The Singapore Medical Council (SMC) has been receiving calls from doctors worried about being in breach of ethical guidelines which come into force today.
To allay their fears, it issued yet another comment yesterday, just a week after its previous advisory had indicated that a number of new third-party administrators' (TPAs) fee structures did not make the mark. This has resulted in TPAs scrambling to make changes so doctors would not be in breach of the ethical code.
The requirement is part of the ethical code and guidelines that prohibit doctors from fee splitting, which occurs if TPAs - which generally represent insurers or employers who provide fully-paid-for or subsidised medical care to their clients or employees - take a percentage of their bills.
The SMC yesterday said it is aware that some TPAs have amended their fee structures further in the past week to try to meet the new requirements.
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One TPA, for example, will charge specialists a flat $20 for outpatient bills and $80 for inpatients.
Others have "explained or elaborated further on the basis of their fees". The SMC told doctors that it is acceptable if the TPAs are able to give the rationale behind different fees collected, for example "higher administrative fees where the claims involve greater complexity of work".
If the doctors themselves are satisfied that the fees do reflect the amount of work done by the third parties, they will not be in breach of the guidelines, the SMC said.
But it added: "However, if two cases within the same tier of complexity are charged different fees, such a fee structure may appear to be based primarily on the services the doctor provides or the fees he or she collects, rather than the complexity of work required of the third party."
This would breach the guidelines.
As to the amount of fees collected, some of which could be in four figures, the SMC said "this is a function of market forces and business costs, and each doctor must assess the reasonableness of the quantum of these fees".
However, the SMC cautioned that payment to TPAs "must not compromise the proper care of his or her patients".
TPAs negotiate rates with doctors to try to keep a lid on healthcare costs for their clients, and collect a fee from doctors for this service. Historically, these fees were a straight percentage of the bill.
But the SMC has said this is fee splitting, which is against the professional ethics for doctors. It also fears that such fee splitting could raise healthcare costs.