Tuesday, December 14, 2010

Cost of preparing a medical report

A letter was published in the Straits Times Forum page complaining about the high fee charged for a medical report. The Singapore Dental Center replied that the cost of $90 (or thereabouts) represent only a part of their total cost in preparing the report.

I consider the cost of $90 to be excessive. An "angry doc" asked me to state what I felt the fee should be. I replied "$30". Another anonymous doctor said that he would outsource the writing of the report to other doctors for this fee. This argument is not fair, as it will be more difficult for another doctor, who is not attending to the patient, to write the report with the same effort.

A member of the public asked me to justify the $30, which he felt to be too high. A doctor charged only $30 for a consultation. He argued that the cost of writing a report should be lower.

This is the kind of problem that can arise when the regulators decide to leave such matters to the "free market". Actually, there is no free market here - but a monopolistic situation.The doctor who attended to the patient is the only party that has the information to write the medical report. They can charge whatever they want, and justify their fee based on the effort taken to write the report. If they are inefficient, their cost is obviously higher, so they can easily justify a high fee.

We also have to define what constitute the report. My suggestion of $30 is for a routine report that will take the attending doctor 10 minutes to write. I have seen many doctors and it takes this time for them to read their patient card and write down what is the problem with me relating to a specific medical condition. In most cases, this is what is needed to support an insurance claim or application for insurance.

A more detailed and complete medical report covering all of a patient's medical condition would obviously cost much more than $30. But, this is only required for exceptional cases, and is not the norm. There is a low cost way and a high cost way to write a medical report. The consumer would want a low cost, and the doctor would want a high cost. How can this be resolved in the "free market environment" in Singapore?

I hope that our government leaders and regulators will find out what is really happening on the ground and why consumers are complaining about the high cost of living in Singapore. There are countless examples happening every day.

Tan Kin Lian

11 comments:

michael13 said...

Recently, my friend, a poor Singaporean retiree was admitted to TTSH for medical problems related to his prostate. He was hospitalised and a biopsy test confirmed that he's got prostate cancer. As a result, an insurance claim of a small amount needed the attending doctor's signature. He was charged an administative fee of S$80.25 for a completion of simple claim form by TTSH and the hospital staff told him that it took at least three(3) weeks to do it.

I fully agreed with Mr. Tan that there are countless examples happening in Singapore everyday. It is about time for the authority-concerned to wake up and to do something about it. Singapore is becoming too inefficient and ineffective in taking care of the basic needs of our own people.

Steven said...

Maybe the slogan of "Faster, Better and Cheaper" should also apply to the medical industry.

Vincent Sear said...

While I agree that writing a legally admissible medical is extra work on top of the consultation, diagnosis, treatment and dispensing of medication process, the going rate is too stiff and up to the attending doctor to charge, as TKL observed, nobody else could have written it unless you seek a second opinion, that'll incur even more cost.

I agree with TKL estimate of S$30 for a straightforward report and perhaps, S$60 for a more complicated report. I have a friend who was hospitalised at TTSH just weeks prior to his reservist call-up. He had to ask for a medical report and was charged S$75. MINDEF won't pay for him. No report, no deferment, you die in service, your business.

Very saddening with this system.

Gerald Tan said...

Looking at AngryDoctors reply http://angrydr.blogspot.com/2010/12/penny-for-your-thoughts-3.html perhaps one solution is to implement a "per-page" charge, e.g. $20 flat + $10 per page of report.

That will come up to $30 that Mr Tan proposes for the for 'simple report', and Angry Doctor may not be _so_ angry when he has to generate 12 page reports...

And while we're on the subject, the last time I went to get stuff notarised, it was $10 per PAGE. (For those of you who don't know what is notarising, the lawyer chops a "This is a certified true copy" on your photostat paper and signs on it). $10. EACH.

Vincent Sear said...

