SMC CIRCULAR NO. 1/2018
[SMC 14.20]
19 March 2018
DOCTORS HAVE AN IMPORTANT ROLE TO PLAY IN KEEPING HEALTHCARE
COSTS AFFORDABLE AND SUSTAINABLE
1. We refer to the recent media coverage on rising healthcare costs (including
medical insurance premiums) and hefty and questionable insurance claims.
2. The Singapore Medical Council (“SMC”) notes that to keep healthcare costs
affordable and sustainable for patients, all stakeholders – healthcare professionals and
providers, insurers and policyholders, employers, patients and caregivers, and the
Government – have their roles and responsibilities. While the SMC acknowledges that
there are various drivers of healthcare costs, many of which are beyond the control of
doctors, doctors 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. In light of the recent scrutiny of healthcare insurance
and unreasonable practices and fees, the SMC by way of reminder, wishes to bring to
bear the ethical principles against complicity by doctors outlined in the 2016 edition of
the SMC Ethical Code and Ethical Guidelines.
Guideline H1 – Fees for services
3. Where patients are covered by medical insurance that guarantee they pay little
or nothing towards their medical bills, they may be less likely to contest the fees charged
by the doctor. However, patients’ acquiescence to a doctor’s fees does not absolve the
doctor of the responsibility of charging reasonable fees; the doctor’s ethical obligation
to charge fair and reasonable fees for services rendered operates over and above
contractual and market forces and is not superseded by any agreement between the
doctor and his patients.
4. Even 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.
Guideline H3 – Financial conflicts of interest
5. In managing patients, a doctor must always place his patient’s best interests
above his personal interests and any business or financial considerations; he must not
let business or financial considerations influence the objectivity of his clinical judgment
in his management of patients. For example, a doctor must not subject a patient to
unnecessary tests or procedures simply because the doctor stands to benefit from the
fees; this could constitute over-servicing and may be a breach of his ethical obligations
even if the patient agreed to undergo the test or procedure.
6. 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.
7. In addition, 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. Such conduct may constitute over-servicing and/or over-charging.
Duty of Doctors
8. 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. The SMC believes that the
majority of doctors continue to strive to practise ethically and to build the trust of the
public, but for the few who are found to have misconducted themselves by unethical
charging and over-servicing and bring disrepute to the profession, disciplinary action
will be taken against them.
Thank you.
PROFESSOR TAN SER KIAT
PRESIDENT
SINGAPORE MEDICAL COUNCIL
[SMC 14.20]
19 March 2018
DOCTORS HAVE AN IMPORTANT ROLE TO PLAY IN KEEPING HEALTHCARE
COSTS AFFORDABLE AND SUSTAINABLE
1. We refer to the recent media coverage on rising healthcare costs (including
medical insurance premiums) and hefty and questionable insurance claims.
2. The Singapore Medical Council (“SMC”) notes that to keep healthcare costs
affordable and sustainable for patients, all stakeholders – healthcare professionals and
providers, insurers and policyholders, employers, patients and caregivers, and the
Government – have their roles and responsibilities. While the SMC acknowledges that
there are various drivers of healthcare costs, many of which are beyond the control of
doctors, doctors 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. In light of the recent scrutiny of healthcare insurance
and unreasonable practices and fees, the SMC by way of reminder, wishes to bring to
bear the ethical principles against complicity by doctors outlined in the 2016 edition of
the SMC Ethical Code and Ethical Guidelines.
Guideline H1 – Fees for services
3. Where patients are covered by medical insurance that guarantee they pay little
or nothing towards their medical bills, they may be less likely to contest the fees charged
by the doctor. However, patients’ acquiescence to a doctor’s fees does not absolve the
doctor of the responsibility of charging reasonable fees; the doctor’s ethical obligation
to charge fair and reasonable fees for services rendered operates over and above
contractual and market forces and is not superseded by any agreement between the
doctor and his patients.
4. Even 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.
Guideline H3 – Financial conflicts of interest
5. In managing patients, a doctor must always place his patient’s best interests
above his personal interests and any business or financial considerations; he must not
let business or financial considerations influence the objectivity of his clinical judgment
in his management of patients. For example, a doctor must not subject a patient to
unnecessary tests or procedures simply because the doctor stands to benefit from the
fees; this could constitute over-servicing and may be a breach of his ethical obligations
even if the patient agreed to undergo the test or procedure.
6. 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.
7. In addition, 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. Such conduct may constitute over-servicing and/or over-charging.
Duty of Doctors
8. 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. The SMC believes that the
majority of doctors continue to strive to practise ethically and to build the trust of the
public, but for the few who are found to have misconducted themselves by unethical
charging and over-servicing and bring disrepute to the profession, disciplinary action
will be taken against them.
Thank you.
PROFESSOR TAN SER KIAT
PRESIDENT
SINGAPORE MEDICAL COUNCIL
