February 25, 1998
Estate Doctors Association(EDA) has been established over 30 years in Hong Kong. The main objective of EDA is to provide and promote community health care, especially in public housing estates which house over half of the Hong Kong population. At present, the number of our member doctors is 1,600 mostly in private practice.
We would like to respond to the Summary Report of "Consultation Pattern of Estate Doctors' Patients" released by the Hong Kong Council of Social Service(HKCSS) on 22nd February, 1998.
EDA agrees to the importance in the development of family medicine in Hong Kong. For many years, EDA and its members are very concerned about establishing strong doctor-patient relationship and promoting the practice of family medicine in private clinics. This important concept of family and preventive medicine should be conveyed to every citizen of Hong Kong. EDA has been actively promoting this concept and it is time for the government to join in our effort. In the recent Consultancy Study on Financing of Hong Kong Healthcare System, EDA has highlighted this particular issue to the Health and Welfare Bureau of the Hong Kong Special Administrative Region in November 1997.
In the past years, EDA has been working in close cooperation with various government departments, namely, Housing Authority, Hospital Authority, Department of Health, the Hong Kong College of Family Physicians and others, in various aspects of promoting family medicine and community health.
We have been organizing activities such as, video-cassette sessions, scientific seminars and workshops for the continuous medical education of our 1,600 member doctors.
With the help of the Housing Authority and the strong support of our members including all estate doctors, EDA has organized a series of health exhibitions on various medical topics in many public housing estates in Hong Kong. The medical topics included prevention of Hepatitis, organ donations, etc. These exhibitions are well received and welcomed by the estate residents.
Under the close cooperation between the Hospital Authority and EDA, programmes such as Community Medical Programmes, Shared Care Programmes are organized frequently in various regional hospitals in Hong Kong such as Tuen Mun Hospital, Princess Margaret Hospital, Caritas Medical Centre, Prince of Wales Hospital, Pamela Youde Nethersole Eastern Hospital, Ruttonjee Hospital etc. These programmes provide very good opportunities for the private and public doctors to exchange their experience in the management of patients of the local community with particular emphasis on the prevention of diseases and the promulgation of such to the regional community.
EDA doctors have been active in promulgation of preventive health education to patients and we dispute the deficiency claimed in the Summary Report of the Survey conducted by HKCSS. Health counseling and education to improve patients' life styles, on diet habit and prevention of diseases are given where appropriate and are not needed for each visit. To benefit from such counseling or advice needs an alert and receptive audience. Sometimes patients may not perceive advice on diet, adequate rest or stop smoking as "advice", since these are quoted too often already. The misconceived "deficiency" can be due to other factors. One of the factors is visits by patients during odd hours, i.e. most patients interviewed are working class and they habitually see the estate doctors either early in the morning before they go to work or late at night just before the estate doctors close their clinics, thus leaving very little time for in-depth medical counseling. Other factors include language problem, patients interviewed with common illnesses only, or enough counseling has already been given to patients previously, the degree of ability to understand the counseling by the patients, etc.
From the view point on cost effectiveness, the estate doctors are in a much better position than Government Out-Patients Departments(GOPDs). The average fee charged by estate doctors is $150 including consultation and two days medicine. As regards GOPDs, the charge per visit is $37 and the estimated cost is $191 (according to the Report on "Long Term Health Care Policy" prepared by the Research and Library Services Division, Provisional Legislative Council Secretariat in October 1997). Since the duration of consultation for each patient is much shorter in the GOPDs (5 minutes by estate doctors and 2.7 minutes by GOPDs in average according to the Summary Report of the Survey conducted by HKCSS), the corresponding medical counseling given in the government setting would not be much better. We suggest that the Council of Social Service should conduct further similar studies on patients from GOPDs, non-estate doctors (including specialists) in the private sector, and also classification of doctors visited into those with or without the specialty of Family Physicians in order to get a more comprehensive picture of the problem, if there is any.
The recent acquisition of solo practices and group practices by business enterprises in certain form of Managed Care in Hong Kong has raised our serious concern. The initial so call purpose of cost containment in return for better quality of medical care in such an establishment will soon turn out to be a big "Monster" in the health care system of Hong Kong. EDA is of the opinion that if such "Monsters" is allowed to grow in Hong Kong, the quality of medical care delivered will be jeopardized and nobody(neither the patients nor the doctors) except those investors will benefit from such an arrangement of Managed Care as evidenced by the experience in other developed countries such as U.S.A. nowadays.
We, members of the Estate Doctors Association, are striving hard to provide quality health care, including preventive health care, to all citizens of Hong Kong.
Contact Person: Dr. Yeung Chiu Fat, Chairman, Estate Doctors Association
Tel no. 7838 2831 (pager) 2388 2728 (office)
Home Page: http://www.eda.org.hk E-mail: email@example.com