I feel particularly disappointed at Angry Dr. comment that medical education and qualification cost lots of money and time to be recovered. We all know that it's hardwork and expensive. I think all would agree that physicians should be well paid, but not for their expenses in medical school. It's for what they learned there and applied to help patients.

I think that any physician doing his honest job and charging an honest rate would become upper-middle income at the very least, and very wealthy if he's a specialist in some complicated surgery. The recovery of education cost in any profession is a natural progression for anyone competent. Citing education cost to charge higher rates, sounds very unbecomingly professionally, especially in medicine that concerns life and death.

rex said...

rex comments as follows,

A doctor like anyone else, does have a right to desire to be wealthy.
But let us try to agree where the source of the money should come from? In my opinion, the source of money should come from the diagnosis and skill and treatment recommednations when the patient seeks consultation. Those charges nobody can argue with because we are layman and don't know the science like the doctor does.

Therefore, if so be, Mr Angry Doctor, please charge $100 or even $200 when you diagnose the patient. If you think there are no other doctors who can perform such accurate diagnosis and also you are very well established, go ahead even charge $300 for consultation, this is competition, just like in the business world.

Beyond that, the medical report - it should be at cost or very nominal profit, e.g $15 if it costs $2 to print the paper, and $2 to deliver it, and $11 to pay the admin staff and hospital commission (hospital earn money from the doctor). The reason is because the doctor's skill is already fully paid for at the time of consultation. The follow up activity should not be the primary source of income of the doctor. Doctors are professionals, they shouldn't be scrapping the bottom of the barrel to get their rice.

Side note: It is said that actually doctors don't get rich from either diagnosis and medical reports issuance... they get a lot of commissions from drug sales and pharmaceutical companies. I don;t know if this is true?

rex

michael13 said...

There is a saying: "People normally do not die in a 'shark's attack' but they do die in a heavy bleeding." In Singapore, sometimes, some of them do not die in their illnesses/diseases. They die because of a huge medical bill that beyonds their means to pay.

pathdoc said...

As Gerald Tan said, "...the last time I went to get stuff notarised, it was $10 per PAGE. (For those of you who don't know what is notarising, the lawyer chops a "This is a certified true copy" on your photostat paper and signs on it). $10. EACH."

The charge is $10 a page for putting a stamp, which takes seconds. I would say that in comparison $90 a report is too cheap. The charge should reflect the effort and cost for providing the service.

The doctor should record the time taken to prepare the report and charge according to his salary. If he is paid $300 per hour and it took half an hour to write the report, then the charge should be $150. The more senior the doctor, the more expensive the report will be.

By the way, do you know how much lawyers charges to photocopy legal documents? :)

angry doc said...

Vincent,

I did not say that we should charge a premium to recover the expenses of our medical school fees - I fully recovered that in the first few years of my practice, thank you very much.

However, if you think medical school was all the training we received and that what we are practising only based on what we learnt then, then you do not have a good idea of what it takes to *stay* a doctor.

Tan Kin Lian said...

My reply to pathdoc

Some lawyers fees are also excessive. i.e. the fee to photocopy papers. I have seen lawyers print a few feet of papers to support a case.

This is ripping off the hapless consumer. This is what is happening in the wonderful pro-business environment in Singapore, except that the hapless people are being ripped off by the unscrupulous professionals.

I hope that doctors are not as bad as some of the others.

Anyway, in any profession, there are white sheep and black sheep. In Singapore, we have so many black sheep that the white sheep is in danger of being the minority.

Tan Kin Lian said...

My reply to pathdoc

Some lawyers fees are also excessive. i.e. the fee to photocopy papers. I have seen lawyers print a few feet of papers to support a case.

This is ripping off the hapless consumer. This is what is happening in the wonderful pro-business environment in Singapore, except that the hapless people are being ripped off by the unscrupulous professionals.

I hope that doctors are not as bad as some of the others.

Anyway, in any profession, there are white sheep and black sheep. In Singapore, we have so many black sheep that the white sheep is in danger of being the minority.

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