Doctors who pay a third-party agent (TPA) a percentage of the fee they get from patients will be infringing the new medical code of ethics which goes into force next month, the Singapore Medical Council (SMC) said yesterday.
The new Ethical Code and Ethical Guidelines released in September had been ambivalent on this, which was a matter of concern to doctors party to such arrangements.
The SMC had said that fees should not be "primarily" based on the work done by doctors, or be "so high" as to constitute fee splitting.
TPAs are a diverse group that generally charge for their services by claiming 10 per cent to 25 per cent of the doctors' fees.
Some represent companies that provide their staff with medical benefits and can also help to keep costs down. Others help insurers manage healthcare claims.
However some, often referred to as a medical concierge, simply collect payment for introducing a patient to a doctor.
The SMC is concerned that such fees could push up costs for patients.
To a query from The Straits Times last month on whether doctors can continue paying TPAs a percentage of their bill under the new ethics code, the SMC had said it was "deliberating" on the matter and would provide clarification.
This came in the advisory sent by SMC president Tan Ser Kiat to all doctors yesterday, which spelt out clearly that "fees that are based on a percentage of what doctors charge patients may be construed as a form of fee splitting".
Elaborating, Professor Tan said the work done by a TPA in handling and processing patients "does not vary depending on the fees doctors charge patients".
So, paying them a percentage of the bill to the patient would reflect the work done by the doctor and not the TPA. This is prohibited.
He added that it would be considered a breach of professional ethics "regardless of when the doctor entered into such an arrangement with the third party".
But to give these doctors time to negotiate a new agreement and in order not to leave patients in the lurch, that particular guideline will be delayed for six months, going into force only on July 1.
He reminded doctors that their duty is to always place patients' best interests above business or financial considerations. They should consider if such agreements "will result in profiteering".
He said: "The fees must reflect the fair work done by third parties in handling and processing the patients. The fees must also be transparent to the patient."
Dr Desmond Wai, a gastroenterologist in private practice who has agreements with three TPAs, applauded the ruling, which he sees as the SMC's "efforts to clamp down on unethical practices" by some medical concierges who merely introduce patients for a fee.
He is fine with telling patients the amount that goes to the third party, which he says comes from his fee, and is not from a mark-up.
When asked about the penalty that doctors face for breaching the code, the SMC said: "The penalty depends on the extent of the misconduct, for example, it may vary from a letter of advice or warning to a formal disciplinary inquiry, depending on the circumstances."