Consultation fees are up! Or are they?

The SMA recently published a revision to the "SMA guidline on Fees"(private practitioners). This is now the 4th edition (2006).

The 3rd edition was published 10 years ago in 1996.

Now let's take a look at how much health care has risen in the past 10 years!

In 1996 the guidline read as follows :

General Practitioner/Family Physician
In-Office Consultation Fees
Short consultation $18 to $26
Long consultation $25 to $55
Extended consultation (per 15 min block) $20 to $25


Out of office consultation Fees
Non-Emergency Consultation $100 to $150
Emergency Consultation $150 to $200
Hospital Inpatient Consultation (per day) $50 to $100

Specialist
In-office consultation fees $45 to $85
Long consultation $70 to $130
Extended consultation (per 15 min block) $40 to $50

Out of office consultation fees $150 to $200
Emergency consultation $200 to $300
Hospital inpatient consultation (per day) $100 to $200

The consultation fees DO NOT INCLUDE costs of medicine, injections, operations, special procedures, laboratory tests and otehr investigations eg X-ray.
Short consultation refers to routine consultation for relatively sinple medical/cases/problems, where the problems allow for quick diagnoses and treatment.
Long consultation refers to cases that are more complex and therefore require more time for diagnoses.

In 2006, the 4th edition reads as follows (percentage increase from 1996 in brackets):

General Practitioner/Family Physician
In-Office Consultation Fees
Short consultation $20 to $30 (up 11-15%)
Long consultation $30 to $55 (up 20% for lowest range)
Extended consultation (per 15 min block) $20 to $25 (no change)


Out of office consultation Fees
Non-Emergency Consultation $120 to $200 (up 20- 33%)
Emergency Consultation $200 to $300 (up 33 - 50%)
Hospital Inpatient Consultation (per day) $50 to $100 (no change)
Death certification $150 to $300 (new addition to guidlines)

Specialist
In-office consultation fees $60 to $100 (up 33%-17%)
Long consultation $90 to $150 (up 28%-15%)
Extended consultation (per 15 min block) $50 to $80 (up 25% - 60%)

Out of office consultation fees $150 to $200 (up 33%-25%)
Emergency consultation $200 to $300 (up 25% - 33%)
Hospital inpatient consultation (per day) $100 to $200 (up 25% for highest range)
Death certification $200 to $400 (new addition to guidelines)

The consultation fees DO NOT INCLUDE costs of medicine, injections, operations, special procedures, laboratory tests and otehr investigations eg X-ray.
Short consultation refers to routine consultation for relatively sinple medical/cases/problems, where the problems allow for quick diagnoses and treatment. Examples : for GPs, uncomplicated cases of influenza or gastroenteritis; for specialists, routine antenatal visits for maternity patients or routine post-operative office visits(added in 4th edition)

Long consultation refers to cases that are more complex and therefore require more time for diagnoses. Examples : for GPs, cases of diabetes or hypertension requiring detailed history, examination and advice; for specialists, complicated cases that require major surgery or complicated cases of cancer requiring detailed examination and discussion. 3 or more minor ailments qualify as "long consultation". Chronic conditions qualify as "long consultation" (added in 4th edition)

First and foremost, let me say that I am a GP. So I will only comment on the fees for GPs.

The price increase for short consultation hasn't gone up by very much in the last 10 years don't you think? Anyway it's a moot point because my clinic used to charge $5 for consult until about 2 years ago and today we charge a grand figure of $10 per short or long consultation (by the definition of the SMA guideline)

Before people start saying that the SMA is a cartel and is always raising prices to starve the people etc......let's consider the facts :

1) This revision is the first in 10(TEN) years! When was the last transport fee hike? Or hike in NUS tuition fees? I think 10 years is a long time and a revision was necessary which goes on to point number 2

2) Have rental rates have gone up in the past 10 years? What about salaries of staff? What about fuel costs? There is something called inflation. And from what I understand inflation rates average about 3% per annum. From the paltry increase of 11-15% for short consults by GPs I would say the consultation rates are growing below the inflation rate! So consultation rates have actually gone down.

3) In reality not many GPs actually charge the recommended fees from the SMA. Not even the lowest range of the fees. Some GPs are up in arms about this. They call it a lack of unity within our ranks. They call it "undercutting" each other. Everybody has their points to argue. But the reality is that the people cannot afford and do not want to pay for health care. The market forces have decided and some GPs are also understanding and compassionate. Hence some of us continue to charge lower than recommended rates. Sadly the public are not aware of this and continue to have misconceptions that GPs are raking in millions of dollars and constantly overcharging. In most cases, such allegations are unfounded.

I found it strange to receive this latest 4th edition of guidlines on fees when my clinic had hardly adhered to the 3rd edition done in 1996! Nevertheless, as doctors, our duty is to our patients. To do the best for them, see them recover, see that their chronic illnesses are well controlled and not run into complications. That is the raison d'etre of doctors. Let us all remember that.

However I do see that if the situation continues, I will have to consider if it makes financial prudence to continue being a GP. Perhaps pursuing aesthetic medicine, mesotherapy, cosmetic work, anti-aging medicine etc would be far more sensible.

As the columnist The Hobbit asked in the latest SMA newsletter, we should do a survey of GPs to find out what percentage of them provide aesthetic services. 50% of each NUS medical school cohort become GPs. If 50% of all GPs provided aesthetic services, that would mean 25% of each NUS medical school cohort would be doing aesthetic medicine work in future. Therefore shouldn't we include aesthetic medicine in the core curiculum for medical students? Otherwise we are not preparing them for the realities of medical practice in Singapore.