Is it a victory? Not long ago, there was a hint from the Medical Council of Hong Kong that certain Insurance Company did promise to revise its contract terms with its panel doctors. Those unethical contract terms would be deleted. This is verified by a new contract produced in front of our Council from the same company this month. What does it mean? It signifies our success in making the wrong doings of HMOs known to the public last year. It means that justice will be done one way or the other with the support from the media and the public. And it means that if we want to ask for a change, we should package our demand to get the support from the public before something can be accomplished. We should say out loud when there is injustice upon us!
However, when we look at what the Government have done for us. Nothing! He is just naive and lassie faire. He is just fond of meetings and meetings, planning and planning, consultations after consultations and saying things repeatedly to make sure that nothing can be done. So that there is no change at the end and no wrong doings that he can be held responsible.
I am talking on the proposal which the Government introduced to the Panel on Health Services of Legislative Council on 12th March 2007 on the ways of regulating HMOs. I have shared with you of our meeting with the task force from the Department of Health (DoH) on 21st Dec. 2006 in Feb. 2007 HKDU Bulletin. At that juncture, we agreed that the company or insurer should bear the capitation risk and such risk should not be transferred to the Panel doctors. We agreed on the establishment of Medical Director and Licensee mechanism but we insist that at least 50% of the shareholders are Medical doctors as in the Dental Registration Ordinance. We suggested deleting those additional clauses in governing clinics.
From the final Government proposal presented to the Panel on Health Services of Legislative Council meeting on 12th March 2007, we found that we have succeeded in convincing the Government not to include clauses in governing front line panel doctors. However, we spotted the following shortcomings in the final proposal:-
1. Medical Director (MD) for Group practices only which is not comprehensive enough to cover the health service market;
In the proposal, there is the appointment of registered medical practitioner as MD for group practices only. We maintain that control should be in a more comprehensive manner. We should control not only service providers but also those whom can influence the provider behavior, like the Insurance agencies, Middlemen companies etc., i.e., those who have the money to buy the healthcare services. At least, there should be establishment of medical departments in these health care companies, and there are MDs in these departments to look after the panel doctor contract terms in finance and medical service delivery matters. These MDs should follow the Code of Practice promulgated by the Medical Council of Hong Kong and should be held responsible for the work of the HMOs.
2. This is not a Legal binding proposal.
With the excuse that it would take a long time to legislate, the Government only proposed a voluntary system by setting up a list of group practices that have appointed MDs in the DoH to be made known to the public. The Government proposed that if a MD has infringed the relevant codes of the Medical Council or the guidelines promulgated by DoH, he/she may no longer be eligible to perform the duties as a MD and the respective group shall be de-listed unless it appoints another eligible medical practitioner as MD. If the management of the group repeatedly and unduly interferes with the MDs¡¦ professional decisions, the group would not be listed again. So you can see, this is just a ¡§wild cat without teeth¡¨ since the medical service can still be provided by the groups or HMOs, no matter they are enlisted or not. The gist of the matter is there is no punitive measure by this voluntary scheme. So this is just another window dressing by the Government in response to stringent requests for control from medical and dental bodies, patients¡¦ groups, Consumer Council, Legislative Council members and even certain HMOs last year.
As such, our Union is totally unsatisfied with the present proposal. We believe in more stringent and comprehensive control of HMOs and this should be formally legislated.
HKDU has received numerous complaints from our members about the malpractices from the HMOs last year. These malpractices are made known to public as our bullets for fighting against HMOs. This year, as I have said previously, we need more. We need your great help again to collect more examples of ¡§misbehaviour of HMOs¡¨ to fight a tougher war, this time, not only against HMOs but also the lassie faire government. At least, we can keep him awake. If you do not want to be restrained by HMOs on your clinical management, please help us by completing the enclosed questionnaire to help you again. We are not demigods now as suggested by some seniors. But as servants to the community, we have to get united to fight for our own dignity. As there shall a meeting of the Panel on Health Services of Legislative Council scheduled in late April or early May this year to revisit the issue, we would like to have your quick response. Many thanks!
Dr. Yeung Chiu Fat Henry