Extent of Doctors Over-servicing Patients

Mr Seah Kian Peng asked the Minister for Health what is the extent of doctors over-servicing patients and what measures are in place to address this.

It is difficult to accurately assess the prevalence of over-servicing. As an indicator, between 2013 to 2017, complaints of unnecessary or inappropriate treatment lodged with the Singapore Medical Council (SMC) averaged 19 each year.

Several measures have been instituted to reduce over-servicing and encourage appropriate care. The Agency for Care Effectiveness (ACE) has developed a total of 39 guidances to date on what constitute rational accepted clinical practice, and appropriate investigations and treatments. These include guidances on the appropriate usage of selected high-cost medications, treatments and investigations, such as indications for the use of Positron Emission Tomography (PET)-Computed Tomography (CT) scans in managing cancer.

The insurance industry has also started implementing measures to discourage over-servicing. Integrated Shield Plan (IP) insurers are developing or enhancing their pre-authorisation frameworks, where insurers would approve the medical treatment and estimated bill sizes prior to the actual procedures. This provides certainty to patients on what can be claimed under their insurance policy, while allowing insurers to assess the medical necessity of the treatment. IP insurers are also required to incorporate a co-payment of 5% or more into new IP riders from 8 March 2018. Co-payment in insurance is a key element that will encourage healthcare providers and policyholders to choose medically necessary and appropriate treatments for the patient's circumstances.

When the SMC revised its Ethical Code and Ethical Guidelines (ECEG) in 2016, a specific section on Finances in Medical Practice was introduced. The ECEG states that in "managing patients, a doctor must always place patients’ best interests above his personal interests and any business of financial considerations. The ECEG prohibits doctors from letting business or financial considerations influence the objectivity of their clinical judgement in their management of patients". In March this year, SMC reminded all doctors about these ethical principles through a circular.

All stakeholders have to play their part to avoid over-servicing and keep healthcare affordable and sustainable for all Singaporeans.