Doctor, Bill Thyself

Bring up the subject of doctors’ bills and many patients will have their anecdotes, but an interesting court trial is currently shaping up in Singapore regarding the way doctors there charge for their services.

A well-known surgeon in Singapore is fighting in the High Court there to disallow the Singapore Medical Council from setting up a disciplinary committee to investigate charges that the surgeon had over-charged her patient from Brunei, who happened to be the Brunei Queen’s sister.

Dr Susan Lim and doctors' charges - how much is too much?


The surgeon, Dr Susan Lim, had begun treatment for breast cancer on the patient in 2001 right till her death in 2007. In the process, she had referred the patient to several colleagues who had their bills directed to her for onward transmission. Here are some astounding facts that were heard in court last week:

The Bill Mark-Ups (courtesy of Straits Times,Singapore,24 Feb 2011)

  • The overall bill for the year 2007 alone came to USD 19.5 million.
  • She charged as high as USD 354,000 per day for her services.
  • The surgeon would inflate her colleagues’ bills dramatically and bill the patient. For instance, doctors’ bill for USD 315 forwarded to her was bumped up to USD 166,000.

When the patient eventually passed away in 2007, the Ministry of Health of Brunei, alarmed at the high fees, complained to their Singapore counterparts. It was alleged the surgeon then gave a 25% discount of the bills accompanied by an apology on “inadvertent mistakes made by her office”; but when this did not work, she then offered to waive all her bills in return for a “letter of good standing” to state that the matter would not be pursued further. The Brunei government did not respond.

In her defence, the lady surgeon said that the patient had been forewarned on her fees of between USD 79,000-168,000 per day and that the patient had agreed to it, saying that the Palace would pay. In addition, the patient had become so dependent on her that no other doctors could provide treatment without her physical presence.

The above anecdote makes grim reading and raises several questions related to medical ethics and human psychology. Can a doctor justify such charges no matter what challenges are faced? Can a patient, assuming he or she is in a mentally fit state, make a financial undertaking  on behalf of  the body paying for the bills? The issue is made complicated by some of the doctors backing the surgeon on the inflated bills. See here.

It also calls attention as to why a developed country like Singapore does not have an approved fixed fee schedule upon which doctors’ charges are based. Most countries have one in place that makes such charges transparent.

Whichever way  you look at it,  healthcare has become an industry; like all industries, standard-operating procedures and adequate legislation must be in place to protect the consumer. This includes a transparent doctors’ fee schedule. Until this is done, Singapore’s credibility as a medical hub is seriously affected.


3 responses

  1. It’s just plain greed.

  2. mentang2 Kerabat Brubnei, bil sampai beratus ribu sehari pun tak apa….

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