The ethics and regulation of overcharging: issues in the commerciality of the health practitioner-patient relationship.

Overcharging by health practitioners is a difficult issue with few guidelines available for practitioners or patients. For the most part it has not been the subject of disciplinary censure and has been dealt with by conciliation processes. However, during 2013 the Singapore High Court twice addressed the commerciality of the health-practitioner-patient relationship, acknowledging that this is a fundamental attribute of the contemporary dynamic between providers and recipients of health services. In Lim Mey Lee Susan v Singapore Medical Council [2013] SGHC 122, it concluded that the obligation to refrain from overcharging is an inherent ethical responsibility of practitioners and affirmed the suspension for three years of a surgeon with Australian training and tertiary connections for what it classified as grossly excessive charging. In Pang Ah San v Singapore Medical Council [2013] SGHC 266, it observed that medical practitioners have a legitimate right to appropriate levels of remuneration but that the right balance has to be struck between professional virtues and business considerations. The Singapore High Court's decisions raise the question of whether professional associations and practitioner regulators have a responsibility to provide guidelines and, potentially, processes by which practical assistance can be provided to medical and other health care practitioners so that they can avoid unacceptable charging practices.