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Guidelines on doctors’ fees could be reinstated

The Singapore Medical Council hopes that the Act governing doctors’ fee guidelines can be changed to override competition laws.

SINGAPORE: Doctors’ fee guidelines could be reinstated and, this time, the hope is that laws governing them will be amended to override competition regulations here.

This is the view of the report by the committee tasked with looking into the disciplinary processes of doctors, which was made public last week.

The committee, chaired by senior doctor Professor Raj Nambiar, reported that the Singapore Medical Council (SMC) – the body that regulates and registers doctors – is internally reviewing the guidelines and principles for “determining ethical and reasonable medical fees”.

Subject to its final proposal, the Council agreed in principle that “perhaps the Medical Registration Act should be amended to include a provision to override any competition commission concerns on setting of fees and to allow SMC (or another body) to set fees”, the report stated.

No timeline was given and, when contacted, the SMC confirmed its review but did not elaborate.

The issue of fee guidelines for doctors has been a contentious one, beginning in 2007 when the Singapore Medical Association (SMA) removed its Guideline on Fees after being told it could be infringing competition laws. Its appeal to the Ministry of Trade and Industry did not succeed, and the Competition Commission of Singapore issued its final decision in 2010 that the guidelines were anti-competitive.

Debate re-ignited last year after the Court of Appeal ruled that the S$24 million that surgeon Susan Lim had charged a Bruneian royal had gone beyond what should be morally charged, and suggested that the SMA publish actual fees charged in the private sector. The judgment led some to question what the “ethical limits” were, as well as the need for objective benchmarks.

Lawyer Eric Tin, who heads the medico-legal practice group at Donaldson and Burkinshaw, said the potential re-introduction of medical fee guidelines appears to be a response to the judges’ view in Dr Lim’s case that there is “an objective ethical limit” that operates outside contractual and market forces.

“The fee guidelines’ reinstatement is probably intended to provide some clarity and certainty to doctors and consumers of medical services as to what would constitute a fair and reasonable fee,” said Mr Tin. “This can help avoid complaints of overcharging.”

The SMA could not respond to TODAY’s queries by press time, but the association – which represents the majority of doctors here – had last October supported private healthcare provider Parkway Pantai’s publishing of fees for 30 common procedures offered at its four hospitals, based on actual patients’ bills.

Private oncologist Wong Seng Weng said fee guidelines are especially useful for doctors just venturing into private practice. “During the initial years, it may be difficult for a person to feel around and know how to peg professional fees, to know what is considered reasonable,” he said.

Demand for different doctors varies, so guidelines have to be flexible and not too restrictive, to allow some degree of market forces for efficient use of manpower, added Dr Wong, medical director of The Cancer Centre. Re-introduction of guidelines must be thought through carefully “so we don’t create one problem while we’re trying to solve another”.

Mr Seah Seng Choon, executive director of the Consumers Association of Singapore, said there should be an independent body consisting of various stakeholders to oversee any adjustments in fee recommendations, if fee guidelines must be re-introduced.

He noted that guidelines were previously issued by “a group of people who were the service providers anyway”, and said: “We’d rather see more details before we say if we can support or cannot support. My thinking now is it should be left to free competition.”

On whether the possible move might lead to calls for fee guidelines to be permitted in other fields, Mr Tin noted that should the Medical Registration Act be amended, the issue must still be debated in Parliament before the guidelines are allowed.

“Even if other professional bodies call for fee guidelines to be allowed in other areas, they can succeed only if they are able to seek an appropriate exemption under the Competition Act or with appropriate legislation,” he said.

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