In a parliamentary debate on Jul 11, it was proposed that 1,600 medical and dental clinics in Singapore offering a government subsidy to patients, may have to issue itemised bills to the patients.

The debate was over the issue of overcharging and over-servicing by general practitioners (GPs) and dentists on the Community Health Assist Scheme (CHAS), which currently provides 1.4 million Singaporeans with subsidised treatments at private clinics, amounting to S$167 million.

Dr Lam Pin Min, the Minister of State for Health, was put in the spotlight during the debate.

The ministry had received about 300 complaints in the three years from 2013 to 2015, of which, Dr Lam has said that it is "a relatively small number" given the 5.8 million claims during that period.

Approximately half of the complaints were about charges including incorrect billing and overcharging.

There were also complaints about clinics refusing to provide itemised bills to explain the fees.

Making itemized bills compulsory – is it the right move?

To address this, Ms Lee Bee Wah (Nee Soon GRC) suggested that itemised bills should be compulsory for patients to have a peace of mind when they know what they have been billed for.

When Dr Lam said the Ministry of Health (MOH) is looking into whether this is absolutely necessary, Ms Lee retorted, "Why is it so difficult, given so much feedback on overcharging?"

In response, Dr Lam remained firm and said that the MOH is "seriously considering making it compulsory" and "we will announce this very soon"

Mr Seah Kian Peng (Marine Parade GRC) asked how widespread excessive claims were and if the recent suspension of two dental clinics for possible cheating was just the tip of the iceberg.

"These are serious monies that are going out, taxpayers' monies," he said.

Dr Lam said a few more clinics have been referred to the police, but was unable to provide details until full investigations are completed.

Mr Leon Perera, a Non-Constituency MP, said residents reported that GPs charge a consultation fee for a follow-up visit if the patient is claiming the CHAS subsidy, but not otherwise.

Dr Lam was quick to address the situation and asked for details so the ministry could investigate to see if "there is any misconduct or malpractice".

Unifying the different CHAS cards – reasonings and implications

Meanwhile, Mr Liang Eng Hwa (Holland-Bukit Timah GRC) suggested having just one CHAS card instead of two -orange and blue.

He claimed that Singaporeans with the orange card are unhappy with the lower subsidy provided, compared with those with the blue card.

CHAS is currently available for households earning S$1,800 and below monthly or households without income with an Annual Value (AV) of the house worth S$21,000 and below.

Orange card receivers have a monthly income of S$1,101 to S$1,800 or residence AV of S$13,001 to $S21,000, whereas blue card receivers have a monthly income of S$1,000 and below or residence AV of S13,000 and below.

Alternatively, the suggestion that more people are given the blue card as the orange card is "so unpopular" was made. However that would mean blurring out the income and residence AV differences.

There was no comment about whether this would affect Government budgets.

Dr Lam claims that the MOH regularly reviews the amount of subsidy as well as the scope of coverage.

He reminded the cabinet that it was public feedback that led it to remove the age criterion for the Chas card in 2014 - it was previously only for people aged 40 years and older.

Mr Cedric Foo (Pioneer) was concerned about the number of Singaporeans qualifying for the CHAS card, of which, Dr Lam reminded him that half of all Singaporeans currently qualify for CHAS, with the bottom 30 percent issued the blue card and the next 20 percent with the orange card.

Dr Lam reassures that the Ministry of State Health would review and revise accordingly. MIMS