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Transparency of hospital bills

Country: 
Singapore
Partner Institute: 
Department of Epidemiology and Public Health, National University of Singapore
Survey no: 
(3)2004
Author(s): 
Lim Meng Kin
Health Policy Issues: 
Funding / Pooling, Access
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no yes no no

Abstract

The Ministry of Health has announced to publicize on its website the hospital bill sizes of common medical conditions across all public and private sector hospitals. Greater transparency of hospital bills is expected to put downward pressure on hospital charges. Hospital prices will be updated online on a monthly basis.

Purpose of health policy or idea

ObjectivesTo engender greater transparency of hospital bills with the aim of putting downward pressure on hospital charges.

Main characteristics of proposalsThe Ministry of Health will publicize on its website the hospital bill sizes of common medical conditions across all public and private sector hospitals.  The prices will be updated on a monthly basis.

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent system-neutral system-neutral

Political and economic background

Singaporeans are served by a total of 26 well-equipped hospitals and specialty centers, with 11,798 beds (or 3.7 beds per 1,000 population). Eight public hospitals and 5 specialty centers, with bed complements varying between 80 and 3,110, account for 80% of the beds. The remaining 13 hospitals are privately owned, varying in size from 25 to 500 beds.

Over the last 20 years, every one of the public hospitals and specialty centers has been systematically "corporatised". Each is an independent entity within the meaning of Singapore's Companies Act and, although remaining 100% government-owned, is autonomous in fiduciary and operational matters.

Both public and private health care facilities have a strong reputation for quality health care, and even attract a steady flow of well-heeled foreign patients from the surrounding countries. While the Ministry of Health regulates ward accommodation charges of the public hospitals, the prices for medical treatment and procedures are not subject to control. Competition for patients, who have complete freedom of choice of health care, is keen. However, both price and quality indicators are not very transparent.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no yes no no

Origins of health policy idea

In August 2003, Singapore had a new Acting Health Minister who, upon taking office, listed healthcare costs as one of his eight priorities.

In October 2003, the Ministry of Health published for the first time on its website, the hospital bill sizes of 28 common medical conditions across all public sector hospitals. The exercise was given wide media coverage and created a national stir.

The result was an immediate downward trend in hospital charges for some of the conditions listed. For instance, in the first set of data released for the period Sept 1, 2002 to Aug 31, 2003, gall bladder removal in Class B2 wards was the most expensive at Changi General Hospital (CGH) at $1,311 and the least expensive at Tan Tock Seng Hospital at $867. The fees have since been revised to 1,190 and $823 respectively.

Pneumonia treatment at CGH's C-class wards is now $502, down from $513. Tonsillectomy at KK Women's and Children's Hospital was $903 and now, $896.  It was $598 at the National University Hospital (NUH)'s Class B2 wards and now, it is $587.  One of the biggest drops was for stroke treatment at Class B1 wards at NUH, which fell from $3,141 to $2,459.

Private hospitals were included in the exercise in December 2003. The initial results showed that private hospitals were charging between 20% to 120% more than public hospitals for the same conditions listed.

The list of procedures on the Health Ministry website was gradually increased, and has stabilized at 70. The prices are updated monthly.

Influences in policy making and legislation

The public was delighted with the new transparency in hospital charges and the sudden downward fee adjustments that followed shortly after. CEOs of hospitals shown to have higher charges than others for the same treatment or procedure scrambled to either justify or cut their fees. The new Acting Minister of Health is riding high on a wave of popularity.

Expected outcome

References

Author/s and/or contributors to this survey

Lim Meng Kin

Suggested citation for this online article

Lim Meng Kin. "Transparency of hospital bills". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/sg/a3/4