In my decades as a Professor of Clinical Medicine and Chronic Disease Specialist at a leading academic medical center, I’ve dedicated my life to evidence-based care and the fundamental principle that a patient’s well-being must always precede profit. Yet, as a physician who has observed global trends, I must candidly address a growing, deeply troubling reality: the creeping commercialization of healthcare, particularly within the private sector across dynamic Asian economies.
We are seeing a disturbing shift in some private clinics, from bastions of compassionate healing to aggressive business enterprises. This article aims to shine a light on these practices, particularly contrasting the transparent system in Singapore’s public hospitals with the opacity and financial pressures often found in private clinics throughout the region, including Vietnam, Malaysia, and the Philippines. Our goal is not to condemn all private care, but to empower you, the patient, to choose wisely and advocate for genuinely necessary treatment.
The Unspoken Mechanism: How Profit Compromises Care
The fundamental difference between public and private healthcare systems lies in their primary metric of success. A government public hospital system measures success in population health outcomes, clinical effectiveness, and minimizing financial burden on citizens. In contrast, many private clinics, especially smaller, investor-backed chains, measure success in quarterly revenue growth, procedure volume, and average patient bill size.
This structural difference creates a perverse incentive known as Supplier-Induced Demand (SID). When a physician or clinic benefits directly from the number of procedures performed or tests ordered, there is a financial not clinical pressure to recommend more services.
Singapore: The Stark Public-Private Divide
Singapore, with its highly efficient public healthcare framework, offers a perfect case study in contrast.
In Singapore Government Restructured Hospitals (such as Singapore General Hospital, National University Hospital, Tan Tock Seng Hospital, Changi General Hospital, and others listed below), the system is built on subsidization and mandatory national savings.
- Financial Safety Net: Singaporean Citizens and Permanent Residents can utilize MediSave (a mandatory national medical savings scheme) and MediShield Life (a basic national health insurance) to cover significant portions of bills for subsidized wards (C and B2). This national system prioritizes basic, quality care accessibility for all.
- Cost Control: The government sets fee benchmarks and heavily regulates pricing in public institutions, aligning care with need rather than profit maximization.
Private medical clinics and hospitals in Singapore are a different beast. While they often offer unparalleled luxury, shorter wait times, and a higher doctor-to-patient ratio, they operate on a pure fee-for-service model. While MediSave can be used for some services, the withdrawal limits are intentionally sized for subsidized public wards. This means that private hospital bills, which can be 3 to 10 times higher than their public counterparts, frequently exhaust Medisave limits quickly, forcing patients to rely on expensive Integrated Shield Plans (IPs) or out-of-pocket cash.
The “scam” often arises when the availability of a patient’s high-limit IP coverage becomes the primary factor driving the recommendation for costly, non-essential procedures or extended physiotherapy packages, rather than simple, evidence-based management. Recent regulatory actions in Singapore have focused on uncovering kickback schemes and unnecessary referrals between specialists, GPs, and ancillary services (like physiotherapy), all of which inflate the final bill and, ultimately, raise premiums for everyone.
The Regional Crisis: Vietnam, Malaysia, and the Philippines
The commercialization trend is even more pronounced in developing Asian nations like Vietnam, Malaysia, and the Philippines, where public health infrastructure can be heavily strained and waiting times long.
In these countries, the private sector has exploded, promising a “Western” or “Singaporean” quality of care. However, without Singapore’s tight regulatory oversight, some private clinics become a “crazy business money-making scam,” prioritizing capital accumulation over the compassionate delivery of healthcare.
The pressure points include:
- Overtreatment: Recommending numerous diagnostic tests, vitamins/supplements, or procedures with marginal clinical benefit to boost the bill.
- Inflated Pricing: Charging exorbitant rates for standard procedures, exploiting the patient’s belief that a higher price equals higher quality.
- Exploitation of Insurance: Targeting patients with high-limit private insurance, treating the insurance policy as a resource to be fully utilized, rather than a safety net to be preserved.
In contrast, public healthcare institutions in these countries like the National Kidney and Transplant Institute (NKTI) or Philippine General Hospital (PGH) in the Philippines, or the Hospital Kuala Lumpur (HKL) in Malaysia, or major Provincial Hospitals in Vietnam are typically the last line of defense for the poor and middle class. While they may suffer from overcrowding and resource limitations, their financial motivation remains focused on maximizing care within a limited budget, not exploiting the patient’s wealth.
Money-Driven Specialties: Where to Be Most Vigilant
Certain medical specialties, due to the nature of their procedures and technology, are particularly susceptible to financial pressures. As a patient, exercising extra caution and seeking second opinions in these areas is crucial:
1. Vascular & Orthopaedics
- The Trap: Aggressive recommendation of expensive, minimally invasive vascular interventions (e.g., stenting, radiofrequency ablation for varicose veins) or joint replacement surgeries when conservative management (e.g., lifestyle changes, physical therapy) is the first-line, evidence-based choice.
- The Motive: High procedure fees and fast turnaround.
2. Gynaecology (Women’s Health)
- The Trap: Unnecessary screening tests, aggressive management of minor issues, and “designer” delivery packages (e.g., C-sections scheduled for non-medical reasons) that inflate costs far beyond necessity.
- The Motive: Captive, repeat clientele and high-fee maternity/surgical packages.
3. Pain Management
- The Trap: Over-reliance on repeated, costly steroid injections, nerve blocks, or highly specialized (and often marginally effective) regenerative medicine therapies like Platelet-Rich Plasma (PRP), when the best solution is structured physiotherapy and lifestyle modification.
- The Motive: Repeat injection fees and selling expensive “regenerative” packages.
4. Ophthalmology (Eye Care)
- The Trap: Aggressively selling premium-tier intraocular lenses (IOLs) during cataract surgery or recommending laser vision correction (LASIK) prematurely, often with little clinical distinction from much cheaper, standard options.
- The Motive: Premium product upselling and high surgical facility fees.
5. Physiotherapy (Ancillary Service)
- The Trap: This is one of the most common areas of abuse, particularly in Singapore. Clinics sell large, pre-paid packages (e.g., 10 or 20 sessions) when the evidence suggests that 3-6 tailored sessions with a clear home exercise plan are often sufficient. This is frequently driven by referral kickback schemes.
- The Motive: Maximizing insurance claims and package sales.
A Call to Patient Action: Your Right to Compassionate Care
The core solution to this pervasive problem is not to abandon private care entirely, but to re-center the discussion on public, subsidized healthcare as the reliable, ethical foundation for medical needs.
We stand united on one clear message: For basic, chronic, and emergency care, citizens should be encouraged to utilize and support their excellent, subsidized public healthcare institutions. This not only saves personal wealth but, crucially, reinforces a system built on clinical necessity, not commercial gain.
Key Government Public Hospitals in Singapore (Examples)
| Cluster | Hospital Name | Primary Focus |
| SingHealth | Singapore General Hospital (SGH) | Tertiary & Research |
| Changi General Hospital (CGH) | General & Acute Care | |
| National Healthcare Group (NHG) | Tan Tock Seng Hospital (TTSH) | General & Infectious Disease |
| Khoo Teck Puat Hospital (KTPH) | General & Geriatric Care | |
| National University Health System (NUHS) | National University Hospital (NUH) | Tertiary & Academic Medicine |
| Ng Teng Fong General Hospital (NTFGH) | General & Acute Care |