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 was:

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. 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. 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.

(3) “Allocation of estate clinics are not supervised”

The allocation of estate clinics have all along been supervised by HKHA and even the ICAC.

新�h西醫協會，香港牙醫學會及公共屋�h牙醫事務組聯合新聞公告

新�h西醫協會，香港牙醫學會及公共屋�h牙醫事務組就香港房委會最近以來一直不聽取民意、一意孤行、嚴重漠視公屋居民的醫療服務質素而繼續堅持以公開投標 (Open Tender) 價高者得的政策去分配公共屋�h診所表示極度失望！

我們在此重申，醫療服務畢竟是一個支持整體民生、福利、社會的安定與繁榮的一個非常重要的環節。如果香港特區政府粗暴地將醫療服務定位為一種純商品是非常危險的，是對大家沒有一點好處。

在一九九九年十一月廿二日，我們以新聞發佈會公報如下：

1. 香港大學社會科學研究中心在一九九九年十一月五日及八日進行“市民對屋�h醫生的意見調查”後指出：(1) 大部份公屋居民對現時屋�h醫生服務滿意。(2) 大部份公屋居民都反對公開投標價高者得去出租屋�h診所。
2. 新�h西醫協會在一九九九年七月對1,524名會員醫生（包括467名在公立機構服務的醫生及1,057名私人執業醫生）作記名調查，所得結果是超過九成一以上皆反對公開投標價高者得去出租公屋診所。

為�茈H更廣泛及全面地去諮詢醫學界及市民意見，我們行內最近有以下行動及其結果如下：

由42位西醫及牙醫發起在一九九九年十二月向全港一萬多名註冊西醫及牙醫發出公開信作一個全面性的記名調查，以收集業界對屋�h診所分配方法的意見。結果有1,405 回信 (見附頁)；其中不乏大學教授，公私營醫院院長，公立醫院顧問醫生；其中八成五以上是非屋�h醫生。結論是超過九成一以上反對公開投標價高者得方法的分配屋�h診所，結果與新�h西醫協會內部調查相若，如非問題大有商榷之處，豈有此理！同業最擔心的問題亦是圍繞著以下幾點：-

1. 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。
2. 屋�h診所容易受財團壟斷，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。
3. 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。

他們亦認為增加診所數目不能夠解決以上種種問題！！

到今日為止，我們亦收到7,153名香港市民（包括公屋居民）的簽名表示強烈反對香港房屋委員會商業樓宇小組以公開投標價高者得的政策去分配公共屋�h診所。

我們覺得這麼多行內，行外的聲音，是不容忽視的。房委會理應更加以本�茠A務大眾市民的方針勇敢地再拿出分配公共屋�h診所的政策讓大家討論，不能夠閉門造車了！

根據以上最新資料，經過反覆討論，我們本�荂G

1. 堅定醫療服務不是一個純商品；
2. 維持醫療服務是�茩奕s貫性；
3. 維繫一向以來最重要的市民與醫生的關係；
4. 打擊牟利商營醫療服務組織，例如：HMOs的擴張去直接影響醫療質素。

堅決強烈要求房委會以大局為重，以民意為依歸，不損房委會收入為三大前提下收回公開投標，價高者得去分配公屋診所。

我們要求一個真正公開、公平的抽籤 (Open Ballot) 方法，容許所有本港註冊的西醫及牙醫去參與分配公屋診所！我們在此重申，參加抽籤的西醫及牙醫不需要是任何醫學組織的成員。

對於未來公屋診所的安排，我們有以下共識，要求房委會接納：

1. 所有公屋診所租約是以西醫或牙醫以個人名義與房委會簽訂；
2. 公屋診所西醫或牙醫不能分租給其他人士以作任何用途；
3. 房委會應該參考我們管理屋�h西醫及牙醫的附例及多年來管理的經驗以釐定機制去監管將來公屋診所的運作，使到公屋居民能夠享受到適當的醫療服務；
4. 設立一個獨立的屋�h診所租金上訴機制去處理診所租金的投訴事宜。

以下我們需要澄清有關傳媒誤導市民的言論：

1. 診所與人口比例

一直以來是房署訂定的。至於有人主張將比例開放，我們無任歡迎。我們希望每個香港市民在醫療服務範圍內得到同等待遇。

2. 公屋診所醫生不進取

屋�h醫生和其他醫生一樣不是“豬籠入水”的；資歷亦是一樣，沒有分別；對提高醫學知識及醫療質素亦不遑多讓；請不要亂扣帽子。

3. 分配公屋診所沒監管