4 March 2000

Government, Patients and Medical Profession 
should all alert of the harms of HMOs

(Keywords: HMO, profiteering, middle man, mishaps)

          Once again, the downside or harm of Health Maintenance Organisations (HMOs) has hit newspaper front pages. This should come as no surprise.

          HMO was an invention of the United States some quarter of a century ago. It mushroomed initially under the belief that it is the saviour of rising health care cost, only to shrivel as problems after problems surface. The harmful effects are obvious. In its country of origin, some 14% Gross Domestic Product are spent on health care. Yet, some 40 million Americans are still without health care coverage.

          During these 25 years in the States, countless patients have not received the best of medical care that they expected; countless doctors have their professional rights to properly treat their patients usurped. Examples abound and a continuous flow appear in the internet. Yet during these times, countless HMO chief executives are acquiring their private jets and ocean couriers. It has been said that these chief executives are amongst the highest paid in the States.

          What is the logistics? In the usual circumstances, when a patient pays a doctor, he/she obtains that degree of quantifiable service. In the case of the HMO, a profiteering business-oriented middle man, the amount paid ends up in at best a three-way split: to the chief executive or management of the HMO, the shareholders of the organisation, and the serving doctor.

          To the medical practitioners, there is another hardship. HMO functions on a fixed contribution by the client and pledge a "total" medical care during a designated period. In short, the less spent on medical care for that client, the more will be the profit for the HMO. High-tech, effective, but costly investigations are therefore seldom allowed. Yet, when things get wrong, the doctor has to bear the responsibilities. With one hand tied most of the time, the service provider has to face the brunt of possible medical mishaps, when the profiteering HMO gets away Scot free.

          Regrettably, Hong Kong has not taken stock of other people's blunders. Instead, with the usual belief that everything in the West is glittery good, and with the fear of escalating health care cost during our economic downturn, big corporations and individuals are lured by the tinted belief that HMOs can and will cap the health care cost. HMOs thus not only set foot in Hong Kong but begin to flourish.

          The sad issue is that to many human resources personnel of major organisations, cutting health care budget becomes their priority concern with no due consideration that it could be at the expenses of denigrating health care standards for their employees.

          The recent revelation of the saga of one HMO in Hong Kong hopefully will wake up our corporations, our Government and our medical profession in the deleterious effects of these profiteering bodies disguised as health corporations before it becomes all too late.

          The harm is blatant. The client pays $180 and the doctor gets $90. The rest goes to fatten the middle man. In this case, the doctors suffer more. Not only do they have to provide the best of care at a cut-throat price, even the meagre earnings are not due to them. It is estimated that some $9 million are owed by the HMO to the various serving providers.

          What can we do? As a start, our corporations should take up their health care policies with their eyes open. For whilst budget is always an issue, a good employer has a responsibility to provide the best health care for its employees. The ever increasing reports on the harm of HMOs in the States should never be forgotten.

          Evidence shows that our neighbour, Malaysia, has been for some time conscious of the harm of HMOs. Whilst that government realise they cannot legislate to stop a business venture, it has specified in law that any such profiteering bodies cannot control doctors' professional autonomy in exercising his/her expertise in serving patients. Our government should take heed of this direction.

          The medical profession should not be complacent either. There is no reason why the some 3,000 plus private practising doctors could not form their own non-profiteering HMO to provide comprehensive service. Every cent paid in by the client will be used back to provide the necessary service. The doctors, now directors of this body, will derive their income from the service rendered.

          This idea has been floated out a few times before, only to be a victim of internal political bickering of the medical profession. It is high time for the profession to be united and take this issue up conscientiously before it is too late!

(Hongkong Standard)