Ministry of Health sets benchmarks for private hospital fees

SINGAPORE – Benchmarks on surgeons’ fees, which have helped to keep a lid on medical bills in the private sector, will be extended to cover all surgical procedures from June 14. New benchmarks have also been published for some hospital charges.

These fee guidelines, first introduced in 2018, have been effective in moderating private surgeons’ fees. They are part of a larger strategy to manage rising healthcare costs, said the Ministry of Health (MOH) on Wednesday.

The guidelines, which provide a reference for patients, insurers and healthcare providers on what is typically charged for a certain procedure, have been updated to account for inflation. New benchmarks for hospital charges, apart from surgeons’ fees, will give patients a better idea of whether their bills are reasonable, the authorities added.

“Doctors and hospitals are strongly encouraged to be upfront on the fee components charged by them. They should work together to keep their charges within the hospital fee benchmarks,” said MOH.

Indicating that the strategy has been working, it said when the fee benchmarks – that provide a range of the charges – were introduced in 2018, about 20 per cent of bills were higher than the upper limit. Now, only 10 per cent of doctors are charging above the upper limit.

Meanwhile, the median private surgeon fee has remained stable, while higher fees have fallen, with fees at the 90th percentile falling by 1.7 per cent per year for procedures with benchmarks.

The benchmarks, which were initially published for 200 common surgical operations that accounted for 85 per cent of all such procedures, will now be expanded to cover surgeons’ fees for all surgical procedures that MediShield Life, the national healthcare insurance scheme, covers. This will be done by adding the remaining 1,900 procedures to the list.

Benchmarks for anaesthetic procedures, first introduced in 2020, have been rolled out for another 300 procedures. This will cover 95 per cent of all cases that require anaesthesia.

For the first time, the MOH has also introduced benchmarks for hospital charges, including components such as room charges and surgical facilities, for 21 common surgical procedures and eight common medical conditions – such as for cataract surgery.

The Fee Benchmark Advisory Committee said: “The hospital fee benchmarks provide a common reference for the reasonableness of the total hospital fee billed by the hospital.”

At a briefing to announce the enhancements, an MOH representative said: “Unfortunately, fees are still rising in some other areas.” Hence, the need for more benchmarks.

Dr Wee Siew Bock, a surgeon in private practice who chairs the committee looking into this, said the team “received strong feedback from both doctors and payers to to develop surgeon fee benchmarks” for all surgical procedures.

Fees for procedures without benchmarks have gone up annually by more than double those of the 200 procedures for which there were benchmarks.

The fee benchmarks act as guidelines, and are not mandatory. They come as a range, based on the 25th and 75th percentiles of actual bills, with the lower end for routine cases and the upper end when there is complexity in treatment.

However, the MOH said on Wednesday that it does keep an eye and has sent more than 600 letters to doctors whose fees were above the upper bound.

Higher fees are not a problem if doctors can justify them. But if the doctor cannot, and continues to charge higher than benchmark fees, he may be referred to the medical watchdog, Singapore Medical Council, for review.

The MOH representative also said that the benchmarks reassure doctors who are on insurance panels that the fees they are paid are fair. Insurance companies often pre-negotiate rates with doctors on their panels to keep costs down.

IP insurers who feel doctors or hospitals are charging too much, or the healthcare service provider is upset that insurers are not paying the full amount, can settle their disputes through the Clinical Claims Resolution Process. The MOH said several such claims have been received.

The 2018 and the 2020 benchmarks were also revised on Wednesday to take inflation into account.

Benchmarks for surgeons’ fees were increased by 12.1 per cent, or 2.3 per cent a year; anaesthetists’ fees are up 9.9 per cent, or 2.4 per cent a year, and doctors’ inpatient fees rose by 5.7 per cent or 2.8 per cent a year.

Ms Melita Teo, chief customer and digital officer of AIA Singapore, said: “While the revision to the fee benchmark that reflects inflation data is reasonable, it will inevitably have the circular impact of raising bill sizes and higher insurance premium.”

Dr Tan Yeh Hong, who is on the Table of Surgical Procedures Review Committee, told The Straits Times: “In general, most private doctors welcome the fee benchmark and use them as reference in the financial counselling.

“Most doctors understand the rationale behind the MOH fee benchmarks in maintaining a sustainable healthcare cost. However, most doctors wish to have a more regular and timelier update of Fee Benchmark.”

The MOH said the benchmarks will be reviewed every three to five years.

This article was first published in The Straits Times. Permission required for reproduction.