One of the problems with private health care in Hong Kong is that charges for treating the same surgical or medical problem can vary widely.
That's why fixed-fee packages for medical services have been a focus of heated discussion. The government hopes fixed-fee packages can increase fee transparency in private health care, and encourage people to join the government's proposed voluntary medical insurance scheme.
Any model of fixed-fee medical packages is about risk-sharing but, in theory, there is no change in private doctors' income in the long run.
But private doctors are not receptive to the idea. One private cardiologist was quoted as saying that with the fixed fees, 'doctors won't be rewarded for explaining more to patients'. Medical Association president Dr Choi Kin said, 'They will damage clinical autonomy and if all the costs are fixed, doctors' hands are tied, and they can't deliver good quality care.'
Are they saying that if they don't have the freedom to charge, they can't do their best for the patients?
The reality is that fixed-fee packages take away their chance to put an extra price-tag on every little thing they do for their patients. When I was a consultant for a medical insurance company, it was not unusual for me to come across claims of thousands of dollars for 'bedside tests' such as the 'tilt test' and 'Tensilon test'. Though uncommon and time-consuming, these tests should be part of the physical examination and should not have been extra charges.
Fixed-fee packages for medical services are not new to Hong Kong. For decades, high-ranking government doctors have been allowed to attend to 'private' patients who pay market price for the services. Standard charges for the various procedures are calculated and published in the Government Gazette.
Private doctors even use the published list of charges in the Government Gazette for reference when it works to their advantage. A few years ago, my wife went to her GP to ask for a copy of her medical record. For a photocopy of the three-page, double-spaced scribble, her doctor charged her HK$500. When asked why so exorbitant a price for so little work, her doctor told her it was the government's gazetted price for a copy of a medical record. However, a HK$500 copy of a medical record for a patient in a government hospital is usually three inches thick.
I have already advocated that our government start its own private hospitals, and now I urge it to consider more seriously than ever taking that step. Senior government doctors and medical school professors already have the experience of attending to private patients, and government hospitals have been taking in private patients for decades. With a bit of fine-tuning, the government can continue to do the same on a larger scale.
Running its own 'private' health care services for the voluntary medical insurance scheme will be less costly and problematic than relying on the private sector.
Dr Feng Chi-shun is a Hong Kong-based pathologist