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13
November 1999
Measures
need to prevent estate clinics being dominated
by
Health Maintenance Organisations
(Keywords:-
estate clinics, EDA, HMO, monopoly, standard)
The recent announcement of the Housing Authority to change
the three-decade-old practice of clinic sites allocation mechanism
in public housing estates has inevitably aroused much concern.
At present, such vacant clinic sites are allocated to
nominees by the Estate Doctors¡¦ Association (EDA), who are
selected via a ballot. The rents of such clinics are still set at market
rate assessed by the Authority, which adheres to the ratio of one
clinic serving 7,500 to 10,000 population.
Such mechanism has been important in ensuring proper care for
public estates population, especially in the earlier days when there
was severe shortage of doctors, and the estates were located in
¡§no man¡¦s land¡¨, hardly accessible by transportation. The
efforts of EDA, Estate Dentists Group and the selfless spirit of the
many estate doctors and dentists deserve due commendation.
Yet, with the change of time, the pattern of societal demand
for health care has gradually changed. Gone are the days when
patients living in estates had little choice of medical services.
Gone are the days when the public cast little doubt on the operation
of public bodies.
Today, public estates tenants need not stick to the doctors
in their own estates. They can easily visit doctors just across the
street of their estates. Furthermore, they always have the
alternative of seeking service from much cheaper public general
out-patient clinics, or even the free of charge emergency
departments at public hospitals.
With half of Hong Kong population living in public estates,
estate clinics certainly still have their roles to play. Yet, a
transformation to cope with societal needs deserve consideration.
For example, could there be measures to ensure tenants that health
care is available during public holidays via, say, rotation of
service by doctors of the same estate? Could poly-clinics, with
different specialties be set up, to cope with the public¡¦s
increasing demand for specialised medicine?
In observing free market principle, and amidst increasing
supply of doctors and dentists, the decision of the Housing
Authority to put up all clinic sites in public estates for open
tendering, in the same way as any other commercial tenants, is
perhaps a forgone conclusion. Yet, certain aspects have to be
further considered in detail in order to ensure protection of public
benefit.
There should be measures to protect the estate tenants from
being exploited by profiteering Health Maintenance Organisations
(HMOs). Such organisations operate on a pre-paid capitation basis,
under which the clients pre-pay a fixed amount so that they could
have unlimited medical consultation and treatment during the set
period. The idea sounds really attractive, but only at the surface.
In order to make the maximum profit out of the pre-paid amount, HMO executives would have to eliminate expensive
medicines, investigative or even treatment procedures. The patients,
therefore, eventually suffer most; the doctors and dentists
concerned face the responsibility; yet the HMO executives and
shareholders reap the profit.
The public in the United States, the birthplace and the land
of rampant HMOs, also fancied them in the 80s. Now there are surging
litigations against their practice, and many states are working out
laws to restrict their operation. We should never inherent other¡¦s
failure.
To prevent future clinic sites in public estates being
monopolised by HMOs, which have strong financial muscle to dominate
the open tendering system, the authorities should stipulate that
only individual doctors and dentists could bid the tender. Also,
those succeeded must operate the clinics on their own, and are not
allowed to transfer the tenancy or operation responsibility.
Only with this mechanism could we ensure a real fair play in
the health care market for the public¡¦s benefit.
(Hongkong Standard)
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