Brunei, UAE billing rows threaten Singapore’s medical ambition

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Plastic surgery

Plastic surgery

It’s a S$24.8m ($20,) medical bill that shocked oil-rich Brunei and may hinder Singapore’s bid to become a top medical-tourist destination.

Susan Lim, Asia’s first liver-transplant surgeon, sought as much as S$200,000 a day over seven months in 2007 to treat a member of Brunei’s royal family who later succumbed to cancer. The bill sparked a complaint from Brunei, a Singapore investigation and an inquiry into her fees.

“Reputations are tarnished at all levels” with such scandals, said Josef Woodman, who spent more than five years researching medical tourism and is the author of Patients Beyond Borders, a guide to finding offshore medical treatment. “This underscores the need for improved oversight and regulations that would help to prevent abuses.”

The Brunei case and another complaint from the United Arab Emirates accusing a group of Singapore doctors, including Lim, of overbilling may hamper the state’s ambition to attract more foreign patients in Asia’s $5.5bn medical-tourism market. Heart-bypass surgery in Singapore costs about a sixth of that charged in the US.

Lim denied any wrongdoing and in emailed responses said the Bruneian patient had agreed to the charges.

“The patient was never held to ransom,” Lim said. “She was willing to pay the price we had agreed to.”

India, Malaysia, Thailand and South Korea are among countries competing with Singapore for a slice of the industry, said Pawel Suwinski, a health care analyst at Frost & Sullivan.

“Singapore is losing ground to cheaper countries and is evolving into a hub for complex surgeries,” said Wei Siang Yu, who owns Fly Free For Health, a Singapore-based medical concierge service.

Brunei is ruled by Sultan Haji Hassanal Bolkiah, the second-richest royal in the world, according to Forbes. The country’s health ministry sought a discount through its counterpart in Singapore on Lim’s S$24.8m bill for treatment of Pangiran Anak Hajah Damit, the Sultan’s sister-in- law, claiming in a letter made public in court documents that the “extremely high” charges weren’t justified.

Lim had voluntarily cut Damit’s original bill to S$12.1m including S$3.3m for a team of doctors and nurses, according to court papers. The amount covered “extraordinary” services including setting up medical facilities in hotel suites and “round the clock devotion,” to the patient, her lawyers from Rajah & Tann said in the court papers.

Lim, 56, married to Citigroup Inc. private bank Chairman Deepak Sharma, said in the email she reduced the bill “as a gesture of friendship.” She said the perception she cut the cost to avoid professional misconduct charges is untrue.

Singapore’s health ministry began a probe in 2007 to determine whether Lim’s bills showed a pattern of overcharging, improper billing and whether some fees were inappropriate for services done by other doctors. A panel appointed by the medical council to hold the inquiry stepped down after Lim complained the members had prejudged her case. A second panel is now pursuing the investigation.

Lim failed to block the second hearing when the city’s high court ruled on May 26 that it could proceed. Lim has until June 27 to appeal.

Officials from the medical council declined to comment for this story, referring to a May 26 statement that said the council will continue to take all steps to ensure “a full, fair and timely hearing of the matter.”

Singapore Health Ministry officials referred inquiries to the city-state’s tourism board, which said Lim’s case had “minimal impact” on the island’s medical tourism industry.

Lim’s case has renewed calls for medical fee guidelines in Singapore to be reinstated. The Competition Commission of Singapore had rejected the proposal last year.

“People who are coming in for medical tourism would like to ensure that the clinics and doctors are credible and have some certainty of their expenses before even making the trip,” said Janson Yap, the Southeast Asia head of life sciences and health care at Deloitte. “Having guidelines would be helpful.”

The antitrust regulator said more effective measures include the health ministry’s requirement for itemized medical bills and hospitals providing financial counseling for patients.

The controversy over the Brunei bills resulted in a loss of new patients and other businesses being put on hold, Lim said. Her medical practice is now “technically bankrupt” and if not for a loan she and her family provided would have shut down, she said.

The value of her medical practice plunged to S$11.6m, based on 2008 financial statements, from S$103m two years earlier, she said.

Singapore earned S$940m from medical tourism last year, according to the tourism board, which has a goal of one million medical tourists by 2012. A group of doctors and investors is building an S$800m integrated private hospital, medical center and hotel to attract more foreign patients.

Other Asian nations have their own initiatives.

Thailand, whose King Bhumibol Adulyadej is the world’s richest royal, has a five-year plan to double revenue from foreign patients by 2014. Malaysia has eased health-care advertising guidelines and offers tax breaks to hospitals serving foreign patients.

India, home to the Taj Mahal, says it’s a “perfect destination” for medical tourism, combining health treatments using the latest technology and visits to “some of the most alluring and awe-inspiring places of the world.”

