Many countries do not allow promotion of health services via mass media, advertisements and other direct promotions, and in a significant way, information on pricing and quality of care institutions and medicines reaches to patient through their primary care physician, many of whom indulge in a referral fee split unethical practice to refer a patient for business to a higher specialist, brand prescription and admissions.
[2] According to the World Medical Association,[3] 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.
"[4] 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 US and are in effect tolerated by key overseeing bodies such as the American Medical Association and Joint Commission International, or JCI.
[5] 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, preferring to concentrate on less challenging areas of healthcare assessment, despite the vast importance of medical ethics to patient safety.
Fee splitting and similar practices are considered unequivocally unacceptable for the medical profession in the United Kingdom.