Itemised Chas bills a first step

Having doctors and dentists provide subsidised patients with an itemised bill is a good move.

With 1.3 million people eligible for the Community Health Assist Scheme (Chas), where the Government pays a portion of their general practice or dental clinic bills, the 1,600 clinics involved should be more accountable for their charges.

A lot of money is involved. Last year, the subsidies amounted to $167 million. As familiarity with the scheme grows, and as the population continues to age, the take-up is likely to increase.

While the vast majority of doctors and dentists are honourable, some would think nothing of making an undeserved buck. Already, two dental clinics have been suspended from the scheme for this.

The current practice, where a clinic simply charges the Ministry of Health (MOH), makes it fairly easy for the unscrupulous to overcharge. The subsidy for a pioneer generation patient who sees a doctor for a simple cold is $28.50. Say the bill comes to $35. There is nothing to stop the clinic from charging the patient $10, which appears reasonable, and MOH $28.50.

But if an itemised bill is given, listing the cost of consultation, medication and Chas subsidy, it is more difficult to "round up" the bill by a few dollars. A few dollars, added to every one of the 650,000 claims made last year, add up to a tidy sum.

Patients would know the amount of subsidy they are getting, which is also a good thing.

Now, while making itemised bills compulsory may stop the petty rounding off, it will not deter those out to cheat. This is because there is nothing to stop a clinic - especially a dental one, as the subsidies are far higher and claims for multiple services can be made for each visit - from issuing one bill to a patient, and submitting a different one to the ministry. It is also possible for clinics to submit claims for a patient it did not see by using details from a previous visit.

So while having itemised bills is a good first step, MOH needs to do more to ensure the public funds it disburses do not line the pockets of the dishonest.

A version of this article appeared in the print edition of The Straits Times on November 03, 2016, with the headline 'Itemised Chas bills a first step'. Print Edition | Subscribe