20 September 1997

Informed Choices crucial in relation to Private Medical Charges

(Keywords:- private sector, charges, insurance, informed choices)

          Of late, private medical fees have again been put under the microscope. This time the issue is brought to the public's attention by the Medical Insurance Association. The undertone, as expected, is that private medical fees are "unreasonably high". There are media reports too that compare private doctors' bills with room rates of top class hotels and airfares to Paris.

          Let us get two facts straight. Private medical bills are not synonymous with private doctors' charges. A sizable percentage of such bills go to cover private hospital charges -- special investigations, laboratory tests, room and drug charges, operating room charges, food charges, even food for visiting friends and relatives.

          Secondly, the medical insurance industry should be the last to "complain" because they have a definite conflict of interest. If a policy holder never gets sick, the industry pockets the whole premium. If the person falls sick, the industry gets less, inversely proportional to the medical bill. It is therefore to the industry's interest that medical bills are kept or controlled to the minimum.

          The comparison of medical fees with hotel rates and airfares is "childish" to say the least. In paying for medical bills, the person is paying for a devoted specialized professional service -- a service that takes years of intense training to acquire, a service that requires a life time continuous medical education to retain. Furthermore, it is a personalized service during which time the professional is wholly devoted to that patient and that patient alone -- a service that cannot go wrong, at the expense of the patient's health or even life.

          On the other hand, the cost of a flight can be kept minimal mainly via "cheaper by the dozen" -- hundreds of people on a Jumbo Jet at the same time. There is no comparison, nor could there ever be any, when professional services are concern.

          There are others who compare privates medical bills of Hong Kong with other countries. Such comparison is ironic. Cost of everything differs from country to country -- land cost, office rentals, staff salary etc are so widely varied from one part of the world to another -- rendering any such comparison meaningless.

          The fact remains that health care cost with modern technology is expensive. It is a commonly acknowledged fact worldwide that health care cost has always increased at a rate above the usual cost of living. Yet, strange enough, few of the Hong Kong public are aware of such. I was recently accosted by a member of the public to push for private hospitals charges to be in par with, or at least close to, public hospitals -- "somewhere around $68 a day" was his suggestion. He was obviously ignorant that $68 a day is the result of some 97% subsidy from public coffer of which private medical institutes have no right to tap.

          What about "scaled" charges or "controlled" charges for private practitioners? The answer must be in the negative. It is against the principle of free enterprise, free market economy on which basis Hong Kong's success depends. If a doctor is genuinely overcharging, he/she will lose his/her popularity and patients. After all, private doctors, generalists and specialists alike, are in abundance in Hong Kong.

          Furthermore, the public medical service which provides the highest standard of medical is an ever available "safety net" and no person could claim being "held to ransom" by the private health care sector.

          Perhaps the most important issue to take on board in relation to private medical charges is that patients must be properly made aware not only of the charges, but also the options available for them before proceeding with treatment by the providers and the institutions, so as to enable them to make diligent "informed choices". This is plain fair -- it is as much a patients' rights and doctors' responsibility. This the medical profession has been for years actively promoting, but it can never be enough!

(Hongkong Standard)