Measures to Prevent Medical and Dental Clinics from Over-provision of Services under Community Health Assist Scheme

14 Mr Seah Kian Peng asked the Minister for Health what are the control measures to ensure that participating medical and dental clinics under the Community Health Assist Scheme (CHAS) do not over-service and that fees remain competitive.

The Minister of State for Health (Dr Lam Pin Min) (for the Minister for Health): Mdm Speaker, under the Community Health Assist Scheme (CHAS), lower to middle-income Singaporeans and all Pioneers enjoy subsidised outpatient treatment at participating private medical and dental clinics, so that primary care is more accessible and affordable. MOH has provided guidelines to the participating clinics to ensure that the subsidies are appropriately applied. We review these guidelines from time to time to ensure they remain in line with our objectives. We also conduct regular audits of CHAS claims to ensure compliance with our guidelines and investigate complaints that we receive. We take a serious view of any errant practices and have recently suspended two clinics' participation in CHAS.

Charges may vary across clinics and patients, depending on multiple factors, such as the patient's condition, the length of consultation, the treatment and medication provided and the cost structure of the clinic, including rental and other overhead costs. We, therefore, encourage doctors and dentists to actively engage their patients, and vice versa, to address any concerns from patients on their treatment and charges. We also encourage clinics to display their common charges like consultation fees prominently in their clinics and provide itemised receipts to patients on request. These will make their charges more transparent to their patients and minimise misunderstanding.

With the number of CHAS clinics more than doubled over the past four years to about 1,600 island-wide, CHAS cardholders and Pioneers have more choices now, compared to when the scheme was first launched. Patients can also be alert to check their bills and alert MOH on any concerns that they may have and we will investigate and advise the clinics if appropriate.

Mr Seah Kian Peng (Marine Parade): A few clarifications for the Minister of State. I have received quite a lot of feedback from residents and friends. From their point of view, it appears that many feel that prices have gone up. So, on the control measures that the Minister of State has outlined, I would like to ask what is the assessment of the effectiveness of these control measures. Do we see the problem of possible over-claims to be widespread? Also, how many clinics are being investigated? Since this question was filed, yes, indeed, there were two dental clinics that were suspended. Is this the tip of the iceberg? Because these are serious taxpayers' monies that are being paid out, we need to have a more proactive approach to this issue.

Dr Lam Pin Min: I would like to thank the Member for the supplementary questions. While there have been some complaints alleging high fees or suspected over-charging, so far, we have not found any clear evidence of over-charging in these cases. Given the considerable variation in GP practices and the autonomy of GPs to determine their charges, cases of overcharging can sometimes be very difficult to define. Furthermore, like I mentioned in my reply, there are many factors that can result in the variation of the bill sizes and these include the patient's condition, how long the consultation is, the type of treatment, the type of medication and the complexity of the medical conditions. All these will be taken into consideration during our investigation on some of the feedback from patients.

We also understand that some patients are quite concerned about being over-charged by their GPs. However, if we compare this to the large number of CHAS claims, we have received a relatively small number of such concerns, although many of us do hear from some of our residents. While we take such feedback very seriously, the small number suggests that the large majority of CHAS clinics continue to be reasonable in their charges.

With regard to the Member's last question on the number of clinics being investigated, other than the two dental clinics which we have suspended CHAS accreditation and are currently being referred to the police for further investigation, there are just a couple more clinics that have been referred to the police for investigations. Because of that, we are unable to provide further details until the investigations have been completed.

Mr Leon Perera (Non-Constituency Member): Mdm Speaker, just a clarifying question to the Minister of State. I have received feedback from residents that there are some GPs who have adopted the following practice where, for a follow-up visit to the GP, the GP now says that consultation fees must be levied if the CHAS subsidy is to be claimed, whereas previously, if the CHAS subsidy was not being claimed, then that consultation fee for a follow-up visit or for replenishment of medication would be waived. I just want to confirm that this practice is not permissible if it is seen and is a ground for complaints.

Dr Lam Pin Min: There are two different forms of subsidy according to the CHAS scheme, that is, there is a subsidy for acute conditions, as well as a subsidy for chronic conditions. For acute conditions, it is claimed on a per visit basis, and we do have a limit to the number of visits the patient can make within a month.

With regard to chronic condition subsidy, there is a claim limit that a patient can claim for a particular year. So, if the patient has already exhausted the total amount that has been allocated, then the patient may have to come up with out-of-pocket expenditure.

With regard to the Member's particular concern, it would be best if the Member can write to us so that we can investigate the matter and have more clarity on whether there is any misconduct or malpractice.

Mr Seah Kian Peng: Precisely because it is difficult to ascertain, how would MOH look at this factor? There is also the danger of doctors over-prescribing, over-servicing. I urge the Ministry to take a more active stance in approaching this issue.

Dr Lam Pin Min: I would like to thank the Member for the suggestions. MOH conducts very regular audits on CHAS claims and we do look into the clinics' compliance according to the existing CHAS guidelines. And if we do receive feedback or complaints from residents, then we will audit the clinic in even more detail to ascertain the rationale, as well as how the charges are being made. If there is any misunderstanding between the patients and the doctors, the Agency of Integrated Care (AIC) will then explain to the residents. But if we do find any misconduct, we will not hesitate to take action against the doctors.