22.11.1999

Press statement of Estate Doctors Association

Estate Doctors Association representing 1,524 doctors in private and public service inside and outside public housing estates objects strongly to the suggestion of the Commercial Properties Committee of the Housing Authority (HA) to change the method of estate clinic allocation from the present balloting system to an Open Tender system. This decision to change was not done with any proper consultation of public housing estates residents, all concerned doctor groups and political parties.

In 1966 when the Government needed registered doctors to cater for the health care of people in resettlement areas and later housing estates, she requested the help of the Medical Profession to form a doctors' group with its own code of rules and regulations to allocate clinics among its doctor members. This led to the formation of Estates Doctors Association (EDA). EDA has fulfilled her function as a pair of helping hands for the HA, acting as a bridge of communication between HA and estate doctors, to vet applicants' qualification and eligibility, approve and nominate applicants to the HA, and to give professional advice to HA regarding multidisciplinary services provision. So far the relationship between HA and EDA has been cordial and the functioning has been smooth and good.

Recently EDA has been attacked with groundless and unfair accusations by mass media, certain doctors and commercial entities pressing the HA to change. But there is no valid reason for change. It only serves to appease unfounded criticisms and benefit prosperous Health Maintenance Organisations (HMOs). In fact, there is rarely any complaint from public estate residents on medical service provided by private doctors in public housing estates.

We have asked the HA to solicit opinion from the whole territory. We have the results of a survey of public housing estate residents' opinion of estate clinic doctors with conclusions made by the Social Sciences Research Centre of The University of Hong Kong. We believe the government should hear people's voices.

The results of survey made by the Social Sciences Research Centre of The University of Hong Kong is enclosed in the Appendix.

The followings are the conclusions from the survey made by the Social Sciences Research Centre of The University of Hong Kong :-

The majority of the Public Housing Estate residents have indicated that:-

1. they are satisfied with the service of the estate doctors;
2. they are worried about the rise in medical charges that will result from higher operational cost with an Open Tender system;
3. they object to the suggested Open Tender system for allocation of estate clinics;
4. they prefer the continuity of care with the same family doctor which occurs with the present system.

Should the Open Tender system be enforced without binding the tenant doctor to be actually providing the service as is being done with EDA's present rules and regulations under the balloting system, there would be a frequent change of attending doctors either as employees or under hand deals. This chaotic situation which is harmful to patients will allow powerful medical contract groups and rich HMOs to dominate medical services and manipulate charges. Then there is real MONOPOLY.

The harmful effects of HMOs is illustrated by the discontent of patients, doctors and politicians alike in USA and Australia, where HMOs have openly interfered with doctors' decision in investigations and medical treatment with the ultimate aim to maximize HMOs profits. Should Hong Kong also become slave to these rich and powerful financial investors and sacrifice the health of the citizens?

EDA has conducted a named referendum among our 1,524 member doctors (1,057 in private practice and 467 in public service) in July 1999. Over 90% is against Open Tender System and supports balloting.

Our other reasons for objecting open tender are:

1) Since tender means going to the highest bidder, clinics' operational costs are most likely to rise and in spite of how efficient the tenant doctor/dentist is, he will be forced to raise patient charges in order to make ends meet. Despite some belief to the contrary about spending power of estate residents, we believe all along there has been a valid reason by the Housing Authority to cater for the less well off and assist the estate doctors by keeping clinic rental to as nearly just or below the market rental so that in fact there has always been a lower figure of doctor charges in the estates on the average compared to charges outside estates all through the past 33 years;

2) If one talks about fairness and equal opportunity, then consider the less well to do or young graduates without the means to compete with the more well off and well established doctors or doctors back up by HMOs;

3) Open Tender system poses an extremely high possibility of estate clinics being monopolised by large financially capable bodies such as HMOs or rich individuals or conglomerates. This situation would be extremely difficult to eliminate administratively;

4) If monopoly does occur, medical charges can be easily manipulated and the quality of health care can be jeopardised through restriction of treatment methods and investigations by HMOs which was proven in the USA and here;

5) Even if tender can be intentionally controlled by limiting to only individual doctors/dentists, there is NO guarantee that those doctors/dentists entering the Open Tender exercise will not be controlled by rich conglomerates or HMOs;

6) As a result of not willing to bind the successful tenderer to be the actual tenant and therefore change of hands be allowed under the table there will be :-

• exploitation of unsuccessful applicants by the successful tenderer;
• lack of continuity of medical care by the same family doctor much like a Government Out-Patient Clinic.

We cannot over emphasize the merits of the existing Ballot system by lots drawing which remains the most fair and, by being open to all doctors which has been advocated by our Association, will be even fairer still. Applicants are no longer required to enter any doctor association.

