Transparency in Pricing Data

The Straits Times published today an article highlighting that Parkway has launched an initiative to make public the prices of common procedures. This is a great start, not perfect but ‘green shoots’ and I hope that this will set in motion a movement towards greater pricing and quality transparency.

The Straits Times asked me for a perspective on this and my thoughts are as below:

“This is overall a positive development for Singapore healthcare. There is great confidence in the quality of Singapore healthcare regardless of whether public or private and the concerns expressed have mostly been around pricing. I do hope this initiative by Parkway will help provide patients with accurate financial information for decision making.
 
What would be useful if we draw parallels with the Ministry of Health website would be to state also the ‘sample size’, i.e. how any cases were used in computing the price estimates as well as the length of stay. For example, in the section on hemorrhoidectomy, it is not clear whether the pricing estimates refer to day surgery on overnight admissions.
 
Also, it is worthwhile to note that Parkway uses the 75th centile while the MOH data uses the 90th centile. Hence, the raw numbers are not comparable.
 
Finally, it would help patients to know what proportion of doctors practicing in these hospitals are included in the price estimations, e.g. in coming up with these numbers, did the hospitals have access to the pricing data of half of the accredited doctors, 75% etc.?
 
All that said, it is a good start and the hope would be that over time, more and more procedures would be included with data collected and presented in the same way as the MOH data so that comparisons can be more meaningfully made. 
 
I do not think the data will ‘fix’ prices but they will be useful reference points for doctors in setting fees as well as for various regulatory bodies in deciding on complaints of over-charging.
 
It will be helpful to keep a close watch on the numbers and how they are used. One metric MOH monitors or used to monitor for the restructured hospitals is the variance between estimated and actual bill sizes. Perhaps in 6 months’ time, the numbers could be reviewed and assessed how accurate they were and how helpful they were in patient decision making.
One last comment in response to your query about protecting patients from over-charging. In the list of the Economic Review Committee’s recommendations that gave rise to SingaporeMedicine in 2003, a specific recommendation was to establish a healthcare ombudsman, a medical CASE, to be an independent voice for patients and consumers and to arbitrate/ mediate in disputed cases. It would be worthwhile to reexamine and ask ourselves whether this recommendation which was never adopted, should be today.”
What the Straits Times also pointed out obliquely is that patients can now shop around for not just doctors but also facilities as the prices are listed separately or can be decomposed. In our practice model in Singapore, most doctors have admitting rights to multiple private hospitals and so patients can (and do) request doctors to perform the surgeries or procedures in a preferred hospital. Will this lead to competitive pressures bringing down prices of both doctors and facility providers? Time will tell…
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