MOH to Publish Data on Total Operation Fees for Common Procedures to Give More Information to Help Patients and Families

From today, the Ministry of Health is publishing on its website statistics on total operation fees for the top common procedures.

Background

1.    Since 2003, the Ministry of Health has been publishing total hospital bill size data for the top medical conditions on MOH’s website1. Commencing with public sector hospitals, the website now features data for both public and private sector hospitals. The data is updated monthly, and has been well received as it helps both patients and healthcare providers to compare prices.

2.    With this new publication on total operation fees, the Ministry of Health is providing additional transparency on the hospital bill component attributed to the cost of performing the surgery. As with the publication of total hospital bill sizes, we will commence by publishing information on the amounts charged at public sector hospitals under this component for common procedures. This will provide more information to empower patients to make informed decisions, and allow market forces to work more efficiently.

Total Operation Fees

3.    Unlike the private sector, many public sector hospitals do not have a separate line item within the total hospital bill for doctors’ fees (e.g. ‘Surgeon Fees’, ‘Anaesthetist Fees’, etc). In the public hospitals, revenue from all sources (substantial Government subvention and patient revenue, including the Total Operation Fees) is used to fund the hospital’s operating expenditure, including doctors’ salaries. There is no direct link between Total Operation Fee and doctors' pay. This publication will therefore feature the ‘Total Operation Fees’ which comprises ‘Surgeon Fees’, ‘Anaesthetist Fees’ and procedure-related ‘Facility Fees’.

Common Procedures

4.    The data published are for common procedures treated in the public sector hospitals, as defined by the updated Table of Surgical Procedures (TOSP) which took effect for patients admitted for surgeries from 1 January 2014 onwards2.

5.    The initial publication covers 65 common procedures, which account for 64.2% of all procedure-related admissions. To ensure statistical significance, only procedures with at least 30 cases will be published. We intend to progressively expand the list to cover other common procedures as they fulfil the threshold number of cases.

Data Source

6.    The data are based on actual hospital bills (and related fee breakdowns) submitted by the hospitals over the preceding 6 months i.e. from 1 January 2014 to 30 June 2014. Subsequently, the data will be updated annually.

Public Hospitals

7.    Unlike the current publication of total hospital bills on the Ministry of Health’s internet website, the data on total operation fees will not be broken down by individual hospitals and ward classes. This is to allow sufficient cases for publication based on the updated Table of Surgical Procedures (TOSP), which only took effect from 1 January 2014. The data will however be broken down into ‘Unsubsidised’ (i.e. Ward Class A and Day Surgery Private) and ‘Subsidised’ (i.e. Ward Class B2, C and Day Surgery Subsidised) cases.

Key Statistics

8.    The published statistics include (a) the 25th percentile, and (b) the 75th percentile total operation fees for each common procedure, to provide an indication of the range of fees for the particular procedure.

Website

9.    The data can be found at www.moh.gov.sg/totaloperationfees.  A list of common procedures featured in the initial publication is attached at Annex.

 

MINISTRY OF HEALTH

1 SEPTEMBER 2014

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ANNEX

List of 65 Common Procedures included in the Publication of ‘Total Operation Fees’ on

1 September 2014

Body Part

Common name

Abdomen

Appendix removal surgery, appendicectomy

Bowel, endoscopic ultrasound

Colon, colonoscopy (Diagnostic)

Colon, colonoscopy (Diagnostic) with removal of polyps (single/ multiple, <1cm)

Colon, sigmoid; sigmoidoscopy

Gallbladder removal surgery, cholecystectomy

Haemorrhoid surgery, haemorrhoidectomy

Hernia repair (Inguinal, children, single side)

Hernia repair (Inguinal/ Femoral, adult, single side)

Upper gastrointestinal tract, endoscopy

Upper gastrointestinal tract, endoscopy (Therapeutic)

Bone/Joints

Bone marrow biopsy

Hip/ Knee, arthroscopy (Therapeutic)

Knee replacement surgery (Total, single side, complex)

Knee replacement surgery (Total, single side, simple)

Chest

Breast biopsy (ultrasound or mammogram guided, single)

Breast lump removal/ biopsy (single)

Heart, angiography (Coronary angiography)

Heart, angiography (Coronary angiography) with left ventricle imaging

Heart, angioplasty (Coronary angioplasty)

Eyes

Cataract surgery (using YAG laser)

Cataract, removal with implantation of lens (complex, single eye)

Cataract, removal with implantation of lens (simple, single eye)

Conjunctiva, Pterygium, removal with conjunctival graft

Eye, photodynamic therapy

Eyelids, botox injections (for eyelid and facial spasms)

Eyelids, surgical correction of drooping eyelids (both eyes)

Iris, laser therapy

Myopia treatment (including LASIK)

Retina, laser treatment (complex, including multiple retinal tears)

Retina, laser treatment of tears (single eye)

Retina, laser treatment of the whole retina

Retina/ macula, laser treatment

Vitreous, removal of vitreous contents from the eye

Female Reproductive System

Delivery (Caesarean section)

Delivery (Caesarean section) with tubal ligation

Delivery, vaginal (assisted, including twins and breech)

Delivery, vaginal (simple)

Ovary, removal of ovarian cyst (complex, >5cm)

Uterus, diagnostic test for fetal genetic abnormalities (Amniocentesis)

Uterus, scope with polyp removal (>2cm)

Uterus, scope with tissue removal (Diagnostic)

Hand/Finger

Carpal tunnel, decompression (single)

Trigger finger, decompression (single)

Head

Gum tissue, repair

Jawbone, repair

Male Reproductive System

Circumcision

Prostate, biopsy

Neck/Throat

Thyroid gland, aspiration/ biopsy

Tonsils, removal

Voice box, scope

Nose

Nose, scope with biopsy

Nose, scope without biopsy

Skin/Soft Tissue

Face, removal and biopsy of lesion (single)

Skin lesion, incision and drainage (<3cm)

Skin lesion, removal and biopsy of general lesion

Skin lesion, removal and biopsy of large lesion (>1.5cm)

Skin lesion, removal and biopsy of small lesion (≤1.5cm)

Skin tumour/ cyst/ ulcer/ scar, removal and biopsy of 2 or more or recurrent or complicated (adherent) lesions

Skin, removal of foreign body

Skin, removal of unhealthy tissues of a skin wound (<3cm)

Skin, removal of unhealthy tissues of deep/ extensive/ contaminated skin wound (>3cm)

Urinary Tract

Bladder, removal of foreign body or ureteric stent

Bladder, scope

Ureter, ultrasound shockwave therapy of stones

[1] (http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/HospitalBillSize.html

[2] The TOSP is a classification of surgical procedures into 21 tables based on their complexity, and currently covers about 2,350 procedures. The use of Medisave and MediShield claims for surgeries also took reference from the updated TOSP from 1 January 2014.

 

 

 

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