Other merits of our suggested Open Ballot system of allocation of estate clinics are :

1) Chances for successful ballot would be fair and equal to all doctors/dentists disregard of financial background;

2) With the present Ballot System, surveys performed by our Association showed lower medical charges in public estate doctors - at present showing 20% lower, as compared with outside doctors;

3) Decrease chance of corruption as advised by Independent Commission Against Corruption in 1991 when the ballot system was being reviewed by the Housing Authority together with EDA;

4) Protect patients' rights to receive optimal health care by protecting doctors' professional autonomy through freedom from control by HMOs;

5) Foster regulatory mechanism for utmost Patient-Doctor relationship to foster better continuous health care and to enhance the concept of family medicine;

By adopting the open tender method, HA has demonstrated that she is only here to make money, and fails to consider the interests of 3 million public housing estate residents and the resulting harmful effects on doctors' professional autonomy. We sincerely hope that the HA should solicit more opinions from the community before making such a drastic change in the method of public estate clinic allocation. We demand that any final decision should be based on our concern on the optimal health care for our citizens!

22.11.1999

新聞稿

本港有一半以上人口居住在公共屋�h及居屋。公共屋�h及居屋的醫療服務政策關係著香港300多萬人的民生與福利和社會的安定與繁榮，事關重要。

香港房委會商業樓宇小組委員會在沒有充分諮詢民意，特別是在公共屋�h及居屋生活著的居民的意見，又沒有與在公共屋�h提供醫療服務的醫生及其醫學團體充分商討及接納其所提出的合理建議，又沒有諮詢各政黨和團體的意見下，一意孤行地催毀了一貫以來33年行之有效，雖有些少不足，但卻易改善的政策，驀然訂下於明年一月一日開始實施以公開投標(Open Tender)價高者得的政策分配公共屋�h診所。

本會堅決反對房委會商業樓宇小組委員會以公開投標，價高者得的政策分配公共屋�h診所。並指出其弊端與錯誤如下：

（一）違背民意

本會委託獨立的具科學性及權威性之香港大學社會科學研究中心進行“市民對屋�h醫生的意見調查”，結果顯示：

1. 大部分公屋居民都對沿習以久的屋�h醫生的服務表示滿意。
2. 大部分公屋居民都認為以公開投標價高者得的方式去出租屋�h診所給醫生勢將會使到診金增加。
3. 大多數公屋居民反對公開投標價高者得去出租屋�h診所給醫生。
4. 大多數公屋居民希望像現時那樣得到長期固定熟悉了解他們的家庭醫生照顧，而不希望由財團投得屋�h診所後，聘請醫生走馬燈式應診

這充分證明房委會商業樓宇小組委員會的決定(公開投標價高者得去出租診所)是違背民意的，現附該份報告供參考。

（二）不理會醫學團體與醫生反對

（三）價高者得，租金上漲，羊毛出在羊身上，診金相應增加，屋�h居民百上加斤

財團以公開投標及借用醫生名義很容易投得某屋�h的全部或大部份診所，造成壟斷，在無競爭的環境下，控制及提高某屋�h診所的診金，令居民加重負擔。

（四）容易受財團壟斷，駐診醫生經常轉換，直接影響醫療質素和病人與醫生的關係

財團聘用的屋�h醫生缺乏歸屬感，很可能在合約滿後另謀高就，或另起爐灶，居民要重新接受另一位接手的醫生，有違延續性醫療服務之原則，一個居民可能要經歷幾個不同家庭醫生。

（五）容易有私相授受，甚至會有炒賣情況出現，既無規定診所開診時間，而且沒有機制監管診所運所。

1. 公開抽籤容許所有香港註冊西醫加入抽籤，而無規定是任何醫生組織的成員，使有志加入屋�h服務的醫生不論財力大小都機會均等。
2. 診金價錢，亦因房署既定的市值診所租金而相應減少，正如本會歷年做的調查所得結果顯示，屋�h醫生的診金較非屋�h醫生的診金便宜大約兩成。
3. 由於屋�h診所沒有被財團壟斷，各屋�h醫生在公平競爭的環境下提供服務，質素有保證，診金由市場主導，這是市民之福。
4. 房署與本會在一九九一年檢討屋�h診所分配的時候，廉政公署指出抽籤方法會減少貪污問題出現的機會。
5. 不容易受財團壟斷，使行醫者有其診所，專業自主得以保持。最終令到公共屋�h居民染病時得到延續性及最妥當的醫治。
6. 有機制監察醫生在屋�h行醫，例如規定每日開診時間，亦可提升家庭醫學的理念。

房委會決定採用公開投標的方法分配屋�h診所，缺乏任何有力之理據支持，既不能解決現存之問題，卻帶來不少後遺症，本會謹希望房委會充份諮詢屋�h居民，有關團體及政黨對公共屋�h診所公開投標的意見後，才作出一個對三方面 － 房委會作為大業主，醫生作為租客及醫療服務提供者，接受醫療服務的屋�h居民 － 都滿意的決定。

Circular No. 1831, 28^th December 1999

16.12.1999

Joint Press Statement of
Estate Doctors Association, Hong Kong Dental Association and Estate Dentists Group

Estate Doctors Association (EDA), Hong Kong Dental Association (HKDA) and Estate Dentists Group (EDG) express grave disappointment at the Hong Kong Housing Authority’s insistence on using the Open Tender method as a means of letting out public housing estate clinics, closing her ears to the voices of the people and seriously ignoring the quality of health care for the public housing estate residents.

