Tuesday, December 07, 2010

Excessive charges to boost profits

I read the reply from the Executive Director of the National Dental Center of Singapore. Dr. Kwa said that the fee for the medical report reflect some of their cost. It seemed to imply that the other part of the fee is to make profit for the center.

The situation in Singapore has become very bad in recent years. Many corporations, private and public,  find ways (and excuses) to increase their profits, imposing a high cost on consumers. This is made in the interest of increasing productivity, efficiency and service. In reality, it is ripping off the hapless consumers in a deregulated environment. It is also unethical business practice, but has become a habit in Singapore.

When will our government leaders wake up and find out why the citizens are complaining about the high cost of living, and the high cost of operating a business in Singapore?

There was a time, in a more ethical environment, when corporation give incidental services free or at a nominal fee. There were not allowed to make profits from these services. I wish to go back to these good old days.

Tan Kin Lian


dsowerg said...

I have asked for medical reports from hospitals (KKH and TTSH) and having seen how one looks like, I do not think it is unreasonable for hospitals to levy a charge.

The cover note is written by the Consultant who has to examine the lab reports, go through the medical notes, and then write a summary of the medical case and findings. Lab reports are attached. The Consultant's time does cost money. I do not think it is fair to expect the Consultant to write a one-page report for free.

It also takes time for hospital staff to retrieve your file, make photocopies and mail the report to you.

For making an oath before a Commissioner of Oath or Notary Public, you also have to pay him to listen to you and issue you a piece of paper. Certainly it doesn't cost $100 to do that but that's the fee. Why? Because it's the lawyer's time you're talking about. He is putting his name on paper so it's not child's play you're talking about.

Gary said...

Mr Tan,
I think it is impossible to go back to the good old days, esp. not with this govt.

The 'revealing' thing about Kwa's reply is that he did not give anything away on what that 'cost' is. But, give the fact that this is not an everyday occurrence and the likely to be only an negligible incremental cost to obtain the files from the registry (how different would it be from getting any other files for a patient?) most of the cost goes to the doctor concerned. and here I would raise a point which is that why are doctors not required to provide a report to a patient at the end of consultation? Would it be any different from what he has told the patient about his or her condition? Shouldn't it be in writing? Surely, it is not the confidentiality of the patient BUT, IMO, it is mainly to protect the doctor that a written report (logically as it may seem to be) is not provided as a matter of course. Why does medical ethics condone this?

angry doc said...

"why are doctors not required to provide a report to a patient at the end of consultation?"

Sure we can, Gary. But that will mean several minutes more time per consultation, which means we can see fewer patients per hour, which will lead to fewer appointment slots, therefore longer waits, and no doubt an increase in the consultation fees.

Seeing as it is that most patients do not require a written report at the end of their consultation (how mnay times have *you* needed one?), is it really that viable a system?

Is it really that repugnant to you that people pay for the services they consume?

angry doc said...

"Excessive charges" you say, Mr Tan?

What then do you think is a reasonable price to charge for a medical report, and how do you arrive at your estimate?

"It seemed to imply that the other part of the fee is to make profit for the center."

I don't speak for NDC, Mr Tan, and I don't even know if $87 covers the cost of producing a medical report in this case, but I suspect that any part of that fee above the 'cost' is to deter people from consuming services that they do not require.

If it costs the consumer nothing to receive a medical report (which does take time to produce - you should know, having been in the insurance business) - what is there to prevent every patient to request one at the end of his or her consultation, as Gary seems to suggest they should?

It takes time for the people involved in the preparation of a medical report to, well, prepare it. The time they use to prepare this cost their employers, and that money has to come from somewhere.

Should the money come from the taxpayers? Or the consumer who diretly requires and benefits from the service?

Tan Kin Lian said...

My reply to "Angry Doc".

If a doctor wants to earn a 6 or 7 figure salary, $85 is not enough. But remember that $85 is what most people earn in a day.

You ask me what is a fair rate. My view is $30. It probably takes a few minutes for the doctor to write his opinion for most simple cases.

Anyway, you can express your opinion without being personal. If you wish to be personal, please use your real name and don't hide under anonymity.

Tan Kin Lian said...

$100 for a statutory declaration is also excessive.

We are used to such exorbitant charges that they are taken as normal. And used as the benchmark for other charges!

This is why the cost of living is so high in Singapore. Lawyers and doctors want to earn high incomes, that they forget that the ordinary consumers cannot afford their fees.

