Fee splitting
Encyclopedia
Fee splitting is the practice of sharing fees with professional colleagues, such as physicians or lawyers, in return for being sent referrals http://www.answers.com/topic/fee-splitting.
In most parts of the world, the practice is considered unethical and unacceptable, hence fee splitting is often covert. The reason it is believed not to be in the interests of patients is because it represents a conflict of interest
which may adversely affect patient care and well-being, since patients will not necessarily be referred to the most appropriate doctor to provide their on-going care but will instead be referred to those doctors or hospitals with whom the referring doctor has a "fee splitting" or commission payment type of arrangement.
According to the World Medical Association
http://www.wma.net/e/meetings/leaders1.htm, "The AMA
Code provides that payment by or to a physician solely for the referral of a patient is unethical as is the acceptance by a physician of payment of any kind, and in any form, from any source such as a pharmaceutical company or pharmacist or a manufacturer of medical appliances and devices, for referring a patient to that source. Another section specifies that clinics, laboratories, hospitals or other health care facilities which compensate physicians for referral of patients are engaged in fee-splitting, which is unethical".
Among its Definitions of Unprofessional Conduct, the "West Hudson Psychiatric Society Virtual Newsletter" (1997) lists Offering, giving or receiving a fee for the referral of a patient (fee splitting), or permitting any person other than an employee or associate to share in your fee, who has not provided an appropriate service directly under your supervision. http://www.rfmh.org/whps/syn1197.html
However, the practice, or something resembling it, tends to be tolerated - in "Medicine, Money, and Morals: Physicians' Conflicts of Interest" by Marc A. Rodwin, forms of fee splitting and commission paying for referrals remain common in the USA and are in effect tolerated by key overseeing bodies such as the American Medical Association
and Joint Commission International, or JCI
. http://books.google.co.uk/books?id=nsUKs1ovVmYC&pg=PA41&lpg=PA41&dq=joint+commission+fee+splitting&source=web&ots=_CyAWz_4xn&sig=ZUZNhoBXpAUjybvjXYn5ZZ-wchI&hl=en
According to their website, the Joint Commission (JCI
) have no published view on the issue of fee splitting, and in fact the Joint Commission stopped trying to provide guidance on medical ethics
to American hospitals many years ago http://books.google.co.uk/books?id=nsUKs1ovVmYC&pg=PA41&lpg=PA41&dq=joint+commission+fee+splitting&source=web&ots=_CyAWz_4xn&sig=ZUZNhoBXpAUjybvjXYn5ZZ-wchI&hl=en, preferring to concentrate on less challenging areas of healthcare assessment, despite the vast importance of medical ethics
to patient safety
. It is not clear if JCI
operate to a similar level of standards when working outside of the USA.
The practice is considered unethical, and offenders can be disciplined and even "struck off the medical register". http://www.gmc-uk.org/guidance/archive/func_proced_and_dis_jan_1970.pdf This is not to say that it does not happen.
, http://www.maltatoday.com.mt/midweek/2007/11/14/n2.html Malaysia, http://www.prlog.org/10039052-doctors-against-ing-proposal-that-will-disrupt-patient-care.html Singapore
, http://news.sma.org.sg/3903/Forum.pdf Thailand
, http://www.bumrungraddeath.com/pages/news_details.cfm?id=112 and India
. http://www.bmj.com/cgi/eletters/326/7379/10/c
Fee splitting in medicine and healthcare
This is essentially the payment of a commission to the referrer with the express intention of ensuring that the referring doctor directs referrals of patients to the payee.In most parts of the world, the practice is considered unethical and unacceptable, hence fee splitting is often covert. The reason it is believed not to be in the interests of patients is because it represents a conflict of interest
Conflict of interest
A conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other....
which may adversely affect patient care and well-being, since patients will not necessarily be referred to the most appropriate doctor to provide their on-going care but will instead be referred to those doctors or hospitals with whom the referring doctor has a "fee splitting" or commission payment type of arrangement.
Fee splitting in the USA
The situation in the USA is not entirely clear.http://www.time.com/time/magazine/article/0,9171,771534-2,00.htmlAccording to the World Medical Association
World Medical Association
The World Medical Association is an international and independent confederation of free professional Medical Associations, therefore representing physicians worldwide...
http://www.wma.net/e/meetings/leaders1.htm, "The AMA
Ama
-Ama:Ama may refer to:*Ama , an outrigger used on sailing boats*Ama , traditional Japanese divers*Ama , a product of digestion...
