Kickbacks may be an acceptable way for casinos to reward operators who bring in customers, but they have no place in referrals of patients to specialists by family doctors. Yet this unethical practice, exposed more than five years ago, continues to thrive in Hong Kong to such an extent that one doctor quoted in our report today says it is deeply rooted. Private doctors involved pocket up to one-third or even more of specialists' fees for sending patients their way. That is not just an abuse of the trust on which the doctor-patient relationship is founded but has implications for patient safety. Referrals should be made objectively and solely in the best interests of the patient. A referral influenced by financial gain can put the patient at risk.
Both morally and in the eyes of the law it is corrupt. A few years ago the Independent Commission Against Corruption launched an investigation into two family doctors and a surgeon, but the Department of Justice declined to prosecute, citing a lack of evidence. The ICAC felt confident enough to appeal against the decision through an internal review committee, without success.
It is a worrying situation which undermines the integrity of our health system. A source quoted in our report tells of having been offered kickbacks for referrals by doctors who have trained in diagnostic procedures that enable them to specialise in investigations or tests for profit. This leads to over-servicing - or unnecessary procedures and operations - one of the main obstacles to containing health-care costs.
The Medical Council seems powerless to deal with what its chairwoman calls this 'invisible crime' and says it is reliant on the ICAC. A court in 2006 ordered it to investigate a complaint by a doctor, but no disciplinary hearing has been held. True, the council has been pressing the government for reforms to make self-regulation more effective. If the profession cannot be empowered to sort this out the government should consider tougher regulations. And if it is serious about health care being based on a public-private partnership, the kickback culture must be stamped out.