Healthcare: Many factors contribute to over-servicing in healthcare

Forum: Many factors contribute to over-servicing in healthcare

https://www.straitstimes.com/opinion/forum/forum-many-factors-contribute-to-overservicing-in-healthcare

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Many factors contribute to over-servicing in healthcare

2026-07-28

As a private specialist, I agree with Health Minister Ong Ye Kung’s comments that over-servicing in healthcare exists and should be addressed (Singapore must grow longevity economy without driving up healthcare costs: Ong Ye Kung, July 25).

While some anxious patients request excessive investigations or treatment, they represent only a minority. In my experience, several factors contribute to the problem.

First, the internet and artificial intelligence have made medical information more accessible than ever. While this empowers patients, it can also increase anxiety. Entering a symptom into an AI search engine often produces a long list of possible diagnoses, including cancer. Without the clinical context to interpret these possibilities, some patients understandably become worried and seek extensive investigations.

Second, media coverage of uncommon but life-threatening diseases can influence healthcare-seeking behaviour. Following reports of several celebrities who died from pancreatic cancer, I noticed more patients requesting investigations for this disease. Pancreatic cancer is devastating, but it is only the ninth most common cancer in Singapore. Greater public health benefit would come from encouraging participation in established screening programmes for more common cancers, such as colorectal, breast and cervical cancer.

Third, defensive medicine may also play a role. Singapore Medical Council disciplinary cases involving delayed diagnoses of conditions such as testicular torsion serve as important reminders of the need for vigilance. But they may also make some doctors more inclined to investigate or refer patients with similar symptoms, even when the likelihood of a serious diagnosis is low. The challenge is to identify the small number of patients with time-critical conditions, without exposing everyone else to unnecessary tests.

Fortunately, Singapore already has several safeguards against over-servicing. The Ministry of Health’s Claims Management Office reviews healthcare claims and treatment patterns, while insurers scrutinise claims before reimbursement. These measures help discourage unnecessary investigations and treatment.

Public education remains important. Patients should understand not only the benefits of medical investigations, but also their potential harms, including false positive results, incidental findings, unnecessary procedures and increased healthcare costs.

The ministry could also continue developing and updating evidence-based clinical practice guidelines for common symptoms and conditions. Clear guidance helps doctors provide appropriate care, while reassuring patients that investigations are recommended according to the best available evidence, rather than anxiety or defensive practice. For example, regular six-monthly surveillance with ultrasound and blood tests for appropriate patients with chronic hepatitis B is well supported by evidence. It helps ensure timely detection of liver cancer while avoiding unnecessary over-investigation.

Ultimately, the goal should not simply be to reduce the amount of healthcare delivered, but to ensure that every patient receives the right investigation and the right treatment at the right time.

Desmond Wai Chun Tao