Steps to cheaper treatment

I REFER to the letters “Two steps away to reducing medical costs” ( The Star, June 22) by Lim Boon Siong and “Medical insurance industry in need of care” (June 1) by LK.

As a medical specialist who has worked in government as well as private hospitals for many years, I agree with LK that there is a lot of “fraud, waste and abuse being committed” not only by private hospitals but, sadly, by some doctors too.

Some of the solutions suggested by Lim are worth looking into, but since they are based on his practice as an eye specialist, which is mainly ambulatory, outpatient care, I would like to offer a few other possible changes that the Health Minister can consider in the regulation of private hospitals.

I suggest that every time a patient is required to undergo an operation or procedure, the doctor must make a provisional diagnosis of the illness and a treatment plan for him. This diagnosis must state the anticipated costs for investiga- tions and treatment, and printed out and given to the patient. If this estimated price increases by 10-15%, this would usually be acceptable and the patient would at least know what to expect and plan accordingly.

The United States has devised systems to manage and control increasing healthcare costs which are worth studying. Examples would be the diagnosis-related group (DRG) and inpatient prospective payment system (IPPS) which were devised because of similar complaints from third-party payers.

The US is quite strict in enforcing these systems to control hospital and physician charges. For example, it is good medical practice to limit the number of stents in a planned treatment for coronary artery disease to two. If more than two stents are required, the cardiologist must make his justification to an oversight committee or the insurance company. If the patient or doctor insists on using more than two stents in a planned case, the extra cost must be borne by the patient.

Another system that can be introduced is co-payment whereby the patient also pays for his medical costs. This would be about 10-15% of the total hospital charges. Co-payment would make the patient more sensitive to the hospital’s and physician’s charges because he might complain about the high fees, and the physician would also be cautious when drawing up the bill.

Hospitals have learned how to itemise the bills into pages and pages of statements which make it difficult for an auditor to check. I think the Health Ministry must insist on bills being summarised and made easy to understand.

Another way to control the escalating fees charged by private hospitals is for the insurance industry, with the approval of the Health Ministry and Bank Negara, to set up a hospital charges oversight committee consisting of four to five well-known specialists who have been in clinical practice.

These specialists must be paid well either by the government or the insurance industry. Any charges or fees considered excessive or unfair by patients or by the insurance providers can be referred to this panel for adjudication. All decisions made by this panel must be considered final.

Finally, the ministry must examine ways to promote healthy competition among the private hospitals in the country. This can be done by publishing the outcome statistics of these hospitals.

The ministry must also require all complaints against hospitals or doctors to be published in an easily accessed website, and make private hospitals advertise not only their bed charges but also the expected fees for various treatments.

If we insist on vendors clearly labelling the price of their goods, why can’t we demand the same from hospitals?