New guidelines on aesthetic treatment

Transcription

1 New guidelines on aesthetic treatment Country: Singapore Partner Institute: Department of Epidemiology and Public Health, National University of Singapore Survey no: (12) 2008 Author(s): Lim Meng Kin Health Policy Issues: New Technology, Others Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change 1. Abstract The Ministry of Health has released new guidelines to better regulate aesthetic treatments carried out in Singapore. Under these changes, general practitioners (GPs) would be allowed to perform liposuction, a move that had been vigorously opposed by plastic surgeons. GPs would also be allowed to offer seven types of aesthetic treatments that have scant scientific evidence supporting their benefits, only if they are doing it as part of a clinical trial. 2. Recent developments The new guidelines, which take effect in November 2008, require private doctors performing liposuction to be assessed by a new five-member accreditation committee before being allowed to perform the procedure. The criteria for accreditation include one year of surgical training in a hospital, having observed at least 10 liposuction surgeries under a qualified medical practitioner, and having performed at least five such procedures under close supervision. Liposuction clinics must also keep mandatory patient medical records, including reports of adverse outcomes which must be submitted to the accreditation committee. Patients must also be given at least seven days to re-consider before any payments or contracts are made. Moreover, while removal of less than one litre of fat in healthy patients under local anaesthesia can be done in properly-equipped surgical facilities in the approved medical clinics, when more than one liter of fat or general anaesthesia is involved, or the patient has a medical condition, the surgery can only be performed in a day surgery centre or hospital. Practitioners who do not comply could have their clinic licenses revoked. The ministry's move to regulate liposuction surgery reflects its concern over Singapore's mushrooming aesthetic medicine business which is estimated to be worth $200 million a year. A survey had shown that 6 in 10 GPs offer some form of aesthetic treatment, including liposuction, under local anesthesia. Most patients who require removal of larger amounts of fat, e.g. more than 1 liter of fat, generally go to plastic surgeons. 3. Characteristics of this policy Degree of Innovation traditional innovative Degree of Controversy consensual highly controversial - 1 -

2 Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral 4. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Initiators of idea/main actors Government Providers Patients, Consumers Others Stakeholder positions Plastic surgeons cried "foul" regarding the liposuction ruling. The president of the Singapore Association of Plastic Surgeons deplored the move, calling it a "mockery of the comprehensive way that bona fide plastic surgeons are trained". He maintained that "any medical practitioner interested in doing major aesthetic procedures and operations should undergo the training process that is required of every plastic surgeon." This would mean four to five years of specialist training after medical school, compared to about three days of training in the case of GPs. The opposite camp was elated. Plastic surgeons had earlier called for restrictions barring GPs and specialists in other fields from performing liposuction, whereas GPs had countered that plastic surgeons were trying to corner the market on liposuction, which is part of the mushrooming $200 million a year aesthetic industry. Speaking for the 150-member Society of Aesthetic Medicine (comprising GPs), its vice-president said the Ministry of Health's decision "underscores our commitment to patient safety first, while being fair to the medical practitioners involved in liposuction'. The President of the Anti-Ageing and Aesthetic Medicine Society of Singapore described the guidelines as "straightforward and rational". Psychologists welcomed the 7 days cooling off period before liposuction, explaining that this would prevent some patients from making the decision on impulse. The surgeons wondered, however, why Singapore was following France's lead in mandating a cooling-off period, but not the French provision that liposuction can be done only by plastic surgeons. They also pointed out the inconsistency in this ruling which applies only to Singapore-based patients but not to foreign patients who travel to Singapore for the procedure. As for the limitation imposed on the seven procedures unless under the "clinical trial" provision, the Society of Aesthetic Medicine sought the support of the College of Family Physicians Singapore (CFPS) in asking for this ruling to be repealed for three of the seven procedures - namely carboxytherapy, cellulite-reducing endermologie, and microneedling. But it received a lukewarm reception from the College. The media reported that some GPs have started making changes in anticipation of the new rules, such as selling their machines, informing patients that the treatments would likely be stopped, and switching to other types of procedures

3 The Consumers Association of Singapore welcomed the guidelines and expressed its hope that doctors will comply with them as well as brief their patients on the new rules. Actors and positions Description of actors and their positions Government Ministry of Health very supportive strongly opposed Providers Plastic surgeons very supportive strongly opposed General Practicioners very supportive strongly opposed Patients, Consumers Patients very supportive strongly opposed Others General Public very supportive strongly opposed Actors and influence Description of actors and their influence Government Ministry of Health very strong none Providers Plastic surgeons very strong none General Practicioners very strong none Patients, Consumers Patients very strong none Others General Public very strong none Positions and Influences at a glance Adoption and implementation The new guidelines take effect in November

4 5. Expected outcome While not all plastic surgeons and GPs in aesthetic medicine practice will be totally satisfied, the guidelines do at least bring an end to their bickering over turf, besides holding promise of greater patient awareness and improved patient safety. However, plastic surgeons may well have the last word as the composition of the accreditation committee includes three plastic surgeons, a dermatologist, and a GP. Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable Cost Efficiency very low very high 6. References Sources of Information Alicia Wong. "Storm erupts over new liposuction rules." TODAY newspaper, Monday, April 28, 2008, Page 4. Salma Khalik. "Aesthetic procedures - GPs cheer, plastic surgeons fume, over new MOH rules." Straits Timers, April 28, GUIDELINES ON AESTHETIC PRACTICES FOR DOCTORS July

5 Author/s and/or contributors to this survey Lim Meng Kin Suggested citation for this online article Lim Meng Kin. "New guidelines on aesthetic treatment". Health Policy Monitor, October Available at -