There is the excuse that these fees are to deter unnecessary requests. This is a lame excuse. How many people want to get a medical report or make a statutory declaration for fun? It is usually required by some other people who think that it is free!

We are so used to being inconsiderate in Singapore, imposing unnecessary costs to other people, that it is part of the Singapore culture.

This is why I am speaking against this bad culture, which is unfortunately caused by our leaders. Monkey do, monkey follow.

angry doc said...

I typed a long reply that seemed to have been eaten by blogger... so just let me summarise by saying this:

It is so easy to complain that people in certain jobs earn too much money, but not so easy to qualify for their jobs, isn't it?

Gary said...

To Angry Doc:

mr Tan reflects many of my sentiments. Did I say the report is to be provided free in my post above? Read it again.

Nobody in his right mind is expecting a doctor to provide a medical report for EVERY patient or visit. Nobody is suggesting that a doctor provides a report for common ailments like a flu, cold or a sore eye. But, if a patient has an ailment/condition that requires further treatment, don't you think as a doctor you are duty bound to give him a report, at a reasonable rate or even free since it is still fresh in your mind, so that your other 'brothers-at-medicine' can take it up from there subsequently-if nec. Right now so called medical consultation amounts to little more than a sick person going from doctor to doctor for treatment with each doctor happy to be ignorant about what other doctors who have been consulted by the patient has said. Is that very caring or professional for the medical practition as a whole? what do you think?

Your preoccupation with money says it all. I certainly wouldn't mind waiting when others before me is being treated as long as when my turn comes the doctor give me the same care and attention.

Unknown said...

Rex comments as follows,

Bearing in mind that this is a Goverhment "National Dental Centre" and not a private one, i also think $100 is excessive for the medical report. (by the way, why did eve+line even mention lawyer fee? this is a medical report from a qualified doctor, what lawyer fee?)

Typically when you see a doctor at govt polyclinics the charge is around $30 to $50. The professional opinion dispensed, is legal in the sense that the doctor can be sued if he makes wrong judgement. Does it make any difference whether he puts in on paper in a REPORT or he dispenses advise and medicine to you? The doctor is paid for his professional services ALREADY at the time of consultation. Additional fees for the report should be to cover just the incremental time spent by the doctor to prepare the report (which most proably is a standard template in Word document, the doc just makes some changes, perhaps 20 minutes or so of his time).

To be more optimistic, there are goverhment departments today, which still operate in the 1960's standard of fairness. For just $1 you can swim at a olympic size, clean, public pool (50 cents for seniors!) for unlimited period of time. Some of the newer pools run by SSC are very impressive and class and you get to use it for just one dollar! That's very cheap - you know you have to pay lifeguards, admin staff, pool mainteneance, etc, yet the govt just charge only ONE DOLLAR. That is very good value for money.
Another example, if you lost your POSB ATM card, do you know how much it costs to replace it? JUST FIVE DOLLARS!

There is enough money around in governmetn and corporations to sustain a reasonable cost of living for services based on true costs.

There is no need for the government to squeeze $100 for charging for a report in a govermment clinic when the consultation fee was already paid at the time of consultation.

It is a matter of consistency and quality of goverhment, right now there is no check and balance in a consistent way, some govt departments are still ok, others are definitely not so like the national dental centre!!


Tan Kin Lian said...

I have friends who are hard working doctors, i.e. GPs, who charge reasonable fees and do not expect to charge $85 for a few minutes of work.

They earn a good income, but are not excessively rich.

I don't know why certainly professionals, i.e. some doctors, lawyers, agents, accountants and actuaries, think that they deserve extremely high incomes because they study to be qualified.

They forget about ethics and how to give give value without overcharging or cheating.

Tan Kin Lian said...

Message to Eve+line
I have not posted your last message as it contained an unfair personal attack. You can contact me directly on this matter or report it without your last paragraph.

Recruit Ong said...

another ridiculous charges from banks. i call up the bank to stop payment on a cheque that has not been banked in for over a month and whose purpose has lapsed, the bank says got a stop payment charge of $20 if i do it thru phone banking, if i do it through customer service it will be $40!

Gary said...

" It is so easy to complain that people in certain jobs earn too much money, but not so easy to qualify for their jobs, isn't it?"- angry doc

I find this statement regrettable. How does the university select its medical students?

Still, a swallow does not a summer make. Black sheep and rotten apples are to be found everywhere. But in the medical profession, it is particularly disappointing and alarm because of the many ramifications and implications here.

Tan Kin Lian said...

A doctor is unhappy with me for suggesting $30 as the cost of a medical report.

For this sum of $30, I do not expect a complete report of the patient. This is the type of report that is required to support an insurance claim, such as X was hospitalised from a certain date to a certain date for treatment of a specified medical condition and is /is not required to attend follow up treatment.

If a more complicated report is required, and more time has to be taken, it will be appropriate for a higher fee to be charged.

So, the fee does depend on the time taken and the nature of the report that is required, and should not be excessive.

The overcharging occurs in so many aspects of our daily lives, that it becomes a habit. The charges are beyond what most ordinary people can afford.

Unknown said...

Angry doc,
why did you become a doc? Why are you angry? I sure can give you a piece of my mind, for free.

Cyke said...

I have done medical reports for insurance companies before.

$30 is roughly what the doctor usually gets. But it is not what the hospital charges the client.

So Mr Tan Kin Lian, are you saying that it is ok for the doctor to be paid $30 for writing the medical report? Or should the doctor be paid less than that?

As for why the charge is $70+ or more that one I suppose the administrative people will have to answer. Added costs?

On a personal level I feel that the number of administrative staff in hospitals and health care institutions are way too many.

When you go to a hospital, what are you willing to pay for? The doctor's time? But do you realize that you are also paying for all the administrators working in the hospital as well? Do we really need all these administrative staff?

Singapore has such a strong obsession with money. Or the lack of it. Everything is "too expensive". This and that profession "earns too much". What is too much? Who decides what is "too much"?

And here's my last point. We are arguing so much about the cost of a medical report. But why does the person need to get that medical report to claim for insurance that he bought for? Is the person claiming every month? Every day? No right? Just only when he needs to make the claim. Yet the insurance company INSISTS on having these medical reports for whatever administrative purposes.

If you ask me, the real WASTE and cause of HIGH COSTS is all these administrative nonsense. We can cut a lot of waste by cutting all these paper work here and there. But then that's not the way admin people work. You should know what I mean Mr Tan Kin Lian.

Don't blame the busy professionals. Blame all the admin people. They are the ones who come up with all these nonsense extra work that professionals need to do.

I am sure every dentist and doctor out there would agree with me that they would much rather be seeing and treating patients than to write all these silly useless medical reports that only admin people know why they want it.

Unknown said...

Hi Mr Tan,

Just like Cyke, I have done many medical reports for insurance companies/police. The amount I earn from each report is somewhere between $20-$30. Depending on the complexity of the case in question, the process of formulating the medical report may take 20-60 min. Fees are the same for both simple or complex medical reports, although I think a premium is charged if the report is to be drafted by a specialist. The process of retrieving all the patient's information via the case notes, hospital's laboratory and radiology systems, and getting a Consultant to vet these reports can further increase the amount of time taken to produce the report.

Actually, each patient already receives a simple summary stating the main diagnosis upon discharge. Could this suffice for a simple insurance claim? Then, doctors would only have to produce medical reports of greater complexity.

To be honest, I would rather NOT go through this tiresome process to churn out another medical report just to earn some extra money. Already, the hospital requires me to work most weekends and public holidays without additional pay, I really do not wish to bring home extra work on a normal working day.

Its probably good that you highlighted this problem of charging $85 for a simple medical report. Hopefully, it is now abundantly clear that most of that money goes to the processing fee rather than the doctor.

I don't think there is any good solution to lower the request fee for a medical report. If this request fee was borne by the insurance companies instead of the patient, perhaps fewer requests for simple medical reports would be received?


pathdoc said...

It is also important to distinguish between different types of medical report. If all that is required in the report is to state the diagnosis and treatment given, $30 is pretty reasonable for the time of the doctor and staff who have to retrieve the records. On the other hand, there is the medical report in which an opinion is required as to the prognosis or likelihood of recovery, as with injury reports in victims of traffic accidents. The latter report has to be completed by a specialist (from Associate Consultant to Senior Consultant) and the report may well be challenged in court by experts from the other party. A doctor who puts his name to such a report (and his hospital, by reason of vicarious liability) takes on the medico-legal responsibility of his opinion. Given the seniority of the doctor, the time taken and the implication of such a report, a charge of $90 is probably an undercharge.

Me said...

"If a doctor wants to earn a 6 or 7 figure salary, $85 is not enough"

Indeed its true most docs barely earn a 5 figure salary unlike most CEO's

Pls do not confuse government salaries with private corporations or those in private practice.

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