24 April 1999

Medical Profession cannot wait to initiate improvements
for our system and our profession

(keywords: Harvard Report, private sector, standard, accountability, charges, Ombudsman)

          The Harvard Report on health care reform has focus not only on future health care financing suggestions, but also made some substantial remarks which the consultant believed are the "weaknesses" of our health care system of today.

          Much criticisms have been levied to the private sector, in particular the lack of transparency and accountability of private hospitals and private practitioners. Whilst many of these accusations are efforts of mudslinging at the medical profession, many are unfair or even erroneous, or taken out of context, the medical profession should have the courage to accept comments, make improvements where due, for the betterment of a service which few would not agree that it is already a very good one considered the total budgetary spending.

          It is said that private hospitals lack monitoring. Yet, the Director of Health is empowered by law to grant licence to hospitals, to set any conditions for licensing, and to inspect any such premises. In short, the law provides a regulatory framework for Government to monitor private hospitals. Regrettably, this has never been taken seriously. Books of private hospitals are checked by officials of the Department on a yearly basis on a pre-arranged date over a cup of tea, glancing over the hospital's annual report. No standard setting has ever been leveled on private hospitals for compliance as a requisite for renewal of license.

          In 1989, such a call was made by the then Medical Development Advisory Committee. Nothing concrete has ever been forthcoming. Now 10 years down the road, the standardisation guidelines are yet to be in sight. It therefore comes as no surprise that there are calls for requesting private hospitals to undergo independent accreditation system. Such may well be the long term goal. Yet there is no reason why, as an interim, that a set of standard guidelines could not be forthcoming from the registrar of private hospitals to ensure that each hospital will provide a minimal quality of care, a baseline set of facilities and an acceptable level of accountability.

          Much criticism has also been raised on hospital charges. Yes, in a free market, there should not be any control of charges the basic hospital fees nor whatever items that are being used be they disposable or otherwise. Yet it would do the hospitals much good to produce a charge list for patients' information when they check into hospitals even if it is only for public relations exercise.

          The Harvard Report has been critical of the variation of standards amongst medical practitioners, in particular those in private practice. Whilst such is unavoidable in a 10,000 strong profession, there should be a mechanism to assure the public that all registered doctors are at least up to a minimal set of standards. It makes a lot of sense that each and every practitioners be required to attend compulsory Continued Medical Education for being eligible to have their practising certificate renewed over a period of time, say three years.

          Much has been levied on the lack of monitoring mechanism of the medical profession. There is suggestion to set up an Ombudsman to monitor the medical profession. The current Medical Council is such a body set up by statue where one of its main function is to deal with professional misconduct or incompetence. It has non medical members who must be present during disciplinary hearings. Furthermore, the Council conducts its hearings in public. If this Council is deemed not to have adequately performed its duty, improve it, alter it by law or otherwise if needed. But to set up another separate body borders on redundancy.

          Perhaps the Medical Council should consider streamlining its reporting procedure to project a more "user friendly" attitude to the public.

          There were many incidences where a culprit of medical misconduct is obviously in variance to the professional code of practice. Yet these doctors often failed conviction through a point of law, simply because they have "heavy weight" legal representation.

          Often times too, such convictions were made at the Medical Council for rampant violation of professional code of practice have been squashed at the high court over a point of law again to the disappointment of the profession. For a more effective prosecution procedure to assure the public that the Medical Council is a body with teeth and is eager to annihilate the blacksheep, it should be served by a few permanent full time legal experts. The good name of the medical profession is at stake!

(Hongkong Standard)