In general, considering practical limitations and patient experience, what is MOH’s guiding principles for when financial counselling needs to be repeated?
Licensees should refer to the general FC principles outlined in Q16.
We strongly encourage licensees to repeat financial counselling whenever there is a significant change to fees or line items of the bill discussed in previous financial counselling sessions. Except for nursing home licensees, licensees can exercise discretion in determining what constitutes “significant change” and how often to repeat financial counselling, in view of practical considerations. The following scenarios are for reference:
Scenario A: Treatments where the doctor may change the treatment details intraoperatively (e.g. interventional cardiologist might use a longer stent than what patient was financially counselled for and as such the estimated price range could be different): As it would not be practicable to perform financial counselling to the patient or next-of-kin intraoperatively, licensees would not be penalised for not providing an updated financial counselling in this scenario. Nevertheless, we encourage licensees to provide an updated instance of financial counselling to the patient or next-of-kin after the fact.
Scenario B: Treatments which require multiple cycles (e.g., chemotherapy): One-time counselling would be acceptable, assuming FC has been conducted in accordance with general FC principles. It should also be made clear that the fees apply to the entire treatment i.e. across all cycles of chemotherapy.
Scenario C: Treatments which require additional medications prescribed for patient to deal with the side effects of the treatment, or other immunosuppressant or hormonal therapy drugs to support the treatment: Additional medications or treatments ordered to support patient treatment or deal with side effects that would cause a significant deviation in the estimated price range would be considered “the fee information that is new to the patient”. As such, financial counselling should be reperformed so that they are aware of the updated fees for the treatment and the MediShield Life and MediSave coverage applicable.
Scenario D: Treatments which are affected by changes in government policy (e.g. revisions to the scope and extent of government subsidy frameworks, MediShield Life claim limits, MediSave withdrawal limits, etc.):
Financial counselling should be repeated if licensees anticipate that changes in government policy are expected to result in a significant difference to the cost of care previously counselled to the patient.
Related questions
For the conduct of financial counselling where there is a change in the licensee’s fees for the treatment or procedure that the patient is undergoing, is there a guide to define fee changes or is there a range that we can work within?
Is financial counselling applicable for drugs, and if yes, is there a need to obtain acknowledgment too?
Can licensees refer their patients to the relevant websites for fee-related information (e.g., MOH fee benchmarks, CPF MediSave and MediShield Life claims calculator to check on estimate claimable coverage) as part of the financial counselling?
For financial counselling performed previously without a formal documentation, is there a need to re-counsel the patient and obtain a written acknowledgement under HCSA?
