Cost of arthroscopy in Singapore

At Limb Salvage and Revision Arthroplasty Surgery we applaud the Ministry of Health in making transparent the cost of arthroscopic surgery in Singapore. A quick check on the ministry website makes apparent the relative cost of such arthroscopic surgery in Singapore. What is perhaps less apparent is what the breakdown in costs are.

Subsidized versus private rates

Comparisons between private and subsidized costs simply cannot be made. While the cost of the procedures done under private rates are closest to the true costs of surgery those in the subsidized clinics have a massive range that cannot be reflected in the way that is required for easy reading on a website.

Those of us who spent many years in the government sector from early years to positions of policy making know full well the costs involved in arthroscopic surgery. The government is to be congratulated for offering this sort of surgery, generally considered lifestyle surgery and not “life and death surgery”, to a population who might not otherwise benefit from such procedures. To be sure such procedures are considered luxuries in other parts of the world including first world countries and can be denied to large sectors of indigent populations. In Singapore, such generous subsidies usually end up with some form of co-payment with the patient paying for the implant and the facility and the government paying for the rest with the provisio that the patient must understand that while he or she is entitled to qualified care this may not be a certified specialist (ie. an associate consultant and above). Usually a senior doctor is assigned to oversee such cases. On this framework, patients on special assistant plans may even have the surgery for 'free' if they are deemed suitable.

True costs

The true costs of surgery can be broken down as hospitalization costs, implant costs and doctors' fees in decreasing order of transparency.

Hospitalization costs include the per day stay which for a 4-bedder room would be about SGD 240 to the Rolls-Royce of suites at SGD 5,000 (!). One needs to factor in a daily cost of treatment of about SGD 240, lodgers SGD100, drugs, etc. One can expect to stay for the day of the surgery. These prices are readily available on the hospital websites and are fully transparent. The added operating theatre charges are variable depending on the consumables used, time spent, etc and can’t really realistically be estimated (SGD 4000).

Implant costs can be very variable. For anterior cruciate ligament reconstructions, the implant designs for primary knee reconstructions would cost about SGD 600 a piece. Typically a screw, loop or pin is used on one end and a screw on the other end (SGD1200). If a meniscus repair is done that would be SGD 600 a piece and usually one or two anchors are deployed (SGD 1200).

On the revision surgery side of things no fair generalizations can be made on costs although the implants can be cost up to SGD 3000 and mostly to pay for allografts. The numbers shown on the MOH website do not refer to revision procedures which are uncommon and undertaken by only a handful of surgeons in Singapore.

When one considers the figures on the MOH website, therefore, at a 75^th percentile cost of knee arthroscopy at about SGD 18,000 one will realise that this is the true cost of arthroscopic surgery - whatever the hospital. This is probably to be expected given the market forces involved- very few people can afford a blank check solution to health care.

Doctor’s fees are usually split between the anesthetist and surgeon.

All these fees are required to be made known to the patient at the time of financial counselling by law.

Conclusions

There can be dramatic exaggerations of the cost of arthroscopic surgery in Singapore. The initiative by the Ministry of Health in publishing such costs are illuminating for patients. Nevertheless, it is improbable that a patient in the appropriate circumstance for surgery would make a decision based purely on the cost. The overarching considerations in our opinion is now as ever before one of need and patient-doctor relationship.