Tuesday, July 14, 2009

Doctors Respect Patient Confidentiality and Rights

The Star reported that the National Union of Bank Employees (NUBE) had accused doctors of violating their patients' privacy, 13 July, 2009.

In response to this sensational news reporting, I was asked to give some comments as to what is going on and if this was true.

1. Are conditional guarantee letters between banks and its panel of doctors a common practice?

Doctors are always faced with many dilemmas, when attending to patients who come to their clinics or hospitals for medical treatment, through a third party payer (TPP) mechanism. While we all have a duty and responsibility to attend to patients, with the strictest confidentiality, there are also reality bites which dictate that doctors have to abide by certain technical requirements.

One of these, is to complete insurance forms or Managed Care Organisation (MCO) forms, sometimes even before any medical consultation can begin. Oftentimes, there's also more forms to fill, post treatment or during treatment, estimations of costs, etc. when complications or prolonged stay is anticipated.

However, all of these forms require that the patient i.e. the employee agree to and sign a formal consent for his/her medical condition and treatment details to be made known to the third party payer.

Whether this is to be construed as a conditional guarantee letters (GL) is subject to different interpretations by different people. But unfortunately that is the process which the employee have to work out, or agree to, with their employers as a benefit of employment. Like it or not, someone has to pay for treatment; even when self-paying, there is that implicit agreement that some payment is expected.

The rationale for such disclosure is so that no frivolous or fraudulent claims can then be made, and the costing of some of these treatment schedules can be checked for consistency and that these are done in accordance with regulations and agreed reimbursement guidelines.

This is the reality that is the process of these third party payment schemes, which help to justify charges and reimbursement. Most employers demand such justification.

Strictly speaking, this exchange of information is purely to help the process of transparency and regularity of the billing process. Some insurers have on occasions even denied hospitalisation or treatment suggestions based on their so-called gate-keeping function to help curb cost and over-utilisation. In many instances, doctors have helped to smoothen some of these disputes in favour of the patient (employee).

Doctors have always believed that one's health status and conditions are always personal and confidential, thus it is hoped that these third party payers would be willing to apply such strict confidentiality rules when interacting with the employers who are the ultimate paymasters.

While doctors will support such strict interpretation of these confidentiality concerns, we cannot be held responsible for what some of these third party payers would do if they breach these conditions, so as to justify payment claims.

The MMA strongly believes that personal details should not ever be revealed to the employers which may jeopardise their working conditions or promotion aspects. However, when requested to provide medical reports to anyone other that the individual patient, doctors are reminded to strictly abide by these confidentiality rules, and be very careful about divulging any information which has not been authorised by the patient. Medical reports are almost always given only to the patient, and rarely to his/her designated agent.

Herein lies the problem with these insurance pre-admission or pre-medical check forms which, must accompany the bills, but which must always also accompany the patient's permission as required in a signature, usually witnessed in full view of the doctor or his assistant.

How the third party payer then uses this information is unfortunately not within the purview of the doctor. Of course, doctors would always support confidentiality and privacy rules, which is every patient's right.

Therefore, the MMA fully supports the view (and perhaps through an improved regulatory framework) which protects the patient's personal information such as health or medical status. We support that such information be considered as fully confidential and only used impersonally (without identifying details) for the above disbursement or checking procedures, and should not be divulged to the employers, unless agreed to by the patient involved.

2. Are there any circumstances which allow a doctor or a panel of doctors to reveal their patients' medical backgrounds to their patients' employers?

Some pre-employment medical check-ups are conditional, and is within the prerogative of the employer, which will usually demand full disclosure of health status and history before confirmation of employment. Such is the right of the employer or employing agency, and is usually made well in advance for the employee to agree to and formally approve before disclosure.

In certain conditions which require prolonged recuperation or when there is a need to modify work conditions, such as following a heart attack, stroke or certain major surgeries, some explanation to facilitate the employer's agreement to such employment changes may be required. These are often requested by the recovering employee and are fully supported by doctors. In other words, doctors have always been very sympathetic and empathetic to employees as patients, and will always place their interests first and foremost.

3. Do you agree with the statement by NUBE secretary-general J. Solomon that "this is not only a form of harassment but a clear violation of basic human rights and infringes on their privacy..."

Therefore, it is mischievous of NUBE to label doctors as colluding with employers to harass their employees. This is certainly never the case. In fact in the past when such requirements were mandated pre-treatment, many of us physicians protested exactly on such confidentiality concerns. It was only then that the TPPs, came forward with the requirement of the employee to acknowledge and sign their consent for divulging their medical information to the TPPs, that doctors agreed.

In many instances, doctors have bent backwards to help and assist their patients to access certain medical tests and therapeutic procedures which have earlier been denied by their gate-keeping third party payers (TPPs) such as Managed Care Organisations (MCOs) and insurance agencies.

The MMA is also working closely with the Ministry of Health to come up with some comprehensive Regulations and Act to ensure that these MCOs and TPPs function within the remit of the law and thus protect the patient's rights more comprehensively. We understand that the MOH is in the final stages of putting this Act through Parliament.

Dr David KL Quek
President, MMA

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