Sunday, July 24, 2016
Singapore - Rooting out health scheme cheats
Any abuse of state health schemes has to be nipped in the bud to ensure it does not undermine the cost-effective delivery of useful programmes.
In the case of the Community Health Assist Scheme (Chas), patients who are eligible for a government subsidy benefit from the convenience of being treated at nearby private clinics, which later claim the subsidy from the authorities.
This ease would be eroded if additional layers of bureaucracy are found to be necessary to thwart the black sheep of the medical profession from cheating.
If Chas is tightened sharply, it could put some lower-income and pioneer-generation patients back in the queues at polyclinics. Such bunching would not only be inefficient but also lead to less income for the 1,500 private clinics now on Chas.
These clinics treated 650,000 Singaporean patients last year and received $167 million from the State.
Regrettably, the dishonest acts of a minority are vitiating the reputation of their medical brethren for providing reliable service to subsidised patients. A number of clinics are being probed for making false or excessive claims for subsidies, and two have been suspended by the Health Ministry. Some procedures were not done at all, yet claims were submitted for payment. In other cases, excessive claims were made from patients' Medisave accounts, without their approval or knowledge.
These are astounding revelations - in particular, the deliberate acts of fraud uncovered at some clinics. Criminal conduct demeans a profession that is generally held in high regard and should be vigorously addressed by the Singapore Medical Council and Dental Council. Meanwhile, weak administration, such as sloppy record-keeping, suggests a slide in professional standards that should not be tolerated if private clinics are to continue participating in government schemes. To root out subsidy cheats, firm action must be taken both by professional bodies and the authorities to deter practitioners from offending.
The broader ethic of prudent health-cost management is vital if subsidised schemes and the universal coverage provided by MediShield Life are to remain sustainable over the long term. A cheating streak among practitioners could lead to ballooning costs if extensive tests and complex procedures are foisted on patients instead of simpler ones. Another ploy is to falsely classify an unapproved procedure in order to make a claim. Rising health costs will impact state health budgets and push up the premiums of compulsory basic health insurance. Everyone will lose out as a result if such irresponsible acts are not curbed.
Patients have a role to play, too, in checking abuses by routinely asking for itemised receipts. It is not uncommon for private clinics to provide receipts only on demand. Such loose practices offer opportunities for improper claims to be made.