HMOs regulation 2007

We have argued rigorously with the HKSAR Government on the needs of regulation of Private Profiteering Health Maintenance Organizations (HMOs) last year. In fact, we have been negotiating with the Department of Health since early 90¡¦s on the Incorporation of Medical Practice since the introduction of HMOs and have urged the previous Director of Health to speed up the drafting of the necessary amendments to the Medical Clinic Ordinance or the new legislation on incorporation of medical practice, and to state explicitly the following points in the relevant ordinances:-

1. It is legal for the medical practitioners to incorporate their private medical practice no matter it is a profit making or non-profit making concern.
2. The percentage of shares in such incorporated private medical practice owned by doctors should be equal to or more than 90% of the entire issued share capital of the company.

However we heard some rumors from the Health, Food and Welfare Bureau recently that our clinic practices would have to be tightened controlled as a prerequisite for legislation on HMO regulation.

On 14th January 2007, there was a report in the Apple Daily on the ¡§Government¡¦s¡¨ plan to outsource General Out Patient Services to selected groups of doctors practising family medicine. Our Council immediately sought clarification from the Bureau on such a plan. At the time of press, there is neither ¡§Yes¡¨ nor ¡§No¡¨ answer received.

As reported, panel doctor of such scheme would receive $45.00 for each consultation from the Government. However, the panel doctor has to bear the risk of capitation, i.e., after receiving a certain amount of prepayment in the beginning of the year, the fee for each consultation would decrease with subsequent visits for each patient until zero. This would be worse than the scheme of School Medical Service in the ¡¥80s. It would be much worse than the capitation scheme in some HMOs in the market, e.g. the P-HMO and the H-HMO. Now it looks as if the Government is learning the private HMO¡¦s way to contain cost at the expense of us ¡V private doctors. This is totally ridiculous. Why don¡¦t they just buy all our services and build up a ¡§National Health Service¡¨ as in the United Kingdom to save all the troubles.

Worse still, in the meeting with the task force from the Department of Health on 21st Dec 2006, we are offered a draft proposal on the HMO regulation. From the way they presented the proposal, I predict they are paving way to such a ¡§Government HMO¡¨ scheme as reported in the newspaper. The proposal at a glance are as follows:-

Definition of HMO ¡V intermediates between Patients and Doctors including Insurance Agencies, Group Practices, MSA etc as compared with simple relationship between Doctors and Patients.

Code of practice (on HMO)

A) Management and Personnel

• Medical Directorship
• Licensee Liability
• Providers¡¦ Contract

B) Information Provision

• Patient¡¦s Contract
• Advertisements

C) Quality of Treatment and Care

• Financial Incentives
• Physician Decision Making
• Utilization management

D) Complaint management

Code of practice (on clinics of Panel doctor)

E) Premises, Facilities and Equipment

F) Risk management

• Infection Control
• Health and Safety
• Medicines management

G) Records and Information Management

Our immediate responses are as follows:-

1. We certainly agree that the company or insurer or HMO should bear the capitation risk and such risk should not be transferred to the Panel doctors. We agree on the establishment of Medical Director and Licensee mechanism for HMOs but we insist that at least 50% of the shareholders are Medical doctors as in the Dental Registration Ordinance;
2. We suggest deleting those clauses, i.e. clauses E, F and G, governing clinics as this will create two mechanisms to control doctors in private practice. If there are two disciplinary bodies to control doctors, the control mechanism will not be unified and would turn out to be disastrous, especially for panel doctors under the control of the HMOs.

The important question now is: ¡§Would the Government succeed in pushing through such HMO plan?¡¨ In fact, the Government would have the support from various stake-holders like the patients¡¦ groups, Private Profiteering HMOs and LegCo members. If there is no strong opposition, they would form the largest HMO in Hong Kong.

We have reported the many malpractices that the HMOs have committed to the Government last year. We pointed out the health of the people in Hong Kong would be at stake if no control measure enforced by the Government.  We have earnestly urged our Government to regulate these HMOs through legislation so that they would be brought under the strict surveillance from the Medical Council and the Medical Registration Ordinance before it is too late. However, the Government seems to turn a blind eye to these and she is going in the wrong direction. She may have lost her way and inadvertently backed up the HMOs, which in return will introduce more illegal and sub-standard medical practices. So, beware, we should put up a stronger fight this year.

I wish you all a happy and prosperous new year of Pig!

Dr. Yeung Chiu Fat Henry