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Most doctors are flexible and moderate their charges according to their patients’ means. Some even waive their fees for the poor. APRIL CHONG reports
 Should general practitioners (GPs) have guidelines on what they charge patients? The Singapore Medical Association (SMA) thought so, but the Competition Commission of Singapore said no.
The SMA said guidelines would prevent over-charging, but the commission argued that it would prevent doctors from charging less even if they could.
What is the truth?
Mind Your Body checked with at least 16 clinics to see what they charged for a short consultation of 10 minutes. The SMA guidelines, which were dropped in 2007, suggested a fee of between $20 and $30.
Fees for a short consultation at 16 clinics in Bedok can start from $10 to $25. The maximum that these clinics would charge for a short visit ranged from $15 to $30.
The doctors said they have not been following the guidelines for some years and were flexible when it came to lower-income patients.
For instance, the clinic that charged $18 did put up a wall display of the guidelines’ recommendation of $20 to $30 for a short consultation of less than 10 minutes. The clinic’s GP, Dr Lai Fui Lin, said she has been charging $18 to $25 all along and may “charge less for certain patients”.
Many doctors that MYB spoke to said that they moderate their charges for certain patients.
“Sometimes they are elderly and they are not rich. We have to decide on a case by case basis,” said one doctor, who declined to be named.
The Bedok GP clinics generally charge a higher consultation fee than the nearby Bedok Polyclinic, which charges a flat rate of $9.50. However, the private clinics still draw patients.
Ms Jenny Ang, 60, a clerk, sticks with her family doctor in Bedok because she has been seeing the same physician for years.
“There are always so many people in the polyclinic and I don’t want to wait so long when I am sick,” she said.
Besides, the medical benefit scheme at her company pays for a sizeable portion of her doctor’s fee so she never has to pay more than a few dollars for treatment of common ailments.
The GPs’ rates also depend on the operating cost and size of their clinics.
For example, one doctor, whose clinic has been around for almost 30 years, said his overheads are not that high, so he could “pass some savings to the heartlanders”.
The commission said that since the guidelines were dropped, complaints about overcharging have dropped and overall private practice professional fees have also gone down by 2.6 per cent.
Dr Theresa Yap, a GP, said she usually charges $25 for a short consultation but reduces or waives her fees for poor or elderly patients.
If the cost of the medicine gets too high, she also lowers the consultation fee.
Although $25 may be on the higher end for clinics in the area, it has not driven
away her patients.
“Our patients already know our fees. We try to round off the total amount they have to pay after looking at the cost of the medicine,” she added.
Another GP in Bedok, who declined to be named, charges $15 to $20 for a short session. He said that he had always been charging this amount because his patients are “not well-to-do” and the “guidelines are just guidelines”.
Dr Ooi Teik Huat, whose clinic is also in Bedok, said he usually charges below what the guidelines suggested, with many patients paying between $10 and $15. He even waives the consultation occasionally.
“The consultation fee is immaterial because you can charge $50 and give the drugs for free or you can charge a $0 fee and mark up on all the drugs," he said.
In his case, he marks up medicine costs a little to offset his cheaper consultation fees.
While rates within an immediate area may not be very different, they can vary much more across locations among the 1,400 GP clinics islandwide.
Clinics in Bukit Timah can charge between $20 and more than $30 for a short visit while clinics in the Orchard road area may charge up to $50.
“We are a little more expensive because we are in a shopping centre. The patients who come to us already know that,” said one doctor from a clinic in the Bukit Timah area.
Itemised bills on request
Visits to various clinics found that about half did not give itemised bills, even though it is a Health Ministry requirement. However, they did not hesitate to do so when asked.
The guideline – under the Private Hospitals and Medical Clinics Act, which covers licensing of practices – came into effect in 2008 to ensure transparency in charges.
“Most of our patients do not need the breakdown, but we will definitely give it if they ask for it,” said one Bedok GP, who declined to be named.
Another said that there was no intention to hide the charges but it was just too time-consuming to itemise each bill.
The guideline on displaying charges upfront was more readily complied with. All but one clinic which MYB visited did so.
Warnings are issued to clinics which do not follow the guidelines while errant doctors may face tougher actions such as fines, said the health ministry.
Patients who are unable to obtain itemised bills from their doctors despite their requests may contact the ministry at 1800-2254122 or MOH_info@moh.gov.sg.
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