Photo from MIMS

Through three medical representation groups, Singapore doctors are up in arm opposing the Singapore Medical Council’s (SMC) recent decision to ban doctors from paying referral fees to a third party – mostly employers, insurers and doctors – who referred patient-clients. SMC has earlier said that such referral fees is “unethical” and that doctors would have vested interests in getting patients through paying referral fees, which in-turn unnecessarily inflate medical bills.

The Singapore Medical Association (SMA), the College of Family Physicians Singapore (CFPS) and the Academy of Medicine, Singapore (AMS) issued a joint statement strongly opposing the SMC’s move and argued that it is not unethical under “very specific and limited circumstances”:

“If the third party administrators (TPA) fee represents a small percentage of the doctors’ fee, and if the doctor’s practice is such that the vast majority – over 80 per cent, for example — of bill sizes falls within a narrow range, such fee arrangements might not be in breach of new ethical guidelines.”

According to a council member of the SMA, Dr Wong Chiang Yin said:

“The SMC’s advisory did not state that percentage fees are not allowed. Doctors who continue to pay percentage fees have to prove why these percentages do not constitute fee-splitting, when they are queried by the authorities. And they must be prepared to defend this practice. it would be anything that approximates the cost of service provided by the TPA, with a reasonable profit margin. It depends on the context. A 5 to 15 per cent fee for a bill of about S$50 may not be excessive. But even a 5 per cent charge for a large bill that is in the tens of thousands (of dollars) may incur suspicion of fee-splitting, and the doctor must be prepared to defend why it is not fee-splitting.”

According to the SMC, the TPA fees stretched as high as 25% of the medical professional fee and that such referral payment constitutes “fee-splitting”. SMC ruled that the ban will take effect from Jan 1, 2017 and the Singapore doctors are worried that it will drastically affect their business. The ban however will lower overall medical fees as such agent fees are removed.

Exorbitant medical fees including unnecessary medical processes charged by “businessman-minded” Singapore doctors have ballooned insurance premiums and medical costs, especially for patients with life-threatening illnesses who are willing to go into bankruptcy to save their life.