by Wan Ting Koh
IF YOU’VE been frustrated by the lack of transparency in private hospital fees, you can now visit the Ministry of Health’s (MOH) website to look for prices of procedures ranging from a Caesarean to circumcision.
We did a cursory analysis of the 141 procedures listed and found that the difference in prices for the same procedure varied widely. We picked out the ones with the biggest price differences for each body part and found that a heart surgery topped the list with a $16,638 difference between its lowest and highest price.
The cost of an eye procedure was three times more than its lowest price point.
MOH started listing private hospital operation fees two weeks ago on its website. Even though individual private hospital fees aren’t revealed, fees are displayed as a range, with the lower amount reflecting the 25th percentile charged and the higher amount, the 75th percentile. Operation fees are split into three components: the surgeon’s fee, the anaesthetist’s fee and the cost of the facility.
The release of fees suggests a greater move towards transparency for the G. In 2013, when Parkway Pantai, the medical group which owns four hospitals, including Mount Elizabeth and Gleneagles, published its prices for 30 procedures for each of its hospitals, some were worried that the act might contravene anti-competition laws.
However the Competition Commission of Singapore said that compiling information from patients already billed, which was what Parkway Pantai did, was not illegal, unlike medical fee guidelines which determine the cost of a procedure. That was something that the Singapore Medical Association had to scrap in 2007 for fear of infringing the competition act.
With escalating healthcare costs in the recent years however, there have been more calls for transparency and the G began publishing total operation fees for public hospitals in 2014.
The biggest differences
But is this move really beneficial, given that the range of some procedures can be as much as three times the lowest price?
This was the case for an eye procedure – a lens implantation surgery after a cataract surgery. The operation fee can cost from as low as $3,605, to a high of $11,014 which is three times the lowest price point.
Delving deeper into operation fee components showed that both facility fees and surgeon fees contribute to the wide range as the highest price for each is nearly three times the lowest price. No anaesthetist fees were given for this procure as there were fewer than 30 cases.
Similarly, a procedure to remove unhealthy skin tissues in a wound measuring more than 3cm, ranges between $3,243 and $6,295, with the highest operation fee pegged at nearly twice the price of the lowest. Surgeon fees are the culprit for this wide range as the highest cost more than twice the lowest price.
In terms of numerical value, the heart and coronary artery bypass graft surgery had the widest range, from $35,566 to $52,204, which makes a difference of $16,638.
|Body Part||Most expensive procedure||Surgeon fees||Difference||Anaesthetist fees||Difference||Facility fees||difference||Total operation fees||Difference|
|Abdomen||Repair of hernia (ventral/incisional/recurrent hernia)||$4,815-$9,095||$4,280||$1050-$1,875||$825||$2,679-$6,294||$3,615||$9,297-$16,398||$7,101|
|Blood vessels||Vein, imaging guided laser treatment for varicose vein (1 leg)||$4,120-$10,165||$6,045||-||-||$1,336-$2,730||$1,394||$8,312-$11,659||$3,347|
|Bone/joints||Hip, total hip replacement||$8,560-$16,050||$7,490||$1,750-$2,500||$750||$4,193-$6,479||$2,286||$14,040-$25,036||$10,996|
|Chest||Heart, coronary artery bypass graft||$18,413-$26,857||$8,444||$3,000-$4,500||$1,500||$13,578-$22,175||$8,597||$35,566-$52,204||$16,638|
|Eyes||Lens implantation after previous lens/cataract surgery||$3,000-$8,239||$5,239||-||-||$830-$2,416||$1,586||$3,605-$11,014||$7,409|
|Female reproductive system||Ovary, removal of both ovaries, uterus, fallopian tubes with further cancer||$9,257 - $15,034||$5,777||$2,000 - $3,500||$1,500||$3,554 - $9,099||$5,545||$17,110 - $27,139||$10,029|
|Hand/finger||Carpal tunnel release (single)||$2,400 - $4,280||$1,880||$500 - $900||$400||$861 - $1,859||$998||$3,499 - $6,106||$2,607|
|*Head||Repair of jawbone (simple)||-||-||-||-||-||-||-||-|
|*Lymphatic system||Cervical lymph node, removal/biopsy of cervical lymph node||$2,140 - $3,745||$1,605||$600 - $875||$275||$1,426 - $2,962||$1,536||$4,289 - $6,390||$2,101|
|Male reproductive system||Prostate, removal of tissue||$4,280 - $5,783||$1,503||$1,000 - $1,500||$500||$3,370 - $4,822||$1,452||$9,191 - $11,819||$2,628|
|*Mouth||Repair of gum tissue||-||-||-||-||-||-||-||-|
|Neck/throat||Thyroid gland, complete removal||$6,634 - $11,400||$4,766||$1,500 - $2,675||$1,175||$4,534 - $6,502||$1,968||$13,226 - $20,606||$7,380|
|Nose||Removal of sinus bones||$6,420 - $10,980||$4,560||$1,500 - $2,200||$700||$3,357 - $6,661||$3,304||$11,148 - $20,384||$9,236|
|Skin/soft tissue||Skin, removal of unhealthy tissues in a wound >3cm||$1,819 - $3,745||$1,926||$500 - $1,000||$500||$1,094 - $2,135||$1,094||$3,243 - $6,295||$3,025|
|Urinary tract||Ureter, non-invasive shock wave therapy for stones||$3,000 - $4,173||$1,173||$750 - $1,000||$250||$1,876 - $3,332||$1,456||$4,000 - $7,309||$3,309|
*Body parts with only one procedure available
What’s in your operation fee?
