It is not exactly analogous, but putting a stop to rewarding third-party operators who refer patients to our public hospitals for treatment is like the Government limiting the number of junket operators bringing gambling clientele to our casinos (MOH puts a stop to foreign patient referral contracts; Sept 30).

Junket casino operators are sometimes sleazy operations fronted by crime bosses. Third-party businesses recommending medical tourism for pecuniary gain are just as harmful for filling up our public hospitals and thus causing delays in medical care when the local demand is already high and the hospitals are barely able to cope.

Universally, doctors receiving commissions for referring patients for investigations or further treatment are harshly pilloried and severely punished for the unethical practice of fee splitting.

In this case, the commissions were offered by the public hospitals to agents.

Under the new medical guidelines that came into effect last year, doctors (and presumably hospitals) are definitely forbidden to pay third-party administrators a percentage of the fees they charge patients. But, one wonders if, even before the new guidelines, this practice by hospitals was a contravention of the law or good ethical practice. Since the hospitals would first collect the fees from the patient before disbursement to the third party, the deal would have looked shady and not transparent to the patient.

Does the new rule apply to only public hospitals, and not the private ones? If so, there should be good reason for that.

Yik Keng Yeong (Dr)