The Society of Physicians of Hong Kong
55th Anniversary Dinner
4 December 2011

Speech by Dr. C. H. Leong

Private Medical Practise in Hong Kong — Past, Present and Future
Dr. Paul Lam, Colleagues, Honourable guests, ladies and gentleman:

      Let me begin by thanking you for the honour to address this august gathering of medical minds.  It is an even bigger honour for me — A surgeon being invited to address the physicians.  Tonight I am addressing you not as a surgeon to physicians but rather as a brotherhood of the medical profession.
     
      In thanking you, let me congratulate you on your 55th Anniversary.  Let me also congratulate you forefathers for the vision to initiate and develop the Society to promote health care standards and to serve the people of Hong Kong with your specialist expertize in these many years.

      In exactly 1 week’s time there will be an election to place 1200 people in the Election Committee to elect the future Chief Executive. 30 of them will come from the doctors and dentists, totally almost 3%.  Not a small number indeed, and 83 of our colleagues will be competing for the 30 seats.

      If you have a chance to read their so called “election platforms”, you will find that, rightly so, they would be talking about manpower problems in the public health care services, they would be talking about importation of overseas doctors, they would be calling for the resignation of the Chairman of the HA.  Most of their requests pertain to the “public health care services”.

      But do not forget, HK’s medical service is based on 2 parallel systems — a pubic medical service and a private medical service.  While they check and balance one another, they also complement one another.  Yet somehow, private medical practise seemed to take a lesser role in our political scene.  Since most of our audience tonight are specialist in the private field, I thought I would say a few words on private medical practice in HK — its past, its present and what do I see of the future — in particular private practise in Private Hospitals.

The Past

      It would be of interest to you that for some 20 years, there had only been one “new” real private hospital — Union Hospital.

      In the past, most private hospitals are catered for those who could afford, the “rich and famous” usually only for “ bread and butter’ medical problems.  That is why ¾i©M was called even up to today, a “Sanatorium”.  Anything urgent was referred back to the public hospitals.

      Private Hospitals then depend on doctors who utilize these hospitals — visiting doctors.  In short, doctors bring in patients and thus bring in business.  It was therefore then “private doctors’ market”, they, private practitioners call the shots.
      If you are of a private consultants status, you are on the top of the world.

      There was no problem with “admission rights”, you are wanted as a “ solo practitioner” in every private hospital.  There was no problem in getting hospital beds, let alone for the surgical discipline operating time. Those were the “golden days” of the solo specialist practitioner.

      In the mid eighties, situation started to change.  Doctors in the pubic services are dissatisfied with then Medical and Health Department.  Many in the senior ranks —  specialists, perhaps even with special skills — resign and leave for private practice.  Private hospitals began to take on services for major illnesses.

      The beginning of the 90’s saw a further change.  With the establishment of the Hospital Authority, public hospitals began to provide better medical services.  Furthermore, improve in terms of services for doctors means less leaving for the private sector.  Overnight private hospitals feel the pinch.  Many patients whom otherwise shun public hospitals because of their poor services, long waiting time, poor hospital environment,  are now moving back into the public sectors which is “affordable” and “cheap”.

      Private hospitals were awaked by fact that they need to improve to compete.  Overnight, every private hospital started to redevelop — new wings, total ward refurbishment, buying  new and up to date equipments and machines, opening up new services, in particular specialist services, etc, utilizing the specialists who left the public services not too long ago.  The war began for the 2 sectors, public and private, to compete for patients.

The Present

      The management of the Private Hospitals now woke up to the fact they are getting themselves a bad deal.  They remodel the hospitals, better equip the hospitals only for the benefit of the “visiting doctors”.  In short, the hospitals have NO way to take a percentage of the doctors’ charge, although the apparent improvement in services rendered by the doctors were entirely due to the upgrading of the hospitals services and facilities.

      Secondly, while hospitals do control the admission rights of doctors, once a doctor is given the admission right, that hospital could do very little to control that doctor’s standards or modes of practise.

      Private Hospitals gradually moved into a new “modus operandi”.  Taking the advantages of a new wave of exodus of young specialists from the pubic hospital after SARS, each private hospital start to establish their in-house specialist teams.  While each hospital could have a different term of services with their in house specialists, I presume, most in house specialists would be offered a basic salary by the hospital, any charges on patients will be shared between the hospitals and the specialists.  Those specialists are not visiting consultants, but employees of that hospital.

      While, in the past, a patient appearing in the outpatients will be admitted under a visiting consultant and the fee charged by the doctors will be that of the doctor, today such a patient say a patient with acute appendicitis will be admitted under one member of the surgical in house team, and a percentage of that surgical fee charge will go to the hospital.

      Private hospital slowly shed their dependence on visiting doctors. 

      Further challenges occur — as economy of HK improve, more and more patients move to the service of private hospitals, luring more and more doctors to leave the public sector, there will be more and more doctors veying for admission rights to private hospitals.  As technology advance and demand of patients increases, few doctors want to be jack of all trades, referrals become more blatant and team work become the rule rather than the exception.

      All these means that

• Group practices becomes the norm;
• Private Hospitals now call the shots.  It becomes the “Hospitals’ Market”.

In short, the golden days of “a private solo specialist practitioner’ are on the way out.

      Let me hasten to add that while I have painted a rather gloomy picture to solo practitioners, and I am one of them, the situation may benefit the private health care services in total.  Today, medical care is based on team work and there is very little room for self heroism.  Secondly, with specialists employed by the hospitals, they are now under that hospitals’ control, to a certain extent, standards could be better assured for the betterment of the public.

The future

      We have all heard that Government has plans for the development of 4 private hospitals and in each of these hospitals, a guarantee percentage of “low charge” beds will be imposed as a tendering criteria. We have also heard that this government is pushing hard to introduce the “Voluntary Insurance Scheme”.

      Both these more means, the government will be pushing for “medical packages”.

      There could also be an “Authority” under the government to manage the issue. 

      I have no crystal ball to gaze into how the whole concept will work, but 2 issues are obvious.

      Since each hospital will need to provide certain percentage of low charge beds, each hospital will utilize their in house specialists team to absorb patients that utilize the “medical package”.

      Secondly, the Authority could well take on the function of an HMO in controlling what can be done and what cannot be done to control cost.

      Colleagues, ladies and gentlemen, in the last 20 minutes or so, I have travel with you over the journey of private medical practise in HK, its up and its downs.  I have also portrait some of the future where I believe is unavoidable giving the rapid rising cost of health care and demand of our patients.  Be that as it may one thing we as doctors, as physicians must stand unperturbed — in no way must the autonomy of practsing our profession be eroded for the sake of administrative, political or financial expediency.  Autonomy in the practise of our profession has nothing to do with professional protectionism, nothing to do with the private practitioners incomes, but it is the only way to provide the best of care to our patients that they deserve, in public or in private sectors.

      I look forward to the 30 members of our medical subsector Election Committee to instill on our future Chief Executive this very important message.