It was reported in the news today ('MOH puts a stop to foreign patient referral contracts', 30 Sep) that the Health Ministry (MOH) has instructed all public hospitals to terminate their contracts with foreign agents who refer foreign patients from overseas to them.
MOH said that the priority of public healthcare institutions is to serve Singaporeans’ healthcare needs. They “are not allowed to actively market themselves to foreign patients”.
Some of the public hospitals which were named in the news to have used such foreign agents include Changi General Hospital (CGH), Singapore General Hospital (SGH) and National University Hospital (NUH).
It was reported that the agents can earn a lucrative commission fee of up to as high as 8 per cent of the patient’s hospital bill. An agent’s duties include assisting potential patients with information they require before making “the most suitable recommendation”, as well as helping patients to arrange specialist appointments.
Dr Keith Goh, consultant neurosurgeon of International Neuro Associates, was surprised when he heard about such practice instituted by the public hospitals, "This practice of giving a ‘referral fee’ to ‘medical agents’ is unethical," he told the media.
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.
Jakarta-based agency has been referring Indonesian patients to Singapore hospitals for 11 years
At the same time, the media also reported that one of the large foreign agencies, HCM Medika which is based in Jakarta, has been helping to send some 15,000 Indonesian patients to Singapore and Malaysia hospitals.
Indeed, its website confirms that HCM Medika is an official representative of the following hospitals in Singapore, including the public ones:
The website said, "We have an official agreement with various hospitals in Singapore and Malaysia to facilitate Indonesians going to those respective hospitals for medical treatment. Our recommendation is always based on patient's medical need and budget."
And according to further information on its website, PT HCM Medika was established 11 years ago in 2007 to "help Indonesians to get great quality medical care from government hospital in Singapore". In other words, HCM Medika started its business as an agent to Singapore's public hospitals 11 years ago.
The best part is their services are provided free-of-charge to the Indonesian patients as they get their fees from the hospitals:
Its services even include recommending doctors to Indonesian patients. It's not known if the doctors pay any additional fees to HCM Medika for the referrals:
It also said that its staff visit Singapore and Malaysia regularly to "learn about the latest developments" and also to "meet with various doctors and hospital staff".
"That way, we can give our customers more useful insights," it said. "Thanks to the hard work of our staff and the continuous support from our clients, we have grown from a small operation to a well-established company with offices in Jakarta and in Bandung".
They also provided cost estimates for some of the medical procedures:
Jakarta-based agency recommends doctors to patients
Most interestingly, HCM Medika also recommends some of the Singapore doctors on its website. It's not known if these doctors are aware of it or have any dealings with HCM Medika directly, as advertising a doctor's service is frowned upon in Singapore.
Singaporean patients live in tents outside CGH
It is most unfortunate that the public hospitals have been taking in foreign patients from overseas all these years when at times, they do not even have enough beds to house Singaporean patients, resulting in them lying in tents outside the hospital buildings.
Four years ago in 2014, the bed crunch situation became so bad that CGH had to pitch tents on its hospital grounds to house patients.
At the time, Dr Lee Chien Earn, CGH's CEO confirmed with the media, "Our bed occupancy rate has crossed 100 per cent for certain periods over the past month and some patients have waited more than 24 hours for an inpatient bed."
This was despite CGH already renting wards from other private hospitals.
Singaporean Madam Fatimah Beevi, 60, was placed in the Admission Transit Area in CGH for 48 hours while waiting for a B2 bed. "There was no shower room and I couldn't bathe for two days," said Madam Fatimah, who was quickly discharged from CGH after her condition "stabilised".
When news broke out that patients had to live in tents at public hospitals, there was a big public uproar. Then, MP Chia Shi-Lu conveniently suggested that the bed crunch might be due to "the holiday season rather than a spike in illnesses".
When questioned in Parliament after the news broke, Health Minister Gan Kim Yong said it was due to Singapore's ageing population, which needed more hospitalization. He replied in the House that this was one of the factors that contributed to the high bed occupancy rate at public hospitals.
But what is not mentioned by the minister is that while the lower tier wards are being fully occupied but higher tier wards such as A2 and A1 are heavily used by medical tourists. Doctors and activists have for years argued that there should be no class separation of wards in the public hospitals. Class C wards are not air-conditioned even when the corridors of the public hospitals are, which some say that it is a measure by hospitals to differentiate between the subsidised and paying wards.
In any case, while Madam Fatimah lamented that she couldn't bathe in CGH for 2 days, Indonesian Ibu Maria was very pleased with the National Cancer Centre Singapore, a public hospital under SingHealth. She wrote to HCM Medika: