22.11.1999

Press statement of Estate Doctors Association

Estate Doctors Association representing 1,524 doctors in private and public service inside and outside public housing estates objects strongly to the suggestion of the Commercial Properties Committee of the Housing Authority (HA) to change the method of estate clinic allocation from the present balloting system to an Open Tender system. This decision to change was not done with any proper consultation of public housing estates residents, all concerned doctor groups and political parties.

In 1966 when the Government needed registered doctors to cater for the health care of people in resettlement areas and later housing estates, she requested the help of the Medical Profession to form a doctors' group with its own code of rules and regulations to allocate clinics among its doctor members. This led to the formation of Estates Doctors Association (EDA). EDA has fulfilled her function as a pair of helping hands for the HA, acting as a bridge of communication between HA and estate doctors, to vet applicants' qualification and eligibility, approve and nominate applicants to the HA, and to give professional advice to HA regarding multidisciplinary services provision. So far the relationship between HA and EDA has been cordial and the functioning has been smooth and good.

Recently EDA has been attacked with groundless and unfair accusations by mass media, certain doctors and commercial entities pressing the HA to change. But there is no valid reason for change. It only serves to appease unfounded criticisms and benefit prosperous Health Maintenance Organisations (HMOs). In fact, there is rarely any complaint from public estate residents on medical service provided by private doctors in public housing estates.

We have asked the HA to solicit opinion from the whole territory. We have the results of a survey of public housing estate residents' opinion of estate clinic doctors with conclusions made by the Social Sciences Research Centre of The University of Hong Kong. We believe the government should hear people's voices.

The results of survey made by the Social Sciences Research Centre of The University of Hong Kong is enclosed in the Appendix.

The followings are the conclusions from the survey made by the Social Sciences Research Centre of The University of Hong Kong :-

The majority of the Public Housing Estate residents have indicated that:-

  1. they are satisfied with the service of the estate doctors;
  2. they are worried about the rise in medical charges that will result from higher operational cost with an Open Tender system;
  3. they object to the suggested Open Tender system for allocation of estate clinics;
  4. they prefer the continuity of care with the same family doctor which occurs with the present system.

Should the Open Tender system be enforced without binding the tenant doctor to be actually providing the service as is being done with EDA's present rules and regulations under the balloting system, there would be a frequent change of attending doctors either as employees or under hand deals. This chaotic situation which is harmful to patients will allow powerful medical contract groups and rich HMOs to dominate medical services and manipulate charges. Then there is real MONOPOLY.

The harmful effects of HMOs is illustrated by the discontent of patients, doctors and politicians alike in USA and Australia, where HMOs have openly interfered with doctors' decision in investigations and medical treatment with the ultimate aim to maximize HMOs profits. Should Hong Kong also become slave to these rich and powerful financial investors and sacrifice the health of the citizens?

EDA has conducted a named referendum among our 1,524 member doctors (1,057 in private practice and 467 in public service) in July 1999. Over 90% is against Open Tender System and supports balloting.

Our other reasons for objecting open tender are:

1) Since tender means going to the highest bidder, clinics' operational costs are most likely to rise and in spite of how efficient the tenant doctor/dentist is, he will be forced to raise patient charges in order to make ends meet. Despite some belief to the contrary about spending power of estate residents, we believe all along there has been a valid reason by the Housing Authority to cater for the less well off and assist the estate doctors by keeping clinic rental to as nearly just or below the market rental so that in fact there has always been a lower figure of doctor charges in the estates on the average compared to charges outside estates all through the past 33 years;

2) If one talks about fairness and equal opportunity, then consider the less well to do or young graduates without the means to compete with the more well off and well established doctors or doctors back up by HMOs;

3) Open Tender system poses an extremely high possibility of estate clinics being monopolised by large financially capable bodies such as HMOs or rich individuals or conglomerates. This situation would be extremely difficult to eliminate administratively;

4) If monopoly does occur, medical charges can be easily manipulated and the quality of health care can be jeopardised through restriction of treatment methods and investigations by HMOs which was proven in the USA and here;

5) Even if tender can be intentionally controlled by limiting to only individual doctors/dentists, there is NO guarantee that those doctors/dentists entering the Open Tender exercise will not be controlled by rich conglomerates or HMOs;

6) As a result of not willing to bind the successful tenderer to be the actual tenant and therefore change of hands be allowed under the table there will be :-

We cannot over emphasize the merits of the existing Ballot system by lots drawing which remains the most fair and, by being open to all doctors which has been advocated by our Association, will be even fairer still. Applicants are no longer required to enter any doctor association.

Other merits of our suggested Open Ballot system of allocation of estate clinics are :

1) Chances for successful ballot would be fair and equal to all doctors/dentists disregard of financial background;

2) With the present Ballot System, surveys performed by our Association showed lower medical charges in public estate doctors - at present showing 20% lower, as compared with outside doctors;

3) Decrease chance of corruption as advised by Independent Commission Against Corruption in 1991 when the ballot system was being reviewed by the Housing Authority together with EDA;

4) Protect patients' rights to receive optimal health care by protecting doctors' professional autonomy through freedom from control by HMOs;

5) Foster regulatory mechanism for utmost Patient-Doctor relationship to foster better continuous health care and to enhance the concept of family medicine;

By adopting the open tender method, HA has demonstrated that she is only here to make money, and fails to consider the interests of 3 million public housing estate residents and the resulting harmful effects on doctors' professional autonomy. We sincerely hope that the HA should solicit more opinions from the community before making such a drastic change in the method of public estate clinic allocation. We demand that any final decision should be based on our concern on the optimal health care for our citizens!

22.11.1999

新聞稿

本港有一半以上人口居住在公共屋h及居屋。公共屋h及居屋的醫療服務政策關係著香港300多萬人的民生與福利和社會的安定與繁榮,事關重要。

香港房委會商業樓宇小組委員會在沒有充分諮詢民意,特別是在公共屋h及居屋生活著的居民的意見,又沒有與在公共屋h提供醫療服務的醫生及其醫學團體充分商討及接納其所提出的合理建議,又沒有諮詢各政黨和團體的意見下,一意孤行地催毀了一貫以來33年行之有效,雖有些少不足,但卻易改善的政策,驀然訂下於明年一月一日開始實施以公開投標(Open Tender)價高者得的政策分配公共屋h診所。

本會堅決反對房委會商業樓宇小組委員會以公開投標,價高者得的政策分配公共屋h診所。並指出其弊端與錯誤如下:

(一)違背民意

本會委託獨立的具科學性及權威性之香港大學社會科學研究中心進行“市民對屋h醫生的意見調查”,結果顯示:

  1. 大部分公屋居民都對沿習以久的屋h醫生的服務表示滿意。
  2. 大部分公屋居民都認為以公開投標價高者得的方式去出租屋h診所給醫生勢將會使到診金增加。
  3. 大多數公屋居民反對公開投標價高者得去出租屋h診所給醫生。
  4. 大多數公屋居民希望像現時那樣得到長期固定熟悉了解他們的家庭醫生照顧,而不希望由財團投得屋h診所後,聘請醫生走馬燈式應診

這充分證明房委會商業樓宇小組委員會的決定(公開投標價高者得去出租診所)是違背民意的,現附該份報告供參考。

(二)不理會醫學團體與醫生反對

(三)價高者得,租金上漲,羊毛出在羊身上,診金相應增加,屋h居民百上加斤

財團以公開投標及借用醫生名義很容易投得某屋h的全部或大部份診所,造成壟斷,在無競爭的環境下,控制及提高某屋h診所的診金,令居民加重負擔。

(四)容易受財團壟斷,駐診醫生經常轉換,直接影響醫療質素和病人與醫生的關係

財團聘用的屋h醫生缺乏歸屬感,很可能在合約滿後另謀高就,或另起爐灶,居民要重新接受另一位接手的醫生,有違延續性醫療服務之原則,一個居民可能要經歷幾個不同家庭醫生。

(五)容易有私相授受,甚至會有炒賣情況出現,既無規定診所開診時間,而且沒有機制監管診所運所

本會三十三年以來,容許所有香港註冊西醫加入本會,以抽籤形式分配公共屋h診所,而有志於屋h工作的醫生,只需要每年支付本會行政費用港幣350元正。本會曾經建議用公開抽籤方法以代替公開投標,希望房署考慮,公開抽籤的好處如下:-
  1. 公開抽籤容許所有香港註冊西醫加入抽籤,而無規定是任何醫生組織的成員,使有志加入屋h服務的醫生不論財力大小都機會均等。
  2. 診金價錢,亦因房署既定的市值診所租金而相應減少,正如本會歷年做的調查所得結果顯示,屋h醫生的診金較非屋h醫生的診金便宜大約兩成。
  3. 由於屋h診所沒有被財團壟斷,各屋h醫生在公平競爭的環境下提供服務,質素有保證,診金由市場主導,這是市民之福。
  4. 房署與本會在一九九一年檢討屋h診所分配的時候,廉政公署指出抽籤方法會減少貪污問題出現的機會。
  5. 不容易受財團壟斷,使行醫者有其診所,專業自主得以保持。最終令到公共屋h居民染病時得到延續性及最妥當的醫治。
  6. 有機制監察醫生在屋h行醫,例如規定每日開診時間,亦可提升家庭醫學的理念。

房委會決定採用公開投標的方法分配屋h診所,缺乏任何有力之理據支持,既不能解決現存之問題,卻帶來不少後遺症,本會謹希望房委會充份諮詢屋h居民,有關團體及政黨對公共屋h診所公開投標的意見後,才作出一個對三方面 - 房委會作為大業主,醫生作為租客及醫療服務提供者,接受醫療服務的屋h居民 - 都滿意的決定。

Circular No. 1831, 28th December 1999

16.12.1999

Joint Press Statement of
Estate Doctors Association, Hong Kong Dental Association and Estate Dentists Group

Estate Doctors Association (EDA), Hong Kong Dental Association (HKDA) and Estate Dentists Group (EDG) express grave disappointment at the Hong Kong Housing Authority’s insistence on using the Open Tender method as a means of letting out public housing estate clinics, closing her ears to the voices of the people and seriously ignoring the quality of health care for the public housing estate residents.

We emphasize here that health care is an essential element in supporting the entire livelihood, welfare, stability and prosperity of the community. It is extremely dangerous and does not do anybody any good if the HKSAR crudely and violently categories health care services as a purely commercial commodity.

In a Press Statement of 22.11.1999 we have issued the following two points:-

  1. After a survey on citizens' opinion towards estate doctors in November 1999, the Social Sciences Research Centre of the University of Hong Kong pointed out that the majority of public housing estate residents are satisfied with their estate doctors and are unanimously against the open tender method in leasing out estate clinics.
  2. In July 1999, a named referendum by EDA of 1,524 doctor members (including 467 doctors in public service and 1,057 private practitioners) revealed that over 91% are against using an open tender method for letting public estate clinics.

In order to obtain a fairer and more comprehensive opinion from our professions and citizens, our professions undertook the following actions:-

In early December 1999, 42 doctors and dentists issued an open letter to the over ten thousand registered doctors and dentists in Hong Kong to obtain a comprehensive named survey to collect the professions’ opinion towards the method of letting estate clinics. The results were: -

There were 1,405 replies (Please see Appendix A). Among the respondents were a significant number of University professors, superintendents of public and private hospitals, consultants of public and private hospitals; over 85% are not estate doctors. The conclusion was that over 91% were against the open tender method as a means of letting estate clinics, a figure similar to that of EDA’s survey.

The problems that our colleagues are concerned most are the following:

  1. Since Open Tender means going to the highest bidder, clinics' operational costs are most likely to rise and in spite of how efficient the tenant doctor/dentist is, he will be forced to raise patient charges in order to make ends meet. If one talks about fairness and equal opportunity, then consider the less well to do or young graduates without the means to compete with the more well off and well established doctors or doctors backed up by Health Maintenance Organizations (HMOs);
  2. Open Tender System poses an extremely high possibility of estate clinics being monopolised by large financially capable bodies such as HMOs or rich individuals or conglomerates. If monopoly does occur, medical charges can be easily manipulated and the quality of health care can be jeopardised through restriction of treatment methods and investigations by HMOs which was proven in the USA and here. Even if tender can be intentionally controlled by limiting to only individual doctors/dentists, there is NO guarantee that those doctors/dentists entering the Open Tender exercise will not be controlled by rich conglomerates or HMOs.
  3. As a result of not willing to bind the successful tenderer to be the actual tenant and therefore change of hands be allowed under the table there will be :

They believe that opening up more clinics in public housing estates is not a solution to the above problems.

Again, we have received the signatures from 7,153 Hong Kong Citizens (including estate residents) expressing strong objection to the decision of the Commercial Properties Committee of the Hong Kong Housing Authority (HKHA) of using open tender method to allocate estate clinics.

We feel that HKHA should not ignore such strong voices and demand from within and without the medical and dental professions. She should bear in mind her policy of service to the community and once more pick up the courage to discuss with us all and stop pursuing impractical and unrealistic solutions!

With the latest information as mentioned above, after thorough study and debate and based on our:

  1. a. belief that health care is not a pure commercial commodity.
  2. belief to maintain continuous health care for the population.
  3. belief to maintain strong doctor-patient relationship.
  4. determination to fight against profiteering commercially owned health service merchants and organisations such as HMOs, the expansion of which adversely affects quality of health care in Hong Kong.

EDA and HKDA resolutely and forcefully demand the HKHA, for the good of Hong Kong as a whole, to adhere to the opinions of the people and without making HKHA losing one cent, to withdraw and rescind her decision of using open tender method for letting estate clinics.

We ask for a Genuine, Open and Fair Balloting System allowing local doctors and dentists to participate in allocation of estate clinics! We have to reiterate once more that such balloting system should be open to all registered medical and dental practitioners in Hong Kong with no requirement on affiliation to any organization.

Regarding the future arrangements of medical and dental clinics in the public housing estates, we have the following suggestions to HKHA:

  1. a Clinics in public housing estates should be allocated to individual doctors and dentists. The successful doctor/dentist must be the person running the clinic.
  2. Subletting or reassignment by the tenant should not be allowed.
  3. HKHA should take reference to our By-laws on Clinic Practice that have been used for many years to establish an effective control mechanism to monitor estate clinic practice and to supervise the running of future estate clinics so that the public estate residents can receive optimal health care.
  4. To establish an independent appeal mechanism for estate clinics' rentals to handle all rental complaints.

We would like to clarify the following misconception of the public:

(1) Estate Clinic to Population Ratio

This ratio has all along been suggested and determined by HKHA alone. Our two Associations welcome the suggestion of HKHA to reduce the ratio. Afterall, every Hong Kong Citizen should enjoy the same quality of health care delivered.

(2) "Estate doctors are reluctant to receive continuing medical education"

Like other doctors in Hong Kong, estate doctors are not privileged as described by the Chinese term “豬籠入水”. Estate doctors, like other doctors, have the same and similar qualification registered in the Medical Council of Hong Kong. And like non-estate doctors, estate doctors are also keen on improving their medical knowledge through continuing medical education.

(3) “Allocation of estate clinics are not supervised”

The allocation of estate clinics have all along been supervised by HKHA and even the ICAC.

16.12.1999

新h西醫協會,香港牙醫學會及公共屋h牙醫事務組
聯合新聞公告

新h西醫協會,香港牙醫學會及公共屋h牙醫事務組就香港房委會最近以來一直不聽取民意、一意孤行、嚴重漠視公屋居民的醫療服務質素而繼續堅持以公開投標 (Open Tender) 價高者得的政策去分配公共屋h診所表示極度失望

我們在此重申,醫療服務畢竟是一個支持整體民生、福利、社會的安定與繁榮的一個非常重要的環節。如果香港特區政府粗暴地將醫療服務定位為一種純商品是非常危險的,是對大家沒有一點好處。

在一九九九年十一月廿二日,我們以新聞發佈會公報如下:

