Statement on the use of prepayment packages

The Chiropractic Association (Singapore) recognises and embraces the diversity in practice style of its members. While it does not seek to limit scope of practice, it acknowledges that it has a duty to regulate the profession in a manner that balances the rights of chiropractors to choose their style of practice with protection of the public.

Prepayment schemes allow a patient to fund a programme of care recommended to them by their chiropractor. The duration of these programmes vary, but not infrequently can be 12 months or more. The theory behind this approach often relates to ‘corrective care’, the perceived need for which is often identified by detailed x-ray analysis. During such programmes, stated aims and objectives include correction of scoliosis and reversed cervical curves. The offer of prepayment is often accompanied by a discount on the regular fees on condition that if treatment is terminated early by the patient, refund is given as if treatments already taken were charged at the full regular fee.

The Association is aware the prepayment treatment packages are utilised by some members. These packages have been the subject of criticism voiced both inside and outside the profession and recent media coverage has exposed public anxieties and ethical concerns. The Association therefore considers it appropriate to set down regulations to safeguard its reputation and ensure public protection.

The Association is concerned that there is little or no independent evidence to support the notion that chiropractic manipulation is able to achieve correction of structural deformity of the spine. In light of this paucity of evidence, it is unable to support any treatment approach that advocates lengthy courses of care for which patients are encouraged to pay in advance.

Notwithstanding the above, the Association does, however, recognise that for administrative and practice reasons, members may wish to offer prepayment schemes to offer patients the opportunity to pay for treatment in advance. In order to satisfy the Association’s concerns and to maintain public confidence in the profession, the following regulations shall apply:

1. Such schemes must form part of a written practice policy and be for a maximum of 12 treatment sessions;
2. This written policy shall offer patients the alternative of being able to pay on a per session basis;
3. Policy wording shall not place undue influence on a patient to select one option over another;
4. Policy wording should not contain any claims that cannot be substantiated by independent peer reviewed evidence and shall not imply any guarantee of success;
5. Patients should not be disadvantaged by terminating a prepaid programme of care, although treatments already taken may be charged at the clinic’s standard per-session rate;
6. Programmes of care shall be reviewed at regular intervals and not less frequently than every 12 sessions; such reviews and reassessments shall be recorded in the clinical record with a future plan of management and rationale for care.

Any breach of the above regulation shall constitute a breach of the rules of the Association and render a member liable to referral to the Disciplinary Committee.