In 1999, we had made a submission on the Harvard Report to the Authority. Among the suggestions to solve the Public Private Imbalance, we proposed the Authority to either close down or contract out some of the public OPCs to stop further influx of patients to the Hospital Authority (HA) system. We did not receive any response from the Authority since.
In deliberation on the formation of the All Hong Kong Doctors Group with representatives from the Association of Private Medical Specialists, The Association of Licentiates of Medical Council of Hong Kong and Practising Estate Doctors' Association in 1998 to 2001, we were of the opinion that the Government should be involved to make it a success. Therefore, we took the liberty to ask Mrs. Katherine Fok, the then Secretary for Heath & Welfare, to look into the possibility or feasibility to spearhead the contracting out of Family clinics¡¦ patients or even public OPCs¡¦ patients to the proposed All Hong Kong Doctors Group on 23.10.1998. We even proposed to set up 24 hour clinics in 18 districts of Hong Kong to ease the burden of the Accident & Emergency (A&E) departments at that time. However, the attitude of the Government was still inert.
Since there was no blessing from the Government, the All Hong Kong Doctors Group got a few contracts to work with and of course had to wind up quickly and silently after twelve months of operation in 2001.
Now, after 7 years of benign neglect by the Government, we finally have a ¡§positive¡¨ response from the HA on our previous proposal of outsourcing HA OPCs in 1999. The reasons given are to minimize the abuse of A&E departments by Hong Kong citizens (which was said to be up to 70% at the present moment), to cut down expenses of the HA for sustainability and at the same time to start a new cooperation model with the private sector and which conform with the future HA policy. The message is loud and clear and we have actually been discussing with HA cluster managers and HA directors in the past 12 months on this topic. That is the reason why I spell out this proposal to the media last month after meeting with the HA chief to collect opinions from the profession and the public.
As some members may have noticed from the newspaper reports on 15th to 16th June 2006 that the HA would like to outsource some of its regional OPCs to us, private doctors. In fact, we have exchanged views on certain details for the conditions of outsourcing. Below is a summary of what HA and we have discussed for members¡¦ easy reference:-
1. The present HA service in OPCs should not be affected, i.e., there would be the same number of quota for patients who would be paying HA fees for services;
2. The group practice in charge of the outsourced HA OPC would be composed of interested private doctors in the vicinity and the formation of which would be assisted by HKDU or other nonprofit making medical body if deemed necessary;
3. We have suggested such group practice should not be HMO or under control by HMO;
4. Every private doctor in the region should not be barred from entering such group practice;
5. For the service provided by the group to ¡§public patients¡¨ as stated in clause 1, HA would reimburse the group practice a lump sum of money each year for the service and such money would be calculated from the OPC accounts in the past years and details would have to be worked out in case for implementation;
6. If the ¡§public quota¡¨ for the outsourced OPC is fully booked, additional patients would have to pay the OPC service charges as private patients;
7. Any patient visiting the center for outpatient service outside normal OPC hours would be charged by the group practice as private patients too;
8. There would be facilities for day surgeries, minor procedures or even CME in the OPC;
9. The service fees after normal OPC hours should be more or less equal to that of A&E department which is said to be increased next year;
10. We have agreed with HA that the minimal requirement for participating private doctors should be CME certified by MCHK or Colleges of the Hong Kong Academy of Medicine;
We stressed that such outsourced OPCs should be seen by the public NOT in anyway connected with the HA except doctors there are paid for services for the ¡§quota¡¨ patients. Otherwise, such cooperation scheme would be just an extended arm of the HA into the private sector that we cannot be in agreement.
Some colleagues might compare the present proposal with 2 private night clinics established near the A&E departments of Queen Mary and Tuen Mun Hospital which proved to be a great failure few years back. However, I wish to point out to our members that there would be at least three big differences between the two:-
1. The outsourced OPC group practice would be able to ¡¥survive¡¦ from the service fee paid by HA for the ¡§quota¡¨ patients from the start;
2. The OPC would not be attached to the A&E department but next to residential areas which would be much more convenient to patients especially in the middle of the night;
3. There should be NO PRICE DIFFERENTIAL between the regular service fees in the A&E departments of HA hospitals and the private patient service fees of the outsourced OPC.
After all, patients served in the outsourced OPC would be admitted to HA hospital ward straight away without going through the A&E department again by prior agreement between HA and the outsourced OPC.
Now, it is time for you to think it over to see whether such OPC and deserved hospitalization should be outsourced to local private doctors, to HMOs or run by the HA with 24 hour clinic services. Or you may just favour status quote in the end.
Dr. Yeung Chiu Fat Henry