  1. 香港大學社會科學研究中心在一九九九年十一月五日及八日進行“市民對屋h醫生的意見調查”後指出:(1) 大部份公屋居民對現時屋h醫生服務滿意。(2) 大部份公屋居民都反對公開投標價高者得去出租屋h診所。
  2. 新h西醫協會在一九九九年七月對1,524名會員醫生(包括467名在公立機構服務的醫生及1,057名私人執業醫生)作記名調查,所得結果是超過九成一以上皆反對公開投標價高者得去出租公屋診所。

為茈H更廣泛及全面地去諮詢醫學界及市民意見,我們行內最近有以下行動及其結果如下:

由42位西醫及牙醫發起在一九九九年十二月向全港一萬多名註冊西醫及牙醫發出公開信作一個全面性的記名調查,以收集業界對屋h診所分配方法的意見。結果有1,405 回信 (見附頁);其中不乏大學教授,公私營醫院院長,公立醫院顧問醫生;其中八成五以上是非屋h醫生。結論是超過九成一以上反對公開投標價高者得方法的分配屋h診所,結果與新h西醫協會內部調查相若,如非問題大有商榷之處,豈有此理!同業最擔心的問題亦是圍繞著以下幾點:

  1. 價高者得,租金上漲,羊毛出在羊身上,診金相應增加,屋h居民百上加斤。
  2. 屋h診所容易受財團壟斷,駐診醫生經常轉換,直接影響醫療質素和病人與醫生的關係。
  3. 容易有私相授受,甚至會有炒賣情況出現,既無規定診所開診時間,而且沒有機制監管診所運所。

他們亦認為增加診所數目不能夠解決以上種種問題!!

到今日為止,我們亦收到7,153名香港市民(包括公屋居民)的簽名表示強烈反對香港房屋委員會商業樓宇小組以公開投標價高者得的政策去分配公共屋h診所。

我們覺得這麼多行內,行外的聲音,是不容忽視的。房委會理應更加以本茠A務大眾市民的方針勇敢地再拿出分配公共屋h診所的政策讓大家討論,不能夠閉門造車了!

根據以上最新資料,經過反覆討論,我們本荂G

  1. 堅定醫療服務不是一個純商品;
  2. 維持醫療服務是茩奕s貫性;
  3. 維繫一向以來最重要的市民與醫生的關係;
  4. 打擊牟利商營醫療服務組織,例如HMOs的擴張去直接影響醫療質素。

堅決強烈要求房委會以大局為重,以民意為依歸,不損房委會收入為三大前提下收回公開投標,價高者得去分配公屋診所。

我們要求一個真正公開、公平的抽籤 (Open Ballot) 方法,容許所有本港註冊的西醫及牙醫去參與分配公屋診所!我們在此重申,參加抽籤的西醫及牙醫不需要是任何醫學組織的成員。

對於未來公屋診所的安排,我們有以下共識,要求房委會接納:

  1. 所有公屋診所租約是以西醫或牙醫以個人名義與房委會簽訂;
  2. 公屋診所西醫或牙醫不能分租給其他人士以作任何用途;
  3. 房委會應該參考我們管理屋h西醫及牙醫的附例及多年來管理的經驗以釐定機制去監管將來公屋診所的運作,使到公屋居民能夠享受到適當的醫療服務;
  4. 設立一個獨立的屋h診所租金上訴機制去處理診所租金的投訴事宜。

以下我們需要澄清有關傳媒誤導市民的言論: 

  1. 診所與人口比例 一直以來是房署訂定的。至於有人主張將比例開放,我們無任歡迎。我們希望每個香港市民在醫療服務範圍內得到同等待遇。 
  2. 公屋診所醫生不進取 屋h醫生和其他醫生一樣不是“豬籠入水”的;資歷亦是一樣,沒有分別;對提高醫學知識及醫療質素亦不遑多讓;請不要亂扣帽子。 
  3. 分配公屋診所沒監管分配公屋診所是一直以來受房屋署甚至廉政公署監督的,並非新h西醫協會或香港牙醫學會公共屋h牙醫事務組某個人說了算數。