Drug cost cuts hit patient care, doctors claim
Doctors say they are not being allowed to treat patients properly because of the Hospital Authority's attempt to cut its soaring drugs budget.
One doctor described as 'big brother tactics' new audit codes that allow hospital managers to check what individual doctors have been giving patients and to ask why certain drugs have been prescribed.
Yesterday, the Public Doctors' Association decided to write to Hospital Authority chief executive Dr Yeoh Eng-kiong setting out members' worries that they were not being allowed to decide the best treatment for patients.
'We have received lots of complaints,' said association president Dr Yip Wai-chun.
'As clinicians we should have our autonomy. We have a drugs budget already - if I live within it I should be allowed to prescribe what I think. If [codes are used for] how many dollars you spend I think it's totally unacceptable, we can't accept that.' Internal memos obtained by the South China Morning Post from the Prince of Wales Hospital and Caritas Medical Centre warn doctors not to use certain drugs.
They include Zantac - the world's most successful anti-ulcer drug - some skin infection treatments 'even if recommended by a dermatologist' and an asthma drug that means asthmatics do not have to use inhalers at night.
The Prince of Wales memo refers to 'doctors' codes for identification and audit purposes' and says that 'prescriptions will be randomly selected for audit purposes on an individual and monthly basis; items marked with an asterisk will be subjected to intensive monitoring and accountability'.
This would pressure doctors not to prescribe expensive drugs they thought were the best treatment, said one doctor.
The Caritas memo for geriatricians required that even patients on Zantac should be taken off it.
But for old patients, said the doctor, 'if you swap it they may not take it [the other drug] or you may have to convince them'.
The authority's chief pharmacist Lee Pak-wai denied doctors were banned from using certain drugs.
He said each hospital drug committee was run by senior doctors who knew expensive drugs should be used in some cases, but some more expensive drugs did not offer advantages over existing versions.
But he said all hospitals were being asked to cut drug costs as the budget had leapt from $550 million in 1991-92 to $980 million in 1995-96 and $254 million in the first quarter this year.
'The hospital management needs to find out where money is going,' he said.