Compared with last year, there are signs of resurrection in Hong Kong this Easter. We have witnessed the boom of the equities and the stock markets, a record high of more than 2 million people spending their holidays outside Hong Kong, furthermore, there are numerous debates and proposals on political reforms and democratic marches one after another. Even the comment as reported in News media : students should be the least qualified to criticize the Chief Executive from Mrs. Fanny Law, Permanent Secretary for Education, invited marked public criticism and appeared on the news headlines. Amidst this Easter uproar, we have received a reply from the Health, Welfare and Food Bureau on 26 March, 2004 writing on behalf of the Chief Executive, who is supposed to be too busy with more important agenda, in response to our previous enquires on subjects of Imbalance between Private and Public Medical Services, Medical Indemnity Insurance and Mandatory CME. Members are referred to page 12 of this bulletin for copy of the letter.
Referral protocols, collaborative models and better information links between the two sectors as pointed out in the reply letter are good attempts from the Government but the progress so far is ultra slow and is not serving any purpose, not to say to improve the condition of public private imbalance. Some colleagues were shocked to learn that on 30th March 2004, the Chairman of the Hospital Authority (HA), was said to propose 6 measures to cap the budget deficit (which was said to reach the record high of more than 6 hundred millions) of HA. According to media reports, the 6 proposed measures are:
(1) Health Care Insurance for all;
(2) Voluntary Retirement Scheme for HA Staff;
(3) Sale of Expertise Service;
(4) Increased Revenue from Academic Activities;
(5) Contracting out of Public Out Patient Clinics (OPCs);
(6) Targeted Subsidies for the Poor and Needy.
Firstly, I do think that the budget deficit should not be replenished if the Government really wants to make the private medical market sustainable and the Government should instead cut the budget in a wise manner to achieve the purpose of balancing public and private medical services. The measure of Targeted Subsidies for the Poor and Needy which we have proposed to the Government 5 years ago should be the right way forward.
Health Care Insurance for all would further jeoparidize the imbalance and has already invited marked criticism from the public. Voluntary Retirement Scheme for HA Staff was said to cater for non-medical staff only. Sale of Expertise Service would not warrant our attention for the time being.
We have proposed to the Government on Health care reform in 1999 that if Public OPCs are to be contracted out, they should be contracted to private doctors or doctors groups in level playing field. Ballot should the best way in the allocation of clinics. On the other hand, if we can supply health coupons to those needy, we suggest that the number of Public OPCs should be scrapped as many as possible leaving those needy receiving medical care in private sector using health coupons for subsidies. Anything short of that would give rise to problems like overdominance of large medical clinics by HMOs, uncertain liabilities of medical personnel working inside in public private mixed OPC model etc.
Doctors are bound by the Hippocratic Oath to share medical knowledge freely among colleagues. Any income out of such activities should be for appropriate administrative purposes and any further excess income from such academic activities should be used to further promote knowledge interchange among colleagues and not to help solve the Budget Deficit due to over expenditure in Public Medical services.
As pointed out in the reply letter, the HKSAR Governement is not going to intervene on the captioned subject as she thinks that Hong Kong has one of the most open insurance markets in the world where the setting of insurance premium rates is a commercial decision of insurers taking into account market forces and other factors. Your Union has provided a Medical Protection Plan to members before, believing also that it should be a commercial decision between the Insurers and those to be Insured. And we believe in open competition market for the captioned subject. Your Union is working out some suitable plans to serve our members.
However, there was a discussion on whether professional indemnity insurance for doctors should be made mandatory in the April policy meeting of the Medical Council of Hong Kong. Such agenda was aroused by a piece of news involving a diseased colleague who ran into bankruptcy and unfortunately there was no coverage for his patients mishap since the diseased colleague was not professionally insured. A certain number of Legislative Councillors and the Kwai Tsing District Board strongly urged such discussions and deliberations in Legislative Council Health Panel. However, the stand of the Medical Council of Hong Kong maintained that there was no sufficient ethical ground to support mandatory professional indemnity insurance and strongly suggested all medical practioners should have professional indemnity insurance. Colleagues are advised to have themselves professionally insured.
After an informal meeting with the Secretary for Health, Welfare and Food recently, members are well assured that the draft for the captioned measure would not be accomplished in the fiscal year 2004 2005. And when the Secretary asked me the best time to implement such mandatory measure, my simple answer was : I shall tell your good self when the time is ripe.
Dr. Yeung Chiu Fat Henry