But why do prices vary across private hospitals?
For many, many reasons. Each of the three components has a number of variables factored in. Surgeon’s fees take into consideration the surgeon’s skill level and experience and the techniques they use. A reputable private surgeon may charge higher prices than a lesser-known counterpart.
The prices charged also reflect the complexity of the operation involved, said Dr Gerard Chee, a specialist Ear, Nose, and Throat surgeon in private practice. “If I open only one sinus, I will charge $X for a procedure that will last about 20 minutes to half an hour. If I open all eight sinuses, I will charge about three times more for a three-hour procedure,” he said.
A difficult surgery might have a wider price range as compared to a straightforward one, like a tonsillectomy, he added. The difference in the range of prices listed for a tonsillectomy – which is the removal of tonsils – is $2,929.
According to Dr Chee, an anaesthetist’s fees is usually about 25 per cent of the surgeon’s fees in private hospitals. The surgeon would bill the fee for them, he said. However, there are other ways that anaesthesia fees may be calculated.
The price may vary according to the type of anaesthesia used, whether regional – which only numbs a specific part of the body – or general anaesthesia, which renders the patient fully unconscious.
There is also a lower level of anaesthesia known as sedation which keeps the patient awake, though unable to remember the operation. Anaesthetists may also charge more for a longer operation as they will have to monitor the condition of the patient throughout.
How the anaesthesia is applied may also be a factor, whether it is topical, injected through an IV drip, or given through a gas mask. Special equipment may also be needed for certain anaesthetic procedures, such as those that deal with complicated nerve blocks.
Then there are the facility fees which include the cost of the operating theatre, which varies according to each hospital’s rental rates, the quantity of disposables used, and the type and quality of equipment.
Will the list work?
The lack of guidelines means that surgeons determine how to charge their patients.
Most, according to a 2012 ST report, refer to fees drawn up by public hospitals and MOH’s rating of complexity of procedures as a benchmark before adding premiums such as the surgeon’s level of experience. Others refer to how much their peers charge by sending spies to rival surgeons’ prices.
But listing the range of fees may have a limited effect on the fees themselves. Plus, it is still possible for private surgeons to overcharge, since there is no hard-and-fast rule for charging patients. Furthermore, the operation fees listed on MOH’s website are only what 50 per cent of patients here pay.
Having the fees listed doesn’t mean that surgeons cannot charge above the norm, said Ms Tin Pei Ling, who is on the Government Parliamentary Committee for Health.
“But then they will have to give patients a full and proper explanation,” she added.
Though there is a possibility that surgeons who charge higher than the 75th percentile might lower their prices, surgeons who have fees which fall below the 25th percentile may also increase their prices. Said Dr Chee: “For example, if I charge $1,000 for a tonsillectomy and I find out that the lowest price in the range is $3,800, I might raise my fee.”
“Surgeons don’t want to look like they are ‘cheap’. If a doctor charges less than his or her peers, some patients might think that the doctor is not good, or that he doesn’t have enough business, or that he is desperate. This is human nature.”
Listing private hospital fees may be a step in the right direction, but more data may be needed to make the list more robust. Can we look forward to more procedures, including non-surgical ones, being added to the list too?
Additional reporting by Li Shan Teo.
Featured image by Natassya Siregar.
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