The new Ethical Code and Ethical Guidelines issued by the Singapore Medical Council (SMC) does not go into force until next year - but it has already become a major disruptor in the private healthcare market.

The crux of the problem lies with the ruling that doctors should no longer pay a percentage of their bill to third-party administrators (TPAs) when treating their patients. The TPAs' clients are usually insurers or companies that provide staff with medical benefits.

Continuing to do so would open them to possible disciplinary action.

But this is a practice that has been in place for decades and which affects more than 1,000 doctors, who pay a part of their fees to a TPA that has referred the patient.

The SMC said that this could be construed as fee sharing, which doctors are prohibited from doing. To make matters even more complicated, the new rule is written in a way that leaves it open to interpretation.

As a result, the question of whether doctors may continue with the practice was raised at four meetings the SMC held on the new code and guidelines. Earlier this month, it also sent out an advisory to try to clarify the question.

When that did not clarify matters sufficiently, three medical bodies here issued their own advisories on how the practice may be continued without infringing the new rules.

Asked for its response, the SMC said it had nothing to add. So until doctors test the waters, they will not know if the suggestion from the three medical bodies is acceptable to the SMC, the medical professional watchdog.

The easiest solution is to accede to the SMC's attempt to change the existing business model.

How that will affect the tens of thousands of patients, and the TPAs, remains to be seen when the rules become effective next year.

Salma Khalik

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