there any recommended consultations charges imposed by Singapore Lawyer's Associations?
Why there is no recommended consultation charges imposed for IT professionals? I hate to be an IT professional.
Does the human life at stake argument apply to lawyers or IT professionals? I dun think so.. They can hence charge anything they want, and if the consumer receives bad service, at most change to another company or sue the company which provided the less-than-satisfactory service lor, won't die as a result of the bad service. -
What if the lawyer was defending for someone like Marx OH, which could be facing a death sentence?Originally posted by cornyfish2000:Yes, human lives are at stake too while extracting tooth, that's why SDA has a recommended min charge for their various dental procedures too.
Does the human life at stake argument apply to lawyers or IT professionals? I dun think so.. They can hence charge anything they want, and if the consumer receives bad service, at most change to another company or sue the company which provided the less-than-satisfactory service lor, won't die as a result of the bad service.
What if the programmers codes was used in the computations of altitude, pressure or whatever in a BOEING plane?
Oh yes, we are putting our lives at stakes by our maids too, shouldn't we reward her handsomely? -
heh.. well, then i guess it's really up to the individual professional body to impose it's own minimum charge like what SMA has been doing.Originally posted by iamgoondu:What if the lawyer was defending for someone like Marx OH, which could be facing a death sentence?
What if the programmers codes was used in the computations of altitude, pressure or whatever in a BOEING plane?
Oh yes, we are putting our lives at stakes by our maids too, shouldn't we reward her handsomely?
Anyway, i like your last point about the maids! Indeed, with the recent spate of maid-kill-employer-yet-get-spared cases, i'm locking my bedroom door every night, lest i wake up with a knife stuck in my back as punishment for telling my maid off in the afternoon.
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Yup, that seems to be the case. But i must say i disagree with SMA's reasoning because i feel that a competitive market will get rid of lousy doctors. Further, i think it is to simplistic to say that $18 is needed to provide satisfactory consultation. I suspect that a large proportion of that amount is taken up by the doctors' fees. Who are we to say that a doctor cannot dictate the amount he is charging? What about doctors who wants to break into the market?Originally posted by cornyfish2000:Yes, but as i mentioned, are we prepared to do so at the expense of health care quality? Assuming that $18 is the min average charge for a satisfactory consultation and any lower than that quality will be compromised. Thus the min $18 rule is needed to prevent the price from dropping below $18 which can well occur if free market forces were to come in and competition to lower prices heats up.
This is the only reason i can think of to explain how SMA came up with this min $18 charge.
Keeping standards up can and is currently being done with government regulation and civil law. We should not be discouraging pressure on lower healthcare costs.
Edit: Another reason for the rule might simply be the profession protecting itself. Afterall, that is arguably what professions do: Limit entry, control the market for the benefit of its members. Usually though, they will argue that they are mantaining standards. -
Well, in fact we do already have a competitive market that gets rid of incompetent doctors. Although there's a min charge of $18, the docs are free to charge anything from $18 to $55. In fact most doctors do not charge the min of $18... i believe the average GP consultation would be around $25? There is hence room for market forces to determine how much GPs will charge and which GPs will get to survive etc. As i mentioned, i believe the whole rationale of the $18 rule is merely to prevent unhealthy price wars below viability and hence undesirable cost-cutting measures, rather than to stifle competition among the GPs.Originally posted by lwflee:Yup, that seems to be the case. But i must say i disagree with SMA's reasoning because i feel that a competitive market will get rid of lousy doctors. Further, i think it is to simplistic to say that $18 is needed to provide satisfactory consultation. I suspect that a large proportion of that amount is taken up by the doctors' fees. Who are we to say that a doctor cannot dictate the amount he is charging? What about doctors who wants to break into the market?
Keeping standards up can and is currently being done with government regulation and civil law. We should not be discouraging pressure on lower healthcare costs. -
However, if we do not have this in place, a GP price war will start, and service standards will drop.
That's an presumption.
Why would a price war lead to service standards to drop?
If Singtel still monopolise our telecommunication market, we could still be paying $18 for a paging service. If not for Starhub, would there be a plan for free unlimited incoming calls?
When the 3 telecoms companies compete, are there any drop in their service standards? The competition in telecommunication results in more options and varieties to us.
Now we have 4 budget carriers compete each other, despite offering $1.99 for a trip to Bangkok, did any of the budget carriers cut corners?
Perhaps you can illustrate how would a price war lead to service standards to drop in this century?
If we have no intend to reward our maid handsomely even though our lifes could be in her hand, why there is no option for us to pay $8 for a private GP consultation?
Here we have willing sellers who are offering their services at $8, they must have done their sums, why are we stopping them? Let's the buyers decide if there are any corners being cut, and let's the market force decide if they should continue to patronise these $8 GP.
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From my earlier post:Originally posted by iamgoondu:Why would a price war lead to service standards to drop?
"Without the minimum limit, the GPs will start to undercut each other to ridiculously low prices. Say, if the GP were to charge only $8 a person, he will certainly not be able to do blood tests, urine tests, give the newest and most effective drug that he thinks is best and yet remain viable right? Considering the high overheads (rental etc) that he has to factor in as well. Also, he will have to see three times his usual number of patients in the same amount of time to earn back his salary. So how long do u think the doc can afford to spend per patient?
