The idea of having another Medical Protection scheme started in 1996 when the rate for Medical Protection rose sharply in Hong Kong. The main reason behind is to get a better or reasonable price for Indemnity Insurance of Medical Practice for our members. Undoubtedly, by introducing competition into the market, we have stabilized or even lowered the Premium of Medical Protection in the past five years or so in Hong Kong. Due to the changing policy of the underwriter of our Medical Protection after the 911 Tragedy, our Plan has to be scrapped despite numerous remedial attempts. However, your Council is still confident on finding another plan for all of our members. We shall keep you informed when the time is ripe.
Now, please allow me to put forward a few ways to get a reasonable and cheaper Medical Protection Premium:-
This is the most important factor among others. As I have said before, by introducing our Medical Protection Plan (MPP) from 1997 to 2002, we have witnessed the stabilization or even the reduction of the premium in other Medical Protection schemes. Only on the withdrawal of all plans but one that we immediately got the marked increase in the percentage of the subscription of the remaining plan ranging from 32% to 126 % for private practitioners.
In our previous MPP, we purposely introduced more choices of Legal Firms for subscribed members so as to introduce competition in “legal prices”. Thanks to our Hon Legal Adviser, a free pre-claim Legal Consultation Mechanism was set up to minimize unnecessary legal costs. Furthermore, Dr. Leung Hon Fai, Chairman of the Medical Protection Committee, has taken the painstaking task to negotiate with some popular solicitors and barristers in the field for capping the legal fees in defense actions for unfortunate colleagues. All these measures help to decrease the legal costs and help to sustain the viability of the MPP.
* From the accounts of MPP, the total claims (including outstanding claims) from 1997 to 2002 is HK$2,181,213.97, the corresponding premium (deducting administrative charge to HKDU) is HK$3,019,912.05 from the subscribers and the net income for our Agent and Underwriter for the MPP is HK$ (3,019,912.05 - 2,181,213.97) = HK$838,698.08 which should be healthy enough for continued running of the MPP. However, the problem is the policy of our underwriter had changed since the 911 Tragedy.
Our administrative charge is kept to a minimum at less than HK$200 as compared to 10% of the Gross Premium for other scheme in the market. And our benefits and welfare to the members did not deteriorate even with such low administrative charge. Whether you are a general practitioner or a specialist, there is no difference in the workload for each subscriber to our secretariat and it is with this concept that we keep the administrative charge the same for every subscriber.
Increase in subscription fees was said to be due to the increase in patients’ claims in the past years. Information from the Preliminary Investigation Committee of the Medical Council of Hong Kong showed an increase in the number of complaints from 236 in 2001 to 287 in 2002, i.e. a rise of 21.6%. Even with that increase, our previous MPP should still be viable. Furthermore, there should not be marked increase in subscriptions if MPP still survives. However, with the rise of patients’ expectations nowadays, our technique to tackle patients may have to be improved in order to minimize the chance of being complained.
Some may think to cap compensation to patients may prove a good method to cut claims and to cut premium in the end, as in New Jersey’s recent proposed law in the United States. “The key to rectifying the situation is comprehensive tort reform like the Medical Injury and Compensation Reform Act (MICRA) that was passed in California in the mid-1970s," says one of the officials of the New Jersey Medical Society. MICRA instituted a US$250,000 cap on non-economic damages such as pain and suffering.
The American Association of Orthopaedic Surgeons believes the tort reform systems that some states of the United States have put into place have helped to resolve the problem of professional liability and have facilitated better patient care. It supports the consideration and adoption of a tort reform at a federal level, as this would permit orthopaedic surgeons to better provide high-quality services at reasonable costs to their patients. "To promote the equitable treatment of injured patients throughout the country, tort reform at the federal level should be a priority," it declares in a position statement. Would similar plans turn out to be beneficial to doctors and acceptable to patients in Hong Kong? Would this concept help to stabilize the rate of growth of medical liability insurance premium in Hong Kong too? Would it be supported by the HKSAR Government? And most important of all, is it the right time to make such a move in Hong Kong?
