Requirement for Third Party Administrators to Adhere to Singapore Medical Council Ethical Guidelines

13 Mr Dennis Tan Lip Fong asked the Minister for Health (a) whether the Ministry tracks the number of medical professionals who currently have agreements with third party administrators (TPAs) and, if so, how many of such medical professionals are there; and (b) whether the Ministry can consider requiring TPAs to adhere to practices which are consistent with the Singapore Medical Council ethical guidelines or other regulations which bind all doctors working with TPAs.

The Senior Minister of State for Health (Dr Lam Pin Min) (for the Minister for Health): Mr Speaker, Sir, Third Party Administrators (TPAs) provide a wide range of intermediary services to healthcare providers, doctors and employers. These include the management of employer medical benefits and claims administration. The Ministry of Health (MOH) does not have the number of healthcare providers or doctors who have arrangements with TPAs.

MOH does not regulate TPAs or their business arrangements today. The Singapore Medical Council's (SMC's) Ethical Code and Ethical Guidelines (ECEG) provide guidance on appropriate fee arrangements between doctors and TPAs so as to ensure that patients' interest and welfare are protected. The SMC has statutory powers to take action against medical professionals who violate these guidelines.

Mr Speaker: Mr Dennis Tan.

Mr Dennis Tan Lip Fong (Non-Constituency Member): I thank the Senior Minister of State for his reply. Yes, I do understand the current position, which I think has also been enunciated in past Parliamentary Question replies. I have this concern which I would like to address to the Senior Minister of State. There are concerns about TPAs driving up healthcare costs. Please let me quote from a Business Times article and I will just quote from the relevant extracts, "Health Economist, Phua Kai Hong, is of the view that third party healthcare financing, which includes insurers, TPAs and medical concierges will drive up Singapore healthcare costs in the long term, as they capitalise on the existing information gap between patients and doctors." Given there is a free market here, Dr Phua said, industry players will continue to take advantage of this asymmetry, unless relevant, regulatory and appropriate laws are in place to regulate the sector and improve transparency.

Would the Senior Minister of State agree with me that we should, therefore, have some form of regulatory control over TPAs so that they will approach all issues with a similar mindset expected of the doctors working with the TPAs and we can then better minimise conflicts between business and professional ethical concerns?

Dr Lam Pin Min: I would like to thank Mr Dennis Tan for the supplementary questions. Like I have mentioned before, MOH does not regulate TPAs who do not provide medical services directly. Those who do will be regulated under the Private Hospital Medical Clinics' Act. However, MOH acknowledges that the TPAs' fee arrangements may have an influence on the doctors' behaviour which can impact the charges and patient care.

While doctors are currently regulated by SMC to ensure that such TPA arrangements do not lead doctors to overcharge or compromise care, MOH will continue to monitor the situation and consider if further actions will be necessary to protect the well-being of the patients and also to prevent the escalation of healthcare costs. Indeed, we have been engaging the TPAs as well. In fact, prior to the implementation of the revised ECEG, MOH, together with the three professional bodies, have engaged major TPAs to highlight the principles and the spirit of the ECEG. They have been advised to provide more clarity in the contracts and how the fees charged must reflect the complexity of the work done by them. I am happy to say that the majority of the TPAs understood the intent of the ECEG and has since revised the contract so as to not violate the ECEG.