Complaints of Excessive Charging by Doctors in Private Practice

5 Er Dr Lee Bee Wah asked the Minister for Health (a) in the past five years, how many reports of excessive charging by doctors in private practice have been received by the Ministry; (b) whether there is a trend of doctors abusing their patients' medical insurance coverage by overcharging them; and (c) what measures can be taken to regulate such a practice.

The Minister of State for Health (Dr Lam Pin Min) (for the Minister for Health): Mdm Speaker, MOH receives feedback on a variety of issues, including on doctor fees and charges. Occasionally, there are cases relating to alleged over-charging.

Doctors are ethically responsible for charging fair and reasonable fees to their patients. The Singapore Medical Council (SMC) Ethical Code and Ethical Guidelines (ECEG) requires doctors to charge reasonably and ensure that their fees are transparent and made known to patients in advance. The SMC can take disciplinary action against errant doctors who do not meet these requirements, and has done so before.

MOH is working with healthcare providers on ways to improve fee transparency. MOH has published "Total Hospital Bill" data for common conditions and "Total Operation Fees" for common surgical procedures for both public and private hospitals. MOH also requires all hospitals to provide patients with financial counselling upon admission. In the outpatient setting, MOH requires all GP and dental clinics under the Community Health Assist Scheme (CHAS) to issue itemised bills to CHAS patients, from January this year. These measures ensure more fee transparency and enable patients to make more informed decisions.

MOH is also studying the recommendations from the Health Insurance Task Force (HITF) relating to over-charging.

Each of us have to play our part to keep our healthcare costs sustainable, while ensuring that patients continue to have access to good quality and appropriate healthcare.

Ms K Thanaletchimi (Nominated Member): Madam, I have two supplementary questions. One on the role of community pharmacists. A lot of times in the GP clinics, the highest cost burden for the patient is the prescription cost, medication cost. Is the Ministry considering expanding the role of community pharmacists where pharmacists are given the prescribing rights as well as able are to provide cost effective medication for the patients?

The second question is: will the Minister consider having survey outcomes listed on the website for GPs that provide general common ailments and how much they charge the patients?

Dr Lam Pin Min: I would like to thank Ms Thanaletchimi for the two supplementary questions. On the role of community pharmacists, MOH does study the role of community pharmacists, focusing more on the areas of public education such as educating patients on prevention of certain diseases as well as the proper use of certain medications. However, with regard to prescription rights, this is one area that MOH will have to seriously consider the pros and cons, because we do receive feedback from patients that when they see a doctor and collect their prescriptive medicine from the doctor, it adds to a lot of convenience, rather than to have them to travel to a pharmacy elsewhere to buy the medication.

With regard to publishing the fees of GPs, this is an area that MOH is currently looking into.

Er Dr Lee Bee Wah (Nee Soon): Thank you, Mdm Speaker. I have two supplementary questions. I think the Minister of State did not answer on my question of how many reports were received in the last five years for excessive charging by doctors.

The second supplementary question is: besides overcharging them, I also receive feedback from residents that doctors issue non-standard drugs to the Pioneer Generation (PG), which they have to pay out of their own pocket. I would like to ask whether the Ministry monitors the issuance of non-standard drugs, or any substitution can be done, so that it does not cost a strain on residents' pockets.

Dr Lam Pin Min: I would like to thank Er Dr Lee for the two supplementary questions. On the first clarification on the data collected, I would like to inform the Member that due to the change in data collection system and the classification of bill-related feedback, we are unable to compare accurately the figures year-on-year over the past five years. However, for the data collected over the past two years, there was an average of about 160 cases of bill-related feedback from both the public as well as the private medical institutions. In 2016, 23 cases received through emails were specific to overcharging, of which 90% are private medical institution related. Ten percent are public healthcare institutions.

With regard to the Member's second question on the appropriateness of prescribing non-standard drugs, I would just like to remind and also reiterate that doctors should and must prescribe appropriately, and it should be in the interest and well-being of the patients and not for personal financial gains. For patients, especially PG patients who need to be on non-standard drugs and who cannot afford the cost of the medication, there is always the Medication Assistance Fund, which helps these eligible patients to pay for expensive drugs that are not in the standard list. I want to encourage these patients if they do encounter any difficulty in their medication bills, to apply for the Medication Assistance Fund. I would also like to inform the Member that MOH has also set up an Agency for Care Effectiveness (ACE). This agency issues guidelines on the use of cost effective drugs for treatment of common medical conditions, and these will be implemented in time to come.

Mr Vikram Nair (Sembawang): Madam, just two supplementary questions. The first is: on the expanded role of pharmacists, I think the suggestion is for the pharmacists to be alternatives to doctors to prescribe simple medicine. For example, in Europe, many pharmacists are confident prescribing medicine for, say, common colds, simple symptoms, as long as you tell them you have no drug allergies.

The second is a suggestion to also consider, perhaps, expanding the role of nurse practitioners to deal with common complaints, because I suspect a very large part of the GPs' load is with very standard ailments, which an experienced nurse practitioner could also handle, and both of these would probably reduce cost for patients.

Dr Lam Pin Min: I would like to thank the Member for the two supplementary questions. For the one on community pharmacists, yes, currently, pharmacists are already allowed to prescribe certain drugs. For example, simple drugs like those for the treatment of common cold and running nose, community pharmacists are allowed to prescribe such drugs. As to the suggestion of enhancing the role of nurse practitioners, we are already doing that. Many nurse practitioners in the polyclinics, as well as in the hospitals, do perform these expanded role, part of which actually superimposes with those of a doctor's, for management of simple conditions.