Most major third-party administrators comply with new SMC guidelines: MOH

Most major third-party administrators comply with new SMC guidelines: MOH

SINGAPORE: A majority of major third-party administrators (TPAs) have revised their contracts with doctors, so as not to violate the Singapore Medical Council’s (SMC) new ethical guidelines, said Senior Minister of State for Health Lam Pin Min in Parliament on Tuesday (Oct 3).

TPAs provide intermediary services like claims administration and management of employer medical benefits to healthcare providers, doctors and employers. SMC’s new ethical guidelines, which came into effect in July, prohibit doctors from paying TPA fees that are calculated as a percentage of the patient’s total bill.

This resulted in doctors facing a dilemma: Whether they should continue to accept patients who are on benefit schemes – and potentially fall foul of the new guidelines – or withdraw from the process altogether, leaving some patients either paying full fees or having to look for treatment elsewhere.

In response to a question raised by Non-Constituency MP Dennis Tan, Dr Lam noted that prior to the implementation of the revised guidelines, the Health Ministry (MOH) and the respective professional bodies have engaged major TPAs to highlight the “principles and spirit” of the guidelines.

“They have been advised to provide more clarity in their contracts, and how the fees charged must reflect the complexity of the work done by them,” he said, adding that the majority of them have understood the intent of the guidelines.

He added that while MOH does not regulate TPAs who do not provide medical services directly, it acknowledges that TPAs’ fee arrangements may have influence on the doctors’ behaviour, which can impact the charges and patient care.

“While doctors are currently regulated by the 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.”

Source: CNA/lc