We emphasize here that health care is an essential element in supporting the entire livelihood, welfare, stability and prosperity of the community. It is extremely dangerous and does not do anybody any good if the HKSAR crudely and violently categories health care services as a purely commercial commodity.

In a Press Statement of 22.11.1999 we have issued the following two points:-

1. After a survey on citizens' opinion towards estate doctors in November 1999, the Social Sciences Research Centre of the University of Hong Kong pointed out that the majority of public housing estate residents are satisfied with their estate doctors and are unanimously against the open tender method in leasing out estate clinics.
2. In July 1999, a named referendum by EDA of 1,524 doctor members (including 467 doctors in public service and 1,057 private practitioners) revealed that over 91% are against using an open tender method for letting public estate clinics.

In order to obtain a fairer and more comprehensive opinion from our professions and citizens, our professions undertook the following actions:-

In early December 1999, 42 doctors and dentists issued an open letter to the over ten thousand registered doctors and dentists in Hong Kong to obtain a comprehensive named survey to collect the professions’ opinion towards the method of letting estate clinics. The results were: -

There were 1,405 replies (Please see Appendix A). Among the respondents were a significant number of University professors, superintendents of public and private hospitals, consultants of public and private hospitals; over 85% are not estate doctors. The conclusion was that over 91% were against the open tender method as a means of letting estate clinics, a figure similar to that of EDA’s survey.

The problems that our colleagues are concerned most are the following:

1. Since Open Tender means going to the highest bidder, clinics' operational costs are most likely to rise and in spite of how efficient the tenant doctor/dentist is, he will be forced to raise patient charges in order to make ends meet. If one talks about fairness and equal opportunity, then consider the less well to do or young graduates without the means to compete with the more well off and well established doctors or doctors backed up by Health Maintenance Organizations (HMOs);
2. Open Tender System poses an extremely high possibility of estate clinics being monopolised by large financially capable bodies such as HMOs or rich individuals or conglomerates. If monopoly does occur, medical charges can be easily manipulated and the quality of health care can be jeopardised through restriction of treatment methods and investigations by HMOs which was proven in the USA and here. Even if tender can be intentionally controlled by limiting to only individual doctors/dentists, there is NO guarantee that those doctors/dentists entering the Open Tender exercise will not be controlled by rich conglomerates or HMOs.
3. As a result of not willing to bind the successful tenderer to be the actual tenant and therefore change of hands be allowed under the table there will be :

• exploitation of unsuccessful applicants by the successful tenderer;
• lack of continuity of medical care by the same family doctor much like a Government Out-Patient Clinic.

They believe that opening up more clinics in public housing estates is not a solution to the above problems.

Again, we have received the signatures from 7,153 Hong Kong Citizens (including estate residents) expressing strong objection to the decision of the Commercial Properties Committee of the Hong Kong Housing Authority (HKHA) of using open tender method to allocate estate clinics.

We feel that HKHA should not ignore such strong voices and demand from within and without the medical and dental professions. She should bear in mind her policy of service to the community and once more pick up the courage to discuss with us all and stop pursuing impractical and unrealistic solutions!

With the latest information as mentioned above, after thorough study and debate and based on our:

1. a. belief that health care is not a pure commercial commodity.
2. belief to maintain continuous health care for the population.
3. belief to maintain strong doctor-patient relationship.
4. determination to fight against profiteering commercially owned health service merchants and organisations such as HMOs, the expansion of which adversely affects quality of health care in Hong Kong.

EDA and HKDA resolutely and forcefully demand the HKHA, for the good of Hong Kong as a whole, to adhere to the opinions of the people and without making HKHA losing one cent, to withdraw and rescind her decision of using open tender method for letting estate clinics.

We ask for a Genuine, Open and Fair Balloting System allowing local doctors and dentists to participate in allocation of estate clinics! We have to reiterate once more that such balloting system should be open to all registered medical and dental practitioners in Hong Kong with no requirement on affiliation to any organization.

Regarding the future arrangements of medical and dental clinics in the public housing estates, we have the following suggestions to HKHA:

1. a Clinics in public housing estates should be allocated to individual doctors and dentists. The successful doctor/dentist must be the person running the clinic.
2. Subletting or reassignment by the tenant should not be allowed.
3. HKHA should take reference to our By-laws on Clinic Practice that have been used for many years to establish an effective control mechanism to monitor estate clinic practice and to supervise the running of future estate clinics so that the public estate residents can receive optimal health care.
4. To establish an independent appeal mechanism for estate clinics' rentals to handle all rental complaints.

We would like to clarify the following misconception of the public:

(1) Estate Clinic to Population Ratio

This ratio has all along been suggested and determined by HKHA alone. Our two Associations welcome the suggestion of HKHA to reduce the ratio. Afterall, every Hong Kong Citizen should enjoy the same quality of health care delivered.

(2) "Estate doctors are reluctant to receive continuing medical education"

Like other doctors in Hong Kong, estate doctors are not privileged as described by the Chinese term “豬籠入水”. Estate doctors, like other doctors, have the same and similar qualification registered in the Medical Council of Hong Kong. And like non-estate doctors, estate doctors are also keen on improving their medical knowledge through continuing medical education.