A heart bypass costs $10,000 in India, $20,000 in Thailand and $23,000 in Singapore, according to data from Deloitte. The same surgery costs $44,000 in Dubai and $130,000 in the US

“While list prices appear higher in Singapore than in other Asian countries, final bills are often comparable due to shorter hospital stays,” said Tan Yen Nee, deputy director of enrichment at the Singapore tourism board.

“We’ve only had two or three patients seek care in Singapore over the last three or four years,” said David Boucher, president of Companion Global Healthcare, a Columbia, South Carolina-based medical tourism facilitator that sends about 25 employees of US companies to Asia each year.

Most go to Bumrungrad Hospital Public Co. in Thailand, Boucher said.

Bangkok’s Bumrungrad treated 30 percent more patients from Singapore between January and April compared with a year earlier, triple the hospital’s overall growth rate, said Kenneth Mays, the marketing director at the hospital.

The United Arab Emirates’ Health Ministry settled a billing dispute with Singapore in 2008 after the fees to about 100 UAE patients were halved to S$17.2m, according to court papers.

Lim had said Damit agreed to her charges of S$100,000 to as much as S$200,000 a day, according to court papers. The Brunei Health Ministry said it wasn’t aware of such an arrangement.

Singapore’s medical fees still are significantly lower than charges patients face in London or Dubai, said Moza Juma Mattr, a Dubai citizen who visits Lim twice a year for treatment. The allegations against Lim haven’t dissuaded Mattr, who spoke in Lim’s clinic where one wall is lined with pictures of the surgeon posing with past US presidents including Jimmy Carter and Bill Clinton.

“I’m shocked by the complaints against Susan,” said Mattr, wife of Mohammed Al Gergawi, United Arab Emirates’ Minister for Cabinet Affairs. “I don’t believe that a smart woman like Susan will destroy her reputation and Singapore’s.”

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Please post responsibly. Commenter Rules

Posted by: Ben Tan

Get real. You choose a world-class surgeon but you do not want to pay world-class fees?
You have the right to choose a doctor you can afford and there are many to choose from.
It's bad faith to demand or expect a discount after that service has been rendered.

Posted by: chatree Niramitvijit

Medical tourism industry in Asia has been very competitive in recent years, Asian governments have been all out to promote their countries, and Singapore government is doing exceptional well in order to attract international patients with their" Singapore Medicine"strategy but seriously, NOT their medical expertise, it 's their promotional strategies. Yes,Singapore is a developed country is terms of economic but NOT in medical, it is a developing country when it comes to medical, the recently established health medical industry in Singapore is far from India and Thailand.
Thailand and India have long been established as world class expertise in practices, you may call them global health destinations.

Posted by: chatree niramitvijit

Ben,
The person replied to your comment previously was nice and polite using the word exorbitant, I would say robbery.
You may ask the whole world if there is any doctor agreed to the bill your surgeon charged.
One way to prove that you are world-class is DO NOT GIVE DISCOUNT.
World-class stands for no compromising.

Posted by: Jojo Payne

Ben,
What's "world class" fees? Value for money? Appropriate and commensurate with other similar procedures? Simply exorbitant? The phrase "world class" usually implies "good". Good fees means "reasonable", "expectable". Not out of the world, gouge your eyes out. And "get real" means "get realistic"; you need to be ?

Posted by: Rowan Trayler

I hope the second hearing will get down to the truth. Singapore does need a cap on their medical fees. I just returned from Malaysia after a Knee Replacement surgery and it was the best! It was only my second trip to the country and they are so far ahead of my native country, Australia on healthcare. Singapore was not an option due to the high costs. I evaluated Thailand, Singapore, India and Malaysia. Malaysia won hands down due to their political stability and advanced healthcare.

Posted by: Telcoguy

Hi Rowan, why does Singapore "need" to cap their medical fees? They may perfectly chose to cater to a smaller number of customers willing to pay more.
I think medical tourism is helping to bring down costs on health care, but there is room for differentiation, and the destinations you described while working well for most people, have also had some issues in the past.
Some people may decide that the risks are worth the savings, other may be willing to pay more for a (either real or perceived) better/safer treatment.

Posted by: Mary

Rowan: What hospital did you use in Malaysia? How was the nursing, were they all RN's? How was the hospital facilities? Did everyone speak English? Were there other foreigners seeking treatment there? What was your overall cost for your surgery? Alot of questions, I know, but I never considered Malaysia as an option.

Posted by: Mary M

Interesting article. I recently had treatment at Brumrungrad Hospital, and truthfully, I could have just been in Dubai because there were so many Emiritis there seeking treatment. The quality of care there was excellent, and the cost, well just couldn't be beat. Singapore is a wonderful country, but Susan, although she is an accomplished surgeon, just may have overcharged the wrong people. The medical tourist is looking for quality treatment with cost-effective prices and if they are paying top dollar, then they might as well travel to the US where the prices are outrageous.

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