Debated in Parliament on 5 Jan 2021.
Dr Tan Wu Meng asked the Minister for Health (a) whether platforms such as DoctorxDentist which publish listings and reviews of healthcare workers are subject to direct oversight and regulation by the Ministry; and (b) what recourse is available to healthcare workers, patients or members of the public in the event of incomplete, false, or misleading information being provided about individuals listed or the platform's operations.
Dr Tan Wu Meng asked the Minister for Health whether the Ministry will consider impact-based regulation, thereby establishing capability to regulate currently unregulated entities such as (i) entities able to direct, organise or influence the provision of healthcare service (ii) entities able to set prices or influence price-setting of healthcare services and (iii) entities which claim to have patients and hence owing a direct or indirect duty of care.
The Ministry of Health (MOH) takes a risk-based regulatory approach towards the provision and advertisement of healthcare services, to ensure patient safety, welfare, and continuity of care. As such, the Ministry focuses on regulating direct providers of healthcare services – where regulatory intervention would have greatest impact. This includes the provision and advertisement of services that diagnose, assess or treat diseases or illnesses; provide nursing or rehabilitative care; or assess the health of individuals. This is a similar approach taken by regional and international healthcare service regulators.
Currently, premises-based direct providers are licensed under the Private Hospitals and Medical Clinics Act (or PHMCA) and their advertisements governed under PHMC’s Advertisement Regulations. Such licensed providers bear full responsibility for the care delivered to patients as well as the content they advertise. Apart from these licensed providers, however, there are also indirect providers that are not engaged in patient care, such as DoctorxDentist (or DxD), and generally fall outside the scope of the PHMCA. They function as platforms to administer various aspects of the patient care journey, which includes appointment booking, insurance claims, and undertaking marketing activities for licensed providers.
Such indirect providers are subject to the Medicines (Advertisement and Sale) Act (or MASA) which prohibits advertisements that induce individuals to seek the medical advice of the advertiser or any person referred to in the advertisement. Entities found to be in breach of MASA (inclusive of those who provide false or misleading information) will be required to remove or amend the errant advertisements. They may also be subjected to further penalties such as fines and prosecution.
Medical and dental practitioners interacting with such indirect providers are required to follow the guidance set by their professional boards such as the Singapore Medical Council’s Ethical Code and Ethical Guidelines (SMC ECEG). In particular, they are to maintain the objectivity of their clinical judgement, uphold the required clinical standard of care for their patients, and advertise in accordance with the principles set out in the Guidelines, amongst others. If medical or dental practitioners do not wish to have their profiles listed with such indirect providers, they may inform the provider directly to remove the profile listing or reviews. They, along with patients and members of the public, may also reach out to MOH for assistance should such providers prove uncooperative.
To strengthen our regulation of evolving healthcare models, MOH is replacing the PHMCA with a new, services-based Healthcare Services Act (or HCSA), which was passed in Parliament on 6 January 2020, and implementation will be rolled out progressively in 2021. Indirect providers shall be subject to the HCSA advertising regulations should they advertise any licensable healthcare services. In particular, an indirect provider may only advertise with a licensee’s explicit authorisation and must comply with all relevant HCSA advertising rules.
The Ministry will continue to monitor the patient safety risks associated with indirect providers and will closely study any impact they might cause to the healthcare services landscape. We will also further explore the concept and feasibility of introducing impact-based regulations in Singapore’s healthcare context to address these evolving changes, where appropriate.
PAPERCUTS