Code provides that payment by or to a physician solely for the referral of a patient is unethical as is the acceptance by a physician of payment of any kind, and in any form, from any source such as a pharmaceutical company or pharmacist or a manufacturer of medical appliances and devices, for referring a patient to that source. Another section specifies that clinics, laboratories, hospitals or other health care facilities which compensate physicians for referral of patients are engaged in fee-splitting, which is unethical".
Among its Definitions of Unprofessional Conduct, the "West Hudson Psychiatric Society Virtual Newsletter" (1997) lists Offering, giving or receiving a fee for the referral of a patient (fee splitting), or permitting any person other than an employee or associate to share in your fee, who has not provided an appropriate service directly under your supervision. http://www.rfmh.org/whps/syn1197.html
However, the practice, or something resembling it, tends to be tolerated - in "Medicine, Money, and Morals: Physicians' Conflicts of Interest" by Marc A. Rodwin, forms of fee splitting and commission paying for referrals remain common in the USA and are in effect tolerated by key overseeing bodies such as the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
and Joint Commission International, or JCI
JCI
JCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
. http://books.google.co.uk/books?id=nsUKs1ovVmYC&pg=PA41&lpg=PA41&dq=joint+commission+fee+splitting&source=web&ots=_CyAWz_4xn&sig=ZUZNhoBXpAUjybvjXYn5ZZ-wchI&hl=en
According to their website, the Joint Commission (JCI
JCI
JCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
) have no published view on the issue of fee splitting, and in fact the Joint Commission stopped trying to provide guidance on medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
to American hospitals many years ago http://books.google.co.uk/books?id=nsUKs1ovVmYC&pg=PA41&lpg=PA41&dq=joint+commission+fee+splitting&source=web&ots=_CyAWz_4xn&sig=ZUZNhoBXpAUjybvjXYn5ZZ-wchI&hl=en, preferring to concentrate on less challenging areas of healthcare assessment, despite the vast importance of medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
to patient safety
Patient safety
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
. It is not clear if JCI
JCI
JCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
operate to a similar level of standards when working outside of the USA.
Fee splitting in the United Kingdom
Fee splitting and similar practices are considered unequivocally unacceptable for the medical profession in the United Kingdom.The practice is considered unethical, and offenders can be disciplined and even "struck off the medical register". http://www.gmc-uk.org/guidance/archive/func_proced_and_dis_jan_1970.pdf This is not to say that it does not happen.
Fee splitting in other countries
Fee splitting in the medical profession of various sorts has been alleged in MaltaMalta
Malta , officially known as the Republic of Malta , is a Southern European country consisting of an archipelago situated in the centre of the Mediterranean, south of Sicily, east of Tunisia and north of Libya, with Gibraltar to the west and Alexandria to the east.Malta covers just over in...
, http://www.maltatoday.com.mt/midweek/2007/11/14/n2.html Malaysia, http://www.prlog.org/10039052-doctors-against-ing-proposal-that-will-disrupt-patient-care.html Singapore
Singapore
Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...
, http://news.sma.org.sg/3903/Forum.pdf Thailand
Thailand
Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...
, http://www.bumrungraddeath.com/pages/news_details.cfm?id=112 and India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
. http://www.bmj.com/cgi/eletters/326/7379/10/c
See also
- Medical Protection SocietyMedical Protection SocietyThe Medical Protection Society is a not for profit organisation which offers legal and ethical help to medical and dental professionals...
- Medical tourismMedical tourismMedical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...
- Hospital accreditationHospital accreditationHospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
- International healthcare accreditationInternational healthcare accreditationDue to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
External links
- http://www.wma.net/e/meetings/leaders1.htm
- http://www.gmc-uk.org/guidance/archive/func_proced_and_dis_jan_1970.pdf
- http://www.aaem.org/feesplitting/602.php
- http://www.time.com/time/magazine/article/0,9171,737214,00.html
- http://www.rfmh.org/whps/syn1197.html
- http://books.google.co.uk/books?id=nsUKs1ovVmYC&pg=PA41&lpg=PA41&dq=joint+commission+fee+splitting&source=web&ots=_CyAWz_4xn&sig=ZUZNhoBXpAUjybvjXYn5ZZ-wchI&hl=en
- http://www.sma.org.sg/sma_news/3710/advisory.pdf