SINGAPORE — The government body that regulates medical practitioners here on Monday (Mar 19) reminded doctors of their “ethical obligation” to charge fair and reasonable fees for services rendered.

This is “over and above contractual and market forces and is not superseded by any agreement between the doctor and his patients”, the Singapore Medical Council (SMC) said in a circular put up on its website.

A doctor must always place his patient’s best interests above his personal interests and any business or financial considerations, stressed the SMC, which highlighted existing standards from the 2016 edition of its Ethical Code and Ethical Guidelines.

For example, a doctor must not subject a patient to unnecessary tests or procedures “simply because (he or she) stands to benefit from the fees”. Such conduct could constitute over-servicing and may be a breach of a doctor’s ethical obligations even if the patient agreed to undergo the test or procedure, the SMC pointed out.

“In the same vein, doctors should not conduct tests or provide treatment merely upon a patient’s request unless there is a clinical basis for doing so. The SMC would like to emphasise that declining to accede to a patient’s unjustified demand is not a breach of a doctor’s ethical obligations – acting in a patient’s best interests does not mean doing everything a patient wants.”

Earlier this month, the Ministry of Health announced that new Integrated Shield plan riders must feature co-payment of at least 5 per cent, and these policies will be available by April next year. The move was aimed at curbing the “buffet syndrome” among healthcare consumers who do not have to pay out-of-pocket for their hospital bills. Senior Minister of State for Health Chee Hong Tat cited concerns with “over-consumption, over-servicing and over-charging, as these will lead to patients and policyholders paying rapidly escalating fees and premiums over time”.

Noting the recent media coverage on rising healthcare costs and “hefty and questionable insurance claims”, the SMC reiterated that in order to keep healthcare costs affordable and sustainable, all stakeholders — including healthcare professionals and providers, insurers, employers, patients and the Government — have their roles and responsibilities. While it acknowledges that many drivers of healthcare costs are beyond the control of doctors, they have a “major role in managing healthcare costs, by advising patients on appropriate and cost-effective tests, medical procedures and treatments, and striving to keep fees fair and reasonable”.

The council noted that patients may be less likely to contest medical fees charged by the doctor when they are covered by “insurance that guarantee they pay little or nothing towards their medical bills”.

“However, patients’ acquiescence to a doctor’s fees does not absolve the doctor of the responsibility of charging reasonable fees,” added the SMC.

Among other things, the council reiterated that even in cases where the doctor does not have the ability to set fees himself, “as long as he has a material financial interest, or significant professional, governance or

management responsibility for an organisation that sets fees from which he directly benefits, he must satisfy himself that the fees abide by SMC’s ethical standards”.

The SMC added that while there is no prohibition against a day procedure being carried out as part of a hospitalisation stay, doctors must not recommend hospitalisation where there is no clinical justification to do so and for the primary purpose of charging higher fees. Doing so may also constitute over-servicing and/or over-charging, the council said.

It reiterated that doctors have a “duty to provide competent, compassionate and appropriate care to patients, based on a balance of evidence and accepted good clinical practice”.

“This duty also entails not over-charging and over-servicing patients for financial benefit. As members of the medical profession, doctors are held in the highest esteem by the public, and much trust is reposed in them. This trust is contingent on the profession maintaining the highest standards of professional practice and conduct,” said the SMC.

Adding that it believes the majority of doctors “continue to strive to practise ethically”, the council said that disciplinary action will be taken against the few who are found to have misconducted themselves by unethical charging, over-servicing and bringing disrepute to the profession.

Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital, said SMC’s reminder was timely but he noted that doctors have to exercise judgement, when it comes to decisions on the appropriate tests or treatments. “From a doctor's perspective, each decision for a test is a judgement call, with possible mistakes,” he said.

Nevertheless, he reiterated: “Patients are the centre of all that we do… we have to remember the reason why we became doctors, which is to help those that are unwell."

Gastroenterologist Desmond Wai at Mount Elizabeth Novena Hospital said that doctors “should not need to be reminded how to carry out our work ethically, charge reasonably and make good medical judgements”.

He added: “It is disappointing that doctors have to be reminded to do the right thing.”

He noted that fees “have to be reasonable for patients to keep coming back”. However, he called for more public education. “Patients are advised wrongly by their insurance agents, that they would be able to claim the full medical bill if they were warded. I feel that more effort should be spent in educating patients on sustainable healthcare and there should be some tightening on how (insurance) agents advise their patients,” he said.

TODAY had reported earlier this month that many insurance agents have been aggressively pushing Integrated Shield plan (IP) full riders to young clients. IP full riders allow policyholders to pay nothing for hospitalisation and treatment after forking out a higher premium initially.

While the higher premiums mean they get to pocket a larger commission, the agents said they are looking out for their clients’ interest by doing so, because premiums are cheaper when they are young and they would not qualify for such policies when they are older and have pre-existing illness. ADDITIONAL REPORTING BY CYNTHIA CHOO