All and all, we should aim at getting a reasonable price for Indemnity Insurance of Medical Practice with a trustworthy Underwriter for us to practise safely and without undue worry for the better health of Hong Kong.
Dr. Yeung Chiu Fat Henry
* Source of information: Alexander Forbes (Hong Kong) Ltd., Agent for MPP
醫生專業保險費曾於1996年暴升，當年引發我們籌劃另一個專業保險計劃，加入市場競爭的主要目標是替會員爭取一個較好或較合理價錢的保障。明顯地，在我們引入了市場競爭後，香港過去五年的醫生專業保險能夠穩定下來或甚至降低了。但911慘劇以後，我們的專業保險承保公司改變了政策，幾經多次嘗試補救，結果仍被迫結束計劃。不過你們的會董會仍有信心能替會員找到另一個保險計劃。待時機成熟時，我們會第一時間通知大家。
現在容我列舉怎樣把保費降低至合理價錢的幾個辦法：-
這是最重要的一環。如前面所述，1997年至2002年自我們引入的醫生專業保障計劃後，我們見證到其他計劃的保費保持不變或甚至減低了。祇是當市場轉變成只剩下一個計劃時，我們便立刻要承受私家醫生保費高達32% 至126% 的增幅。
在過往的醫生專業責任保險計劃(MPP)中，我們刻意引入多間律師行以供會員作選擇，以達至訴訟費用的競爭。感謝我們的義務法律顧問為會員提供免費索償前的法律諮詢，得以將費用盡量減少。再者，我們專業保險委員會主席梁漢輝醫生，不厭其煩地與幾位訴訟著名的律師及大律師討價還價，得以將辯護律師費用減至最低。這些方法均有助減低律師費和幫助MPP的生存。
*從MPP的收支記錄中所見，1997年至2002年索償總數（包括未付的賠償費）是HK$2,181,213.97，而相關投保者所付出的保費（扣除HKDU的行政費後）是HK$3,019,912.05。經紀與承保公司的淨收入是HK$ (3,019,912.05 - 2,181,213.97) = HK$838,698.08，故MPP是有足夠經費繼續運作。可惜是，911慘劇改變了承保公司的政策。
我們所收行政費用保持最低而以200元為上限，比起其他市面上計劃所收取的十份之一佣金實在是小巫見大巫。不過即使我們收費低廉亦完全不會影響到會員所得到的保障與福利。普通科醫生與專科醫生購買專業責任保險所引致秘書處的工作量是完全沒有分別，故此我們對每位參與保險計劃的醫生所收取的行政費用是一視同仁。
提高保費的藉口通常是因為過去的病人索償大大增加。從最近醫委會初級偵訊委員會的資料顯示，投訴醫生個案由2001年的236宗增加至2002年的287宗，即是21.60% 的增幅。縱使有此增幅，筆者相信我們以前的MPP應仍然可生存。況且如MPP繼續存在的話，保費肯定亦不會有顯著的升幅。不過以現在病人要求與期望的提高，為了減低被投訴的機會，我們應付病人的技巧可能亦要有所改良了。
有人或會想到限制病人索償金額是減低索償及最終減低醫生保費的好辦法。美國新澤西州最新建議的法律是一例。新澤西州醫學會幹事說：「糾正時弊的竅門是全面的法律改革，如加州於1970年中業所通過的MICRA醫療創傷與賠償改革法案。」MICRA把非關經濟的損害例如痛楚與受苦的賠償設立了250,000美元的上限。
美國骨科學會相信某些州所實施的法律改革制度已成功幫助解決了專業責任賠償的問題，亦幫助了提高照顧病人的質素。其意見書中有道：「為著推廣受創傷病人的正確治療，全國性的法律改革是應優先實行」。相似的計劃若在港實行應否對醫生有利和會否為病人所接納？這概念可以把醫生專業責任保險的保費穩定下來？特區政府會不會支持？最重要考慮是現在是不是最好採取這行動的時機？
總括來說，我們應以找到一個可信賴的保險公司和取得一個合理的保費為目標，好讓我們能安心替港人健康服務，不被無謂煩惱纏擾。
楊超發醫生
*資料來源：安博保險顧問香港有限公司，MPP代理人