SINGAPORE: Health screening services will soon face tighter regulation as authorities seek to introduce licensing requirements. This will come under a new Healthcare Services Bill, which will replace the Private Hospitals and Medical Clinics Act, the Ministry of Health (MOH) told Channel NewsAsia.
A quick search on the Internet turns up numerous health screening packages in Singapore. Each package includes a battery of 10, 20 or even 30 tests with prices starting from S$100 for a basic assortment of tests, and they go up to the thousands for something more premium.
But does having more tests necessarily mean better?
“Sometimes, doing more tests makes you worried, costs you more money ... and they may not bring any health benefits,” said Dr Desmond Wai Chun Tao, a gastroenterologist at Mount Elizabeth Novena Hospital. “I have patients who come and see me because a health screening company goes down to a company to do a mass health screening for the employees, picks up some health results and posts the results and advises them to do certain things. But I notice that some of the tests are not necessary.”
One example is the prostate-specific antigen (PSA) test, which is used to detect prostate cancer. It is included in many health packages but has a high false-positive rate. About four in 10 men who test positive later find out that it was a false alarm.
To reduce unnecessary anxiety, one doctor suggests setting up a panel to come up with a recommended battery of tests for the population. This guide would help people decide which screening package is best suited for them.
Associate Professor Lee Soon Chin, who is the head of the Department of Haematology–Oncology at the National University Cancer Institute, said: “The danger now is you get a test result that you don't really want, because it may not be very useful and the results may lead to false positives or negatives, which may cause a lot of problems for the patient.”
Assoc Prof Lee also suggests that a national committee be formed to provide some advice for the general public. It could answer some questions such as what elements should be in a health screening package, and which tests are essential for each population segment.
“You may end up having a few generic packages for women and men of a certain age. These are the things that should be included and go from there. And maybe a strong statement that certain tests should be excluded from the package,” she said.
FOLLOW-UP PROCESS NEEDS IMPROVEMENT: DOCTORS
Doctors Channel NewsAsia spoke with hope it will be mandatory for all private operators to have a trained doctor or nurse conduct face-to-face consultations on screening results.
Dr Wai added: “Recently, a lady came to see me for anaemia. I noticed that her lab test was a form of health screening done about half a year ago. So I asked her if the doctor told her to go and see either a specialist, gynaecologist or gastroenterologist because she was anaemic. She said no. Her results were posted back to her and didn't have a medical consultation with her, and that’s why she didn’t follow through with any treatment.”
Such practices are widespread with some companies simply uploading the results to an online portal. Even those that do conduct evaluations may not be adhering to recommended guidelines.
In 2012, the Health Ministry issued an advisory which stated that medical consultations should only be conducted by medical practitioners registered with the Singapore Medical Council.
But a check by Channel NewsAsia with more than 20 private companies showed that they do not follow this practice. Instead of doctors, they engage “health consultants” – who could be clinic staff with no medical background – to conduct medical evaluations.
Doctors warned against this as medical knowledge is crucial when it comes to interpreting screening results.
“I don't think it's a good idea that people go for a general screening test and then get posted the results without a face-to-face interpretation, because there are certain things that should be highlighted to the patient directly,” said Assoc Prof Lee. “The patient will need further follow-ups. There could be some regulations to make sure there is proper and timely physician interpretation of the results, so the results will be acted upon.”
Private company Trinity Medical Group, which conducts more than 100 corporate health screenings a year, works closely with the company’s human resource department to customise screening packages based on the employee’s occupation instead of selling generic packages.
For instance, delivery drivers could undergo tests for colour vision and hearing.
Its medical director Dr Lim Yeeu Kuang said: “The biggest concern currently with the health screening industry is that there are some companies which just sell packages. There are no explanations. There's no review and it's basically a set of numbers. The employee has the right to understand what these numbers mean. Hopefully with the regulations, this industry can up their standards and ensure they get a proper review.”
Chair of the Government Parliamentary Committee for Health Chia Shi-Lu acknowledged that regulation may be challenging as health screening services cover a broad range of tests. But if done right, it would give patients greater clarity and expand the scope of enforcement, he said.
Currently, if there’s one test that’s useless or harmful, we can only give a practised guideline to doctors telling them not to include it in their health screening protocol. However, those who aren’t doctors won’t care," Dr Chia said. "Some of these private companies won't get this message and it doesn't affect them at all.
“One of the conditions of licensure would be to listen to guidelines given by the licensing body, which is MOH. So when the licensing body tells you that this is a useless test and you shouldn't be doing it, you will be obliged to follow or you will lose your license,” he added.
More details on the consultation of the Bill will be released later this year.