Your Council has received messages on the HKDU Web forum (http://forum.hkdu.org) complaining about our Union’s inaction towards HMOs. Some of the messages are reproduced below for your reference: …
“...I think you doctors should have a trade union (indeed we have), and is the trade union doing anything to help your business? I don't think so, your doctors are just unwilling to help each others!
I think we have to take the initiative to strike back since this Union has been doing nothing rather than a club house each month showing pictures of our honorary president message and photo!
Can someone monitoring this forum pass the message to the union to answer our question? Is she planning to do anything or just let us get ripped off by HMO. If the union has no answer, I think someone should set up another union to deal with HMO.
Surprisingly, the HKMA magazine showed much concern about HMO and both the " message from the editor" and the open letter to Mr. Tung also mentioned about HMOs and the president was asking us openly do not join some HMO…”
I do not know the persons who posted the aforementioned messages. I do not know whether they are our members or not, or if they are even doctors. One thing I am sure is: Tackling HMOs is one of the most important functions of our Union. As stated in our Constitution and Rules, the second objective of our Union is: “To regulate relations and to settle disputes between members and their employer, between one member and another, and between members and other employees, between members and contract medicine associates, and between members and any statutory bodies concerned with medical service in Hong Kong by amicable and conciliatory means.”
Such objective is the driving force behind our Union to protect our members from ill treatment by HMOs; and only under this main objective are we united in this Union. I have clearly spelt out our roles and limitations in the fight against Commercial Profiteering HMOs in my message to you in July 2003 HKDU Bulletin entitled “Please Do Not Join HMO with Capitation Scheme.” You can also refer to the informative High Court decision in the message.
Since there are questions about what policies or measures have been undertaken by the Union to fight off HMOs, I would like to recapture the following history of our Union for members’ reference:-
Proposal on Legislation of Incorporation of Medical Practice
In 1997, we proposed to the Department of Health a new legislation on the incorporation of medical practice to state explicitly that the percentage of shares in such incorporated medical practice owned by doctors should be equal to or more than 90% of the entire issued share capital of the company in order to stop non-medical people from playing a dominant role in Hong Kong’s healthcare system. However our former Director of Health was not at all supportive and went on to state in her response letter to our Union in 1998 that every person, regardless of doctors or non-doctors, can run a medical practice business, and hence opened a door for HMOs to bloom in Hong Kong.
Code and Conduct of the Medical Council of Hong Kong on capitation, transparency of HMOs etc
In 1997, we suggested to the Medical Council of Hong Kong that something should be done in the Professional Code and Conduct to control HMOs, especially those administrating commercial capitation schemes. The following clauses in the code were enacted thereof:
Clause 14.2 on Contract medicine and managed care
“A doctor who is an owner, a director or an employee of, or in contractual relationship with, an organization which, either directly or indirectly, provides medical services or administers medical schemes, may only continue such association provided that the organizations conforms to the following principles :-
14.2.3 When administrators, agents, brokers, middlemen etc. are involved in a medical contract, information pertaining to the financial arrangements must be readily available to all parties on request.
14.2.5 Commercial pre-paid capitation schemes (whereby a doctor or a group of doctors undertake certain insurance-type financial risks) which may be incompatible with a high standard of medical practice should not be entered into…”
All Doctors Group
As a last resort, we attempted to establish the “All doctors Group” from 1998 to 2000 with other medical bodies but in vain for professional and commercial reasons.
However, our results have not been dismal and we have not given up. We are actively pursuing ways to tackle HMOs from time to time. We have metamorphosed from Estate Doctors Association as a Limited Company to Hong Kong Doctors Union as a Registered Trade Union in 2002 to look after our members’ rights and interests in coping with HMOs.
Our recent actions included filing two complaints to the Medical Council in 2002 and 2003 on HMOs which contemplated on capitation schemes but in vain because of the word “MAY” in clause 14.2.5 which said Commercial pre-paid capitation schemes (where by a doctor or a group of doctors undertake certain insurance-type financial risks) which may be incompatible with a high standard of medical practice should not be entered into. Noting such defective word in prosecution, the Ethics Committee of the Medical Council (with which I am a member) have improved on the wordings on 16th March 2005 with the objective to be able to condemn all those commercial capitations effectively. Of course, we also need your support in disclosing your observations on the behavior and operations of the HMOs.
We have introduced the Medical Practice Act of Australia on "Corporations Engaged in the Provision of Medical Services" to the former Chief Executive and the Secretary for Health, Welfare and Food for reference to control or monitor HMOs in Hong Kong and they have agreed tentatively to make sure that the quality of medical services provided by the HMOs would not be jeopardized. In the recent Policy Meeting of the Medical Council, even those in the ivory tower realized the serious problems imposed by the HMOs and did write again to the Secretary for Health, Welfare & Food to see whether appropriate regulations could be laid on them. I promise to raise this issue to the new Chief Executive of the HKSAR Government if I have the chance at the end of this year to do so.
Apart from pushing for legislations to control HMOs, pushing legislations for Incorporation of Medical practice with 90% shares at least owned by medical practitioners, we have contemplated on setting up HMO concern groups to address members’ concerns in a hopefully fast and concerted manner. As an initiative to our future joint effort to fight against Commercial Profiteering HMOs, you are urgently required to cooperate, complete and return the enclosed HMO survey 2005 issued by the Doctors’ Rights and Autonomy Committee.
For the better survival of us and our future generations, I am sure the war against HMOs would be an ongoing process in the coming future and to this end, Hong Kong Doctors Union would not shed her duties!
Dr. Yeung Chiu Fat Henry