Several doctors have asked the Singapore Medical Council to clarify if they can continue to pay third-party administrators (TPAs) a percentage of their takings when the new code of ethics comes into force next year.
The answer could affect the hundreds of thousands of people here who have employer or insurance health coverage.
The new code from SMC, the medical professional watchdog, comes into effect on Jan 1.
It had said doctors may continue to pay for such services, but added: “Such fees must not be based primarily on the services you provide or the fees you collect and you must not pay fees that are so high as to constitute ‘fee splitting’ or ‘fee sharing’.”
At recent dialogues with SMC to discuss the new code, doctors asked what “primarily” means in this case, and how high do fees have to be to seen as fee splitting. Those who have agreements with TPAs wondered if they needed to terminate their contracts.
There has so far not been a definitive answer. To a query from The Straits Times, the SMC said: “We are deliberating this matter at present and will be providing clarifications to the doctors in due course.”
How each TPA works varies but the majority have some control over the fees charged. They also do the administrative work, which often includes billing, and take a fee for their services.
The practice in the market is for the fee to be a percentage of the doctor’s bill. The majority charge 10 per cent to 15 per cent, though some charge even higher.
This is different from medical concierge services, which collect payment for introducing a patient to a doctor, with little or no additional services.
Tan Chi Chiu, a gastroenterologist and SMC council member who chaired the committee that shaped the new ethics code and guidelines, said a reasonable observer might view 10 per cent of a $20,000 bill “as representing a windfall, rather than a fair business margin”.
Parkway Shenton chief executive Veronica Allen noted that a flat fee might not be the best solution. She said: “A simple flat-fee model may not be equitable in all situations and, in fact, may penalise doctors when they have smaller bill sizes.”
Still, Parkway Shenton, which currently charges a flat 10 per cent fee, has decided to play it safe with a variation of fixed and variable fees to be launched by the end of this year.
Said Ms Allen: “Parkway Shenton is working out a fair fee structure with fixed limits and thus be based on the value we provide… (to) benefit all doctors.”
salma@sph.com.sg
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