16 January 1999

Smearing tactics offer no help in healing our ailed health care system

(keywords:- Harvard Report, smear, private sector, charges, monitoring)

          The purported "leaked" report of the Government's consultant on health care financing has adorned our newspapers recently -- not just once but in succession, often given the prominence coverage. How genuine are the "leaked" informations? Who initiated the leakage? Time will tell. The Health and Welfare Bureau has repeatedly indicated that it is not the "culprit". Yet, there is no smoke without fire.

          In any case, such piecemeal informations with possible exaggeration and other inputs by the media have produced unnecessary concern, worry, frustration and much uncalled-for smear.

          The public become concerned of when and for whom will the heavy subsidized public health care be taken away. Both employers and employees are worried how much contribution they have to put in for their health on top of the already determined Mandatory Provident Fund. The health care profession are concerned that their professional autonomy, the way they practise medicine could be controlled by a "central funding body" that holds the purse and acts as an agent, with doubtful professional support, to buy health care services for the public.

          The Hospital Authority is worried not only that it might be disbanded but that the suggested 10 to 12 regional bodies, which in essence are multiple "mini hospital authorities", will duplicate effort. Worse there will be no "one standard control". Even the insurance industry is concerned in relation to their future role, or lack of it, in financing health care.

          The situation is very much akin to the golden fable of a group of blind men feeling up an elephant and try to describe what an elephant is. The only way to dispel all these misconceptions and frustrations is to put a stop to speculations through release of the full report and Government's approaches to the document.

          A quick scan through the media reports indicated the consultant's document has sizable section devoted to criticise the medical profession -- having a high income, varied standards, lacking discipline and working in close shop. Criticisms should always be welcome as they could bring on improvement. Yet most of such accusations, as reported, was uncalled-for, not basing on facts and belied common sense.

          To condemn a doctor for having a high income is against the principles of free economic as his/her emolument could well be related to hard work through protracted long hours, often time 10 to 12 hours per day compared with the usual eight. Yes, some doctors may ask for a high fee. Yet this is a free market where patients have a choice to seek another provider and where Government provides an equally high standard safety net at going away price. The crux of the matter is that patients must be informed beforehand the expected fees for them to make their decisions and choices.

          Since the Academy of Medicine was established and a specialist registry instigated, doctors practising as specialists are requested to have compulsory career long education, lest their names would be struck off. This scheme is being introduced to all practising doctors on an education basis.

          No doctors can work in a close shop nor has the Government handed over all their monitoring and controlling mechanism to the profession through a system of "benign neglect". The Medical Council, which discipline the profession, is at least 50% controlled by Government through its appointed members including representatives of the general public. The Hospital Authority is in charge of all the standards of public hospitals and staff, and it is accountable to the Government.

          Private medical institutes are within the monitoring remit of the Department of Health through issuing of licences. For years, some medical professionals have called for the Department to issue guidelines for standards of private medical institutes and to police their implementation. Regrettably, since 1990, nothing active has been done. Instead, Government still relies on a yearly hospital social visit and a copy of the hospital's annual report as their vetting yardstick.

          If the purpose of the Government's consultant or the Government's brief to the consultant is to smear the medical profession and apportion the doctors all the blame to the projected ailing health care system, then the move is downright amoral. Let us do not forget it is the medical profession who has pointed out that the system of using a finite budget to provide infinite needs will soon face a fiasco. It is the medical profession who has consistently and persistently call onto Government to do a total health care revamp -- something 25 years too late!

(Hongkong Standard)