November
& December 1999
Correspondences
on Estate Clinic Allocation
Letter
from Dr C H Leong to Mr Anthony Miller,
Director
of Housing on 8 Nov 1999
Dear
Tony,
It was nice
having lunch with you and exchange views on 2 November 1999.
I was given to
understand that the Housing Authority has decided to open all
housing estate clinic sites to open tendering, as announced in the
news today.
I would like to
stress my main concern as I conveyed to you over lunch. Should open
tendering be adopted, it should be extended to individual doctors
and dentists. The successful doctor/ dentist must be the person
running the clinic. This is to prevent business consortiums (be they
run by medical and dental practitioners or wives) to monopolise all
housing estate clinics and contract them out to doctors and dentists
at a cut-throat price (similar to the practice
of Health Maintenance Organisations -- HMOs -- in the United
States).
I cannot stress
more strongly than to express the harm HMOs will bring to the
standard of health care service in the long term. A large portion of
fees paid by patients would be channelled to support the HMO
administration, its chief executive and share holders, instead of to
provide the health care services. Furthermore, most HMOs will put
unnecessary stringent restrictions on the use of expensive medicines
and investigations to maximise their gain.
In the long
term, the patients suffer by not getting the best and most
appropriate management, the doctors or dentists will have to bear
the responsibility, and the HMOs run away with the profit.
Twenty five
years ago, HMOs started in the United States. Today, they are
suffering from the consequences. Many states in the United States
are now establishing laws to restrict the practice of HMOs. Hong
Kong should not suffer from other people’s bad experience.
I hope the
Housing Authority will look into the matter.
Yours sincerely,
(signed)
C H Leong
c.c.
Dr the Hon Rosanna Wong, JP, Chairman,
Hong
Kong Housing Authority
The
Hon Ng Leung Sing, Chairman, Commercial Properties
Committee,
Hong Kong Housing Authority
Dr Yeung Chiu Fat,
Chairman, Estate Doctors’ Association
Dr
So Kai Ming, President, Hong Kong Medical Association
Letter
from Dr C H Leong to Mr Anthony Miller,
Director
of Housing on 15 Dec 1999
Dear
Tony,
I was given to
understand that the Housing Authority will initiate new procedures
in the allocation of clinics for doctors and dentists in housing
estates in January of the new millennium.
I was also
given to understand that whilst the whole revisit of the said
allocation procedure was initiated, at least in part, by the
announcement of investigatory action of the Ombudsman, that
investigatory process has not yet been completed. As such, it would
be more meaningful to await the report of the Ombudsman and take
into consideration its recommendations before finalising possible
new allocation procedures, if necessary.
Needless to
say, the Housing Authority does not need to abide by the
recommendations of the Ombudsman, if any. Yet, it would make it a
farce of the Ombudsman investigations if actions are already taken
even before the investigations are completed.
I look forward
to your response.
Yours sincerely,
(signed)
C
H Leong
c.c.
Dr the Hon Rosanna Wong, JP, Chairman, Housing Authority
The
Hon Ng Leung Sing, Chairman, Commercial Properties
Committee, Housing Authority
Hong Kong Medical
Association
Hong
Kong Dental Association
Estate
Doctors Association
Estate
Dentists Group
Practising
Estate Doctors Association
The
Association of Licentiates of Medical Council of Hong Kong
Letter
from Dr C H Leong to Estate Doctors Association
on
15 Dec 1999
Dear
Dr Yeung,
Thank you for
the kind invitation to attend tomorrow’s press conference
pertaining to the survey on possible new allocation procedures for
clinic sites for doctors and dentists in public housing estates. I
apologise that I will not be able to attend due to previously
arranged meetings. Nevertheless, I am forwarding to you and
colleagues my stand on the issue. Hopefully it will lend support to
the profession’s request for a procedure that is in the best
interest of the public, yet fair and equitable to the health care
providers.
1.
Clinic sites should only be allocated to individual registered
medical / dental practitioners. It should be stipulated that the
successful candidate must be the person practising in the clinic.
This is to prevent business consortium monopolizing all housing
estate clinics and contract them out to doctors and dentists at cut
throat prices (similar to the practice of Health Maintenance
Organisations, HMOs, in the United States). The harm of HMO as
witnessed in the US can never be too strongly emphasised.
2.
Allocation exercises should be open to all registered medical
/ dental practitioners in Hong Kong (except those already allocated
other estate clinic sites) with no requirement on affiliation to any
organisations.
3.
Choice of Open Ballot / Open Tender
Open tender, as expected, will lead to competition.
Regrettably the competition will not be on quality and standard of
service, which will be beneficial to patients. Instead the
competition will in effect be a commercial competition in rent which
will ultimately be translated into charges to patients -- to their
disadvantage. In the end, the Housing Authority could possibly
benefit by increasing its coffer at the expense of hardship onto
both the patients and the service providers.
Open ballot caps the rental level. Service providers will
still be able to operate at a modest fees affordable to the
estates’ public.
On balance, open ballot is a better choice.
4.
Timing and decision of the Housing Authority
The move to revisit the allocation procedures after some 30
years with no hitch was, at least in part, motivated by the
announcement of the Ombudsman to investigate. The Office of the
Ombudsman has not even completed its investigation, not to say
producing its report. The Housing Authority should delay from making
any decision on changing the allocation method, let alone
implementing it, until the Ombudsman’s report is made available.
Any “Pearl Harbour” activity by the Housing Authority will not
only make it a farce of the Ombudsman investigation, but is also
unfair to the public and service providers as the possible
recommendations of the Ombudsman would not have been taken into
consideration.
I will be
grateful if you could make my stand available to the media.
Yours sincerely,
(signed)
C H
Leong
c.c.
Hong Kong Medical Association
Hong
Kong Dental Association
Practising
Estate Doctors Association
The
Association of Licentiates of Medical Council of Hong Kong
Estate
Dentists Group
一九九九年十二月十六日
(新聞稿)
公共屋村診所分配政策
得悉數個醫學團體今日就屋村診所分配政策問題舉行記者會，茲將本人立場陳述如下：-
| (一) |
公共屋村診所應祇分配予個別註冊醫生或牙醫，獲分配者必須親自於該診所執業。此舉乃為防止財團壟斷屋村診所後以割喉式價格外判予醫生或牙醫，做法一如美國甚流行的牟利式「保健組織」
(Health
Maintenance Organization, HMO) 般，美國經驗顯示，不少HMO為求牟利，不惜犧牲病人應有的診斷或治療，因而亦嚴重影響醫生與病人的關係。
|
| (二) |
任何註冊醫生或牙醫(除已獲分配公共屋村診所者以外)，均可參與診所分配，毋須先加入任何組織。
|
| (三) |
公開投標抑或公開抽籤？
公開投標祇會引入商業性的租值競爭，而非服務質素與水準的競爭，在價高者
得下，成本最終自然會轉嫁病者收費之上。
公開抽籤則先釐定固定租值，免卻投標推高價錢之弊，中籤的醫生或牙醫因而較能為公共屋村居民提供可負擔的服務。兩者相比之下，公開抽籤乃較佳選擇。
|
| (四) |
房委會檢討公共屋村診所分配程序，申訴專員較早前公佈就此展開調查乃原因之一，然而，申訴專員的調查尚未完成，房委會已決定改變行之三十年的分配程序，並於下月推行新方案，這樣當然無法兼顧申訴專員可能提出的改善建議，更有漠視申訴專員調查之嫌，對醫療服務提供者及公共屋村住戶均欠公平。 |
|
