MOH didn’t know about referral fees that has been going on for years?

I refer to the articles “MOH puts a stop to foreign patient referral contracts“, “Helping Indonesians get treatment in Singapore” and “Singhealth, NUH to stp using agents by end of Oct” (Sunday Times, Sep 30).

The former states that “The Health Ministry (MOH) has told public hospitals to terminate all contracts with foreign agents who refer patients from overseas, after The Sunday Times highlighted the existence of such a practice.”

This has been going on for decades. So, arguably, aren’t you surprised by “(MOH) has told public hospitals to terminate all contracts with foreign agents who refer patients from overseas, after The Sunday Times highlighted the existence of such a practice”?

This is arguably even more ludicrous, given that the payment of referral fees to third parties has been barred since December 2016 (“Doctors barred from paying percentage of fees to 3rd-party agents”, Today, Dec 14, 2016).

The above mentioned article said that “Some major TPAs here charge percentage fees and have done so for years, but what had doctors crying foul in recent months was a few players charging fees of up to 25 per cent of doctors’ professional fees — in some cases, for merely the “referral” of patients on a particular insurance scheme or panel.”

As to “The Sunday Times learnt that the National University Hospital (NUH), Singapore General Hospital (SGH) and Changi General Hospital (CGH) have such contracts with third-party agents.

In one case, an Indonesian agent was contracted to provide NUH “administrative services”. For every foreign patient accepted by NUH, the agent is paid 8 per cent of the patient’s hospital bill, excluding doctors’ fees.

If patients brought in by the agent spend more than $500,000, the agent gets an additional 2 per cent cut for every dollar above the cap. If the fees go past $1 million, the agent gets an additional 4 per cent for every dollar above that.

The agent must ensure the patient pays the hospital first before getting the fee. The agent’s duties include assisting potential patients with information they require before making “the most suitable recommendation”, as well as helping patients arrange specialist appointments, according to the NUH contract” – I understand that even agents in Singapore have been getting referral fees for years.

In respect of “Other agents from Indonesia and Vietnam told The Sunday Times that they also had arrangements with SGH and CGH, both run by SingHealth. The hospitals declined to say how long such practices have been going on.

Asked about such contracts, MOH said the priority of public healthcare institutions is to serve Singaporeans’ healthcare needs. They “are not allowed to actively market themselves to foreign patients”.

Some public healthcare institutions (PHIs) have contracts with agents who facilitate and assist foreign patients seeking medical treatment in Singapore. While these agents have not been tasked to market their services, we have asked the PHIs to discontinue such practices and terminate existing contracts with the agents, to avoid potential misinterpretation and misrepresentation,” it said.

SingHealth and NUH told The Sunday Times they will cease the agreements by the end of next month.

“NUH’s foremost priority is to provide care for Singaporeans,” the NUH spokesman added. “NUH reviews all referrals to ensure that it has the capacity, capability and resources to provide treatment that will be beneficial to the patient. Singaporeans are given priority, for appointments and hospital beds.”

SingHealth said the primary role of medical associates is to help overseas patients navigate the healthcare system, including advising patients on relevant health records needed, and assisting with the administrative processes, paperwork and travel arrangements.

“Medical associates are non-exclusive to SingHealth and they charge an administrative fee (per patient) for their services,” said SingHealth.

Doctors whom The Sunday Times spoke too were surprised that public hospitals engaged such agents.

“This practice of giving a ‘referral fee’ to ‘medical agents’ is unethical,” said Dr Keith Goh, consultant neurosurgeon of International Neuro Associates. The 8 per cent commission on a hospital bill of $500,000 would be $40,000 – “which is more than the annual salary of a staff nurse”, he added.

Some doctors pointed out how under the Singapore Medical Council’s (SMC) ethical code and guidelines, they are not allowed to offer a percentage of a bill as a referral fee” – in this connection, in a reply to my letter “Give breakdown in medical bills” (Business Times, Apr 13, 2005) – the Singapore Medical Association (SMA) said “Mr Leong further claims that doctors may make excessive profits by marking up the cost of medicines and investigations, and receiving a typical referral fee.

The Singapore Medical Council’s (SMC) Ethical Code strictly prohibits fee-sharingand obtaining commissions from referrals, and the SMC has previously disciplined doctors for doing so.

This is a serious allegation and SMA would like to invite Mr Leong to inform us if he has any concrete examples of this happening. SMA will investigate and take the necessary action. Alternatively, Mr Leong can inform SMC directly.”

So, it is good now (13 years after my above letter to the newspaper forum!) for the practice of giving or taking of referral fees or sharing of fees, to be finally and totally outlawed, as it is a big step towards reining in rising medical costs..

In respect of “Dr Tan Chi Chiu, chairman of SMC’s Medical Ethics Committee, said that there are no issues with public doctors treating foreigners. But foreign patients may pay more, and “doctors need to ensure that this does not set up a financial incentive” to favour such patients over subsidised ones” – some issues similar to the outlawing of fees sharing may still exist:

Free benefits?

Several years ago – medical groups started to give free accident insurance for a few months to newborn babies.

Initially, the medical groups paid for the premiums, but subsequently third parties paid the premiums.

Mutual benefits?

Over the years – we understand that this has evolved into third parties paying upfront cash benefits to medical groups.

Tender to highest bidder?

We understand that one medical group had even put out a closed tender, and about 10 third parties made proposals to bid for an automatic free medical expenses cover for one year for newborn babies.

Similar issues to fees sharing?

We understand that the proposals may include cash benefits, referring patients, etc.
How different are such arrangements to the fee sharing that is now forbidden under the ethical code?

