Doctors attack 'inhumane' insurers

Ethics fear over contracts limiting patient visits and referrals

The Medical Council of Hong Kong and doctors' unions have accused health insurance firms of imposing 'inhumane' contract conditions on doctors that are against medical ethics and patients' interests.

They have also warned doctors that complying with unethical terms could leave them open to disciplinary proceedings.

David Fang Jin-sheng, who chairs the council's ethics committee, said the constraints affected the quality of patient care and posed a serious ethical problem.

'We are very concerned about this, as the market share of the companies concerned is quite big,' Dr Fang said yesterday.

The Hong Kong Doctors' Union has received 50 complaints about unethical contract terms in six months.

The union's president, Henry Yeung Chiu-fat, estimated that 60 per cent of the 2,000 members were affected by the measures which, among other things, restricted the number of repeat visits by patients and specialist referrals.

'This is inhumane,' he said. 'Doctors should give patients treatment they need. The government keeps telling the public to buy medical insurance and get a family doctor. But what kind of quality health insurance do we have now?'

Examples of the constraints include asking doctors to maintain the repeat visit rate of their general practitioner and specialist services below 10 per cent and 15 per cent respectively.

Contract doctors are also required to maintain a specialist referral