MOH to monitor situation on managed care providers and TPAs

THE Ministry of Health (MOH) will monitor the situation on managed care providers and third party administrators (TPAs) and, where necessary, "will not hesitate to take further steps to protect the interests and well-being of patients" and safeguard the integrity of Singapore's healthcare system.

The point was made on Monday by Minister of State for Health Chee Hong Tat in response to the parliamentary question by Desmond Choo, member of parliament for Tampines GRC, on whether MOH will regulate managed care companies (MCCs) and TPAs as healthcare entities.

The ministry had earlier received feedback from medical professionals on their concerns over the charging practices adopted by some TPA companies.

In MOH's review, Mr Chee said there is agreement among stakeholders that the charging practices must not compromise patient safety and well-being, and should not lead to escalation of healthcare costs.

He said MCCs and TPAs provide a wide range of intermediary services, including management of employer medical benefits and claims administration.

Those that provide healthcare services directly to patients will be regulated under the Private Hospitals and Medical Clinics Act (PHMCA), said Mr Chee.

Mr Choo also asked how transparency on the fee arrangements between doctors, TPAs and insurers can be improved.

To provide clarity on how doctors should engage MCCs and TPAs, the Singapore Medical Council has recently revised its Ethical Code and Ethical Guidelines (ECEG) to state that doctors must not allow financial arrangements to lead to any compromise in the care of patients.

"Any charges which doctors pay to MCCs or TPAs should be commensurate with the actual administrative work done by these intermediaries in processing the cases, and not based primarily on the fees charged to patients. The revised guidelines will take effect from Jan 1, 2017," Mr Chee said.

He added that to enhance transparency, the revised ECEG indicates that doctors should disclose any TPA fee arrangement and referral fees to their patients, if these are passed on to the patients.

Mr Chee said MOH is now assessing if these disclosure requirements should be further reinforced through its regulations.

"We are also working with the Life Insurance Association (LIA) and the Integrated Shield Plan (IP) insurers to ensure that their appointed TPAs do not have any conflict of interest. In addition, the insurers should disclose to their policyholders any financial arrangements they have with the doctors."