The extent of the fraudulent claims made by some dental and medical clinics seeking to exploit the Community Health Assist Scheme (Chas) and Pioneer Generation (PG) subsidies illustrates fundamental deficiencies within the present system ("More clinics under probe for possible cheating" and "Health Ministry must do more to deter fraud"; both published on July 4).

It is inherently unwise for the subsidy to be applied by way of a closed circuit between the state and the claimant clinics.

This is not least because, as profit-driven entities, clinics and their proprietors have a vested interest in minimising their losses, or even indulging in profiteering, by exploiting state mechanisms.

Part of the problem lies in unsatisfactory bookkeeping. Despite multiple government advisories cautioning against the practice, many clinics still do not provide itemised invoices to patients. This leaves the door open for exaggerated subsidy claims.

Moreover, patients, the intended beneficiaries of the subsidies, are effectively disconnected from the system and, as a result, are unable to take full ownership of their own healthcare purchasing decisions.

At worst, they might experience a sense of alienation, given that the subsidy framework appears to be an opaque concept.

Thus, keeping the patient in the loop as to where subsidies have been applied naturally acts as an additional layer of checks and balances.

The Health Ministry should publish allowable claim details under both schemes in booklets and on a website. This will also enable individuals to play a more proactive role in managing their own healthcare.

Another pressing question is the seeming lack of enforcement by the Health Ministry regarding Chas and PG subsidised transactions. Indeed, the clinics' transgressions were not discovered until well after the fact.

The additional level of scrutiny that is afforded by engaging patients in the process provides for improved detection of inconsistencies and anomalies.

Chas and the PG package play a crucial role in ensuring that no Singaporean is denied access to high-quality healthcare. We must do our utmost to ensure that these systems operate as efficiently and effectively as possible.

Paul Chan Poh Hoi