SINGAPORE GENERAL HOSPITAL (Hike in consultation fees for specialist-outpatient clinics)

Dr Lily Neo asked the Minister for Health how does his Ministry (i) justify the big hike of 70% in the consultation fees for specialist-outpatient clinics (SOCs) at the Singapore General Hospital; and (ii) ensure the affordability of specialist care to the lower-income Singaporeans.

Mr Tay Beng Chuan asked the Minister for Health (a) what is the justification for the Singapore General Hospital (SGH) to increase with effect from 1st December 2000 its consultation charges at specialist-outpatient clinics by as high as up to 70%; and (b) what productivity and control measures are put in place by his Ministry to prevent, in the future, spiral increases in operation costs and charges by SGH and other Government-linked hospitals with no regard to the affordability of the average Singaporean.

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, can I be permitted to take Question Nos. 5 and 6 together?

Mr Speaker: Yes.

Mr Lim Hng Kiang: Let me put the recent SGH specialist outpatient fee increases in perspective. The 70% increase in consultation fee applies only to private patients on repeat visits to the senior consultants, the most senior grade specialist in the hospital. In absolute terms, the increase is from $32 to $55. The rate of $32 before SGH's recent fee revision was close to the charges of GPs and therefore not reflective of the actual cost of specialist care rendered by a senior consultant. Therefore, the relatively larger increase is to better reflect the actual cost of specialist care as well as to close the fee differential for initial and repeat visits.

The 70% increase in consultation fee does not apply across-the-board. For private patients on initial visits, the SOC consultation fees were raised by $13 to $18 and now range from $60 to $80, depending on the seniority of the doctor. This is an average increase of 30%. If we look at the total bill size, which includes prescription and other investigations which patients are more concerned with, the increase for private SOC patients is about 12%. As the last time SGH revised its SOC fees was in June 1997, the recent fee revision should therefore not be deemed excessive.

While fees for healthcare services would have to be revised regularly, my Ministry will ensure that the cost of subsidised healthcare remains affordable. We will provide heavy subsidies to moderate fee increases so that healthcare continues to remain accessible and affordable to the middle and low income Singaporeans. In this recent fee increase by SGH, the consultation fees for subsidised patients, for both initial and repeat visits, were raised by $4 to $21. So for subsidised patients, whether they see the consultant for the first time or for repeat visits, they pay $21 for the consultation fee. This increase is reasonable given that the last time SGH revised its subsidised SOC consultation fees was way back in 1993. As for the total bill size for subsidised SOC patients, the increase was kept to about 8%.

SGH's fee revision is unavoidable, given the economic recovery and the need for SGH to keep up with the increase in its operating cost, contributed largely by manpower, medical supplies and medical equipment. Nonetheless, our restructured hospitals will always be mindful of the need to moderate the increase in healthcare cost. As such, they have undertaken various productivity and cost saving measures, including bulk purchasing and e-procurement of supplies, implementation of electronic medical records system and skills redevelopment programmes to deliver more cost effective and efficient healthcare services to Singaporeans.

For Singaporeans who still cannot afford to pay even the highly subsidised rates due to financial hardship, they can always apply for Medifund help. I would like to give the House my assurance that no Singaporeans will be denied essential medical care because of their inability to pay.

Dr Lily Neo (Kreta Ayer-Tanglin): May I ask the Minister whether he has a breakdown on the cost of running specialist outpatient clinics, whether the increases of charges could have been spread out in stages and whether part of the cost could have been defrayed or absorbed by the hospitals.

Mr Lim Hng Kiang: Mr Speaker, Sir, the fee structure of our SOCs is a little out of sync and therefore we have taken this opportunity to try and re-align it correctly. As I explained earlier, the SOC fee is structured accordingly to whether you see a senior consultant, consultant or a Registrar. So it is structured based on the seniority of the people you see. It is also structured on whether you see the consultant for the first time or for repeat visits. Based on this structure, we have a set of fees. For the private patients, the higher end of this structure will be when you see the senior consultant for the first time and that would now cost $80. If you see the Registrar for a repeat visit, which is the other end of the structure, it will cost you $35. So that is the range of fees. And to see a consultant, as a private patient, paying this range of fees from $80 or $35, I think, is a reasonable reflection of the actual cost of the consultant rendering the service.

As a subsidised patient, we also follow this structure. But because of the very heavy Government subsidy, we charge a single rate of $21 to see a consultant and we do not vary, whether by senior consultant, consultant or Registrar, and we do not vary whether it is an initial visit or a repeat visit. So for subsidised patients, every time they go to the SOC, the consultation fee is a flat $21. But for private patients, we adopt this structure to better reflect the costs. For the subsidised patients, as I have explained, the fees have not been revised since 1993 and even in this revision, we have raised it by only $4. $4 over $17 is a big percentage increase, $1 over $17 is a 6% increase. So raising it by only $4, is already an increase of 24%. But $21, I think Members will agree with me, is a very affordable cost to pay to see a senior consultant in the restructured hospitals.

Dr Lily Neo: May I ask the Minister whether the reason for the hike in specialist outpatient clinic charges is to address the cost of running such clinics or to address the long waiting times? If it is the latter, could other avenues, such as administrative policy and efficacy improvements be sought first before raising the charges?

Mr Lim Hng Kiang: It is related because we are under recovering. Because it is relatively inexpensive, people will come to see the specialists. When a specialist's cost is just slightly above a GP's, Singaporeans will all troop to see the specialist instead of going to the GP. I think we have to have a sensible structure so that there is a differentiation in the fee structure between a specialist and a GP. But, at the same time, we know that costs have increased and in running a healthcare system, 60% of the cost is manpower cost, and the public sector is losing doctors very rapidly. We have to adjust the pay and other remuneration structure for the public sector doctors and that goes into the cost. The Government subsidises this portion but part of that cost increase will have to be recovered from the fee increases.

Mr Jeyaretnam: Do I understand, when the Minister talks about private patients, he is referring to patients referred by private medical practitioners?

Mr Lim Hng Kiang: Under our system, if you have stayed in a B2 or C class ward in a hospital, and you later return to the SOC for follow-up treatment, you are treated as a subsidised patient. If you visit the polyclinic and the polyclinic's GP refers you to a specialist, you are treated as a subsidised patient. If you go to the SOC on your own or you are referred to by a private sector GP, then we treat you as a private patient.

Mr Jeyaretnam: Does the Ministry realise that this may put specialist care out of reach to about 40% of our people?

Mr Lim Hng Kiang: Anybody who wants to be treated as a subsidised patient can easily go to a polyclinic, be seen by the GP there and if his condition requires specialist care, the GP will refer him to the specialist outpatient clinic and he will be treated as a subsidised patient. So I do not know where he got the 40% from. Today, if you go to a polyclinic and you are suffering from a major ailment and you need to see a specialist, the GP will refer you to a SOC, and you will be treated as a subsidised patient.