Then u say if thats the case the docs will go out of business, and GPs will close shop etc etc.. ok, then where will that leave us? Everyone will have to cross the island and queue 5 hours to see the few GPs who still manage to survive in Singapore."
Does this make sense? -
Have u ever visit a polyclinic? $8 covers only consultations. You need blood test? pay. You need urine test? pay. You need drugs? pay.Originally posted by cornyfish2000:From my earlier post:
"Without the minimum limit, the GPs will start to undercut each other to ridiculously low prices. Say, if the GP were to charge only $8 a person, he will certainly not be able to do blood tests, urine tests, give the newest and most effective drug that he thinks is best and yet remain viable right? Considering the high overheads (rental etc) that he has to factor in as well. Also, he will have to see three times his usual number of patients in the same amount of time to earn back his salary. So how long do u think the doc can afford to spend per patient?
Then u say if thats the case the docs will go out of business, and GPs will close shop etc etc.. ok, then where will that leave us? Everyone will have to cross the island and queue 5 hours to see the few GPs who still manage to survive in Singapore."
Does this make sense?
As I said they have probably done their sums prior deciding to offer consultations at $8. They know at $8, their business models would still be viable. Why do we doubt the business sense of a GP?
Would a GP simply close his business when he fails to recover his overheads? The GP could raise from $8 to $10, if still fails, raise $10 to 15 and so on..., would he give up his business so easily?
Perhaps someone can tell me how much does a GP earns in a polyclinic and in a private practice.
So does it mean that every polyclinic patient receive a $10 subsidy from government from each visit? -
Yeah, apparently they find that charging $8 is still viable. But i would really like to know if they are doing this by cutting corners. If they are not, then my assumption that $18 is the minimum charge for a private medical practice operating with a reasonable standard of medical care to be viable is wrong. Then we would be back to the qustion of how did SMA come up with this figure of $18?Originally posted by iamgoondu:Have u ever visit a polyclinic? $8 covers only consultations. You need blood test? pay. You need urine test? pay. You need drugs? pay.
As I said they have probably done their sums prior deciding to offer consultations at $8. They know at $8, their business models would still be viable. Why do we doubt the business sense of a GP?
Would a GP simply close his business when he fails to recover his overheads? The GP could raise from $8 to $10, if still fails, raise $10 to 15 and so on..., would he give up his business so easily?
Perhaps someone can tell me how much does a GP earns in a polyclinic and in a private practice.
So does it mean that every polyclinic patient receive a $10 subsidy from government from each visit?
If the GP fails to recover his overheads, he has 3 options:
Option 1: Cut corners to lower cost so as to maintain viability
Option 2: Raise the consultation charges again
Option 3: Give up his practice
Ideally, we would like the GPs who are unable to cover their overheads to raise their consultation charges again, rather than to cut corners. But do all business-minded GPs think the same way? As in every other profession, there will be some who will cut corners rather than raise the price, so that they can grab a larger slice of the market share (since they can then afford to charge cheaper than the rest). And very often in medicine, the patient will not be able to recognise that he has received a lower standard of care from this corner-cutting GP, since almost all patients know next to nothing about their medical condition and its appropriate management anyway, until it's too late. And even then, it will be difficult to prove that the delay in diagnosis and treatment was because of cost-cutting measures by the doc, and not because of other factors like the fact that different individuals have different responses to a disease.. when in fact it was.
The result? Patients will all flock to the corner-cutting GP who charges less than the 'ethical' one. So what is this 'ethical' one gonna do? He is left with 2 options:
Option A: Close shop
Option B: Cut corners too so that he can charge lower and remain competitive with his neighbouring GP
So there we are. The patient loses eventually, whichever option this 'ethical' GP chooses.
Btw to avoid confusion, a GP refers to a doctor who runs his own private practice, whereas a polyclinic doctor is one employed by MOH and shouldn't be considered a GP. -
SMA only recommend those fee.GPs need not follow.If they want to charge lower,i think it is entirely their wish
Perhaps GPs who want to charge polyclinic rate is just a temporarilly measure (just like sales).When they have sufficient steady patients,they may charge higher rates.
Cornyfish,u do have a point.Overcutting may lead lto ower standard of services.But isn't it the duty & moral duty for docs to give proper services?Does it mean when the fee is low,doc can give substandard service?Well,even with high fee,docs can also give dishonest services!So it is really up to the docs. -
Yup, no doubt it is. I would like to believe that all docs are truly altruistic and mean the best for their patients even if it is at the expense of their own salary!Originally posted by PRP:Overcutting may lead lto ower standard of services.But isn't it the duty & moral duty for docs to give proper services?Does it mean when the fee is low,doc can give substandard service?Well,even with high fee,docs can also give dishonest services!So it is really up to the docs. -
remember, docs are humans like the rest of us too. they have mouths to feed, bills to pay and material wants...don't expect something from somebody if you yourself can't do it. you tell me, after taking like what? more than 6 years of shit in medical school and the high tuition fees charged, shouldnt they at least have the right to be rewarded a little?