The Ministry of Health (MOH) has released new fee benchmarks for hospital fees, and surgeon and anaesthetist professional fees for the private healthcare sector. This will make the charges more transparent and allow stakeholders such as patients, healthcare providers and insurers to make more informed healthcare decisions. The key changes are: (a) benchmarks are adjusted to take into account cost increases; and (b) introduction of new benchmarks for hospital charges and professional fees.
Fee benchmarks have been effective in moderating growth of private surgeon fees
2. Fee benchmarks are MOH’s recommended charges for a particular medical procedure or service, as part of MOH’s larger strategy to manage rising healthcare costs. In 2018, MOH introduced surgeon fee benchmarks for 200 common surgical procedures on the Table of Surgical Procedure (TOSP)[1]. In 2020, the benchmarks were extended to include anaesthetist fees and doctors’ inpatient attendance fees.
3. Since its introduction, close to 90% of doctors have been charging within the recommended surgeon fee benchmarks. The median private surgeon fee has remained stable, while the 90th percentile private surgeon fee has decreased by about 1.7% for procedures with fee benchmarks. MOH will continue to monitor the impact of the fee benchmarks. Overall, while not mandatory, fee benchmarks have fostered price transparency, instilled discipline in charging, and helped moderate increases in fees.
Developed in consultation with stakeholders
4. The latest fee benchmarks were recommended by an independent Fee Benchmarks Advisory Committee (FBAC), chaired by Dr Wee Siew Bock, and accepted by MOH. Please refer to ANNEX A for the composition of the FBAC.
5. The new fee benchmarks include:
a) Hospital fee benchmarks for 29 common surgical procedures and medical conditions; and
b) Surgeon fee benchmarks for 2,100 procedures, anaesthetist fee benchmarks for 500 procedures, and doctors’ inpatient attendance fee benchmarks.
The full list of fee benchmarks is published on MOH’s website (www.moh.gov.sg/billsandfees).
6. In developing and updating the fee benchmarks, the FBAC reviewed past transacted fees data. More than 10 stakeholder consultation sessions were held between June 2022 and March 2023, with about 600 specialists, administrators from all private hospitals, and insurers.
Adjustment in benchmarks
7. To ensure that the benchmarks remain reflective of current costs and inflationary pressures faced by doctors, MOH has also adjusted all existing and new doctors’ professional fee benchmarks by a growth factor, which has considered key costs, such as manpower, rental and other operating expenses for the past years.
Fee benchmarks for hospital charges
8. MOH has introduced hospital fee benchmarks for 21 common surgical procedures and 8 common medical conditions. Hospital fee benchmarks includes fee components such as hospital room charges, surgical facilities and equipment, implants, consumables, investigations, general nursing services and treatment, and medication. However, hospital fee benchmarks exclude doctors’ professional fees (i.e., surgeon, anaesthetist and doctors’ inpatient attendance fees), which have separate fee benchmarks. An illustration of cost component of hospital bill is as follows:
Figure 1: Illustration of cost components in a private hospital bill
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Hospital Invoice |
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Billed by the doctor(s): · Surgeon fees |
Doctors fee benchmarks |
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· Anaesthetist fees |
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· Doctors’ inpatient attendance fees |
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Billed by the hospital: (Some fee components below could also be charged by the doctors) · Room charges |
Hospital fee benchmarks |
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· Surgical facilities and equipment (e.g., use of operating theatre) |
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· Implants |
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· Consumables (e.g., gauze, swab) |
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· Investigations (e.g., radiology tests, laboratory tests) |
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· General nursing services and treatments (e.g., basic monitoring, taking regular blood test, administering drugs and/ or fluids prescribed) |
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· Medication |
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TOTAL BILL |
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9. Patients and payers should take note that some fee components of the hospital fee benchmarks could be charged by the treating doctor, but billed through the hospital. Such charging practices could vary across hospitals and doctors, even for the same procedure or medical condition. Using cataract surgery as an example, a surgeon could order and charge for a lens implant and bill it through the hospital. In this situation, if the patient or payer has questions on the cost of the lens implant, they should enquire with the doctor directly. Patients can clarify with their doctor or hospital if in doubt over who the charging party is. Notwithstanding this, the hospital fee benchmarks provide a common reference for the reasonableness of the total fee billed by the hospital, regardless of the charging party.
10. 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.
Fee benchmarks for doctors’ professional fees
11. Patients and payers may also be charged by doctors for their professional services, such as surgeon fees and anaesthetist fees. MOH has introduced new surgeon fee benchmarks for the remaining 1,900 less common surgical procedures. With this, all 2,100 procedures[2] which can tap on MediShield Life and MediSave will now be covered. Anaesthetist fee benchmarks have also been rolled out for a total of 500 procedures. These benchmarks cover almost all surgical cases in the private sector.
Use of fee benchmarks and available recourse for disputes
12. Providers should refer to and quote the relevant fee benchmarks when providing financial counselling to patients. Providers who charge above the fee benchmarks should be prepared to justify their higher fees when queried by the patient or payer, including whether the fees are charged by the hospital or doctor. Patients are also encouraged to use the relevant fee benchmarks and hospital bill size information found on MOH’s website as references for cost comparison when considering care options. When in doubt, patients are encouraged to seek clarification from their providers.
13. An example of how the fee benchmarks should be used is provided in ANNEX B. The full list of fee benchmarks can be found in Annex C.
14. In the event of a clinical-related claim dispute between Integrated Shield Plan (IP) policyholders, IP insurers or healthcare providers, parties may file their dispute with the Clinical Claims Resolution Process (CCRP) at www.ccrp.com.sg. The CCRP, which is administered by a secretariat from the Academy of Medicine, Singapore, will facilitate the resolution of clinically related IP claim disputes, including concerns on over-charging by medical practitioners and medical institutions, concerns on over-servicing by medical practitioners, and concerns on unfair rejection of claims for medically appropriate treatment or procedures.
15. Dr Wee Siew Bock, Chairman of FBAC said, “The trends are encouraging, and more doctors are charging within the fee benchmarks since their introduction in 2018. Rolling out more surgeon and anaesthetist fee benchmarks will give patients, doctors and insurers a more complete reference and help them make better informed decisions. For the hospital fee benchmarks to have a similar effect on hospital charges, both doctors and hospitals will need to work together to ensure that either party charges reasonably. I hope all stakeholders continue to use the fee benchmarks fairly to ensure that healthcare costs remain sustainable.”
16. MOH would like to express its appreciation to Dr Wee, members of the FBAC, and all stakeholders who were involved in the process for their invaluable time and contributions to the development of fee benchmarks in support of a sustainable healthcare system.
MINISTRY OF HEALTH
14 JUNE 2023