Implications for consumers?

At the end of the day – what are the implications for consumers?
Wouldn’t possible allotment to the highest bidders be ultimately detrimental to consumers?Wouldn’t it push up the cost to consumers ultimately? Wouldn’t there be a risk that referrals will be made on the basis of who gives the best mutual benefits to the companies or in a sense – fee sharing directly or indirectly – instead of on the basis of the best medical practitioner or provider that can give the best treatment and care or cost value to the patient?


Leong Sze Hian



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6 Responses to “MOH didn’t know about referral fees that has been going on for years?”

  • opposition dude:

    Just like how Keppel O&M management “didn’t know” about the bribes paid to Brazilian officials for more than a decade.

    “Didn’t know” indeed! In future just use these 2 magic words to explain everything can liao! The dafts will believe it anyway, it’s why they are daft!

    Never mind the FACT that you make yourself look extremely stupid by even daring to say you “didn’t know”. Just say you close both eyes and let it pass by lah ok?

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  • Concerned:

    For me, the big question in this paying-agents-for-patients
    situation is why MOH decided to stop it NOW. Suddenly.

    I recall a lot of fanfare and pride years ago in the decision
    to launch medical tourism. It was touted and praised as THE
    way to go. Over the years, the public hospitals got increasingly
    crowded, waits for medical help got longer, but medical tourism
    was still seen as the way to go. There was talk of having more
    hospitals to ease the crunch, but nothing happened.

    That medical tourism was causing the bed crunch was hilighted
    over the years. So MOH cannot say it did not see this consequence.
    And despite the crunch, medical tourism was Still touted as THE
    way to go for public hospitals.

    Now, suddenly, out of the blue, MOH has put a stop to it. WHY?
    What prompted this decision, which should have been made at least
    10 years ago? A decision any idiot could see was needed, but MOH
    refused to go in that direction.

    Singaporeans deserve an explanation!

    We also deserve to be told the impact of stopping the foreign
    connections and whether medical fees in public hospitals will
    sky rocket to make up for the “loss” in foreign business. Or
    is the hike going to be sneaked on us?

    Finally, shouldn’t we be getting an apology for the medical trauma
    we’ve had to put up with for the last 15 or so years??? An apology
    for making the wrong decision and being blind to the consequences?

    GD Star Rating
  • LIONS:

    MEDICAL touri$m…sure we need to collect more $$$.
    if you have to wait hours for a bed,pls bear with it.

    if you cannot wait or wait until cannot wait anymore ,you die your business.

    we have no time to waste on you.

    who ask you to stoopidly keep voting for us after getting cheated time and time again.

    GD Star Rating
  • HarderTruths:

    I have waited with my friend for 5 hours to see a doctor at SGH.

    The $G doctor was GREAT and the nurses were TOP CLASS. ButI saw FT upon FT go in and out and in and out befoe even one $G was admitted to the consultation room. This is a DAILY situation.

    Our doctors and nurses cannot stop FT tourists from demanding first rate care and cut in front of $G locals – they must obey the rules from MOH.

    So is the 70% happy now? Or do the ballsless want more of the same? I think it is the latter.

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  • SeeNoEvilSpeakNoEvil:

    Its not putting a stop to medical tourism..just the referal fees!
    As long as the powers that be arent getting a cut in the form of taxes or licences, its a NO NO!
    But i oso 100% dont believe they didnt know! Impossible.

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  • Rabble-rouser:

    Greed is a powerful but ultimately destructive emotion. S’pore’s healthcare & medical institutions are deeply affected through CORPORATE MEDICINE! The late LKY introduced CORPORATE MEDICINE into state-owned Healthcare & medical institutions by CORPORATISATION. He hived off the state-owned entities through shifting the assets of Healthcare & medical institutions into share-equity, self-funded models & for-profit making organisation whose primary motivation became making profits, no longer ensuring the societal well-being of good health & strong bodies.
    CORPORATE MEDICINE is using “For-Profit” principles to run hospitals & medical practices to achieve financial rewards & power in wealth (profits, accumulate wealth, etc), reap ‘efficiencies’ in financial management over ‘human’ consideration in healthcare & societal well-being.
    After CORPORATE MEDICINE gains traction, the medical philosophy shifts from PREVENTIVE MEDICINE to CURATIVE MEDICINE. Why? Because CURATIVE medicine is much more profitable than PREVENTIVE MEDICINE. Asked yourself why doctors in S’pore are more predisposed towards prescribing more medicines, higher dosages, greater frequency of consultations & if nothing works, prescribed operations or high-cost remedial medical solutions. “For-profit” motivations exacerbates these problems with “commission-based” medical tourism, profiteering & price-gouging (Dr Susan Lim), etc.
    PREVENTIVE MEDICINE is analysing the cause-&-effect of Illnesses & Diseases. In many cases, the solutions of PREVENTIVE MEDICINE is to have an alternative lifestyle change. But in S’pore where the livelihood is so stressful & time-sensitive (high cost of living) – health is always compromised & secondary.
    The biggest killers in S’pore are Cancer, Hypertension, Diabetes, Cardiac & Kidney Failures. A high proportion of these can be attributed to a highly stressful lifestyle, lack of physical effort & a poor diet. The eco-system in S’pore is highly pollutive (too many cars, buses,& people), too many people (causing stress) & time-deficient (not enough rest, long working hours), etc.
    Ask yourself why the Public Healthcare System is so clogged with unhealthy people suffering various ailments? And why so many S’poreans have high incidence of Type 2 diabetes which ends up in amputation of their legs? ANSWER: PAP’s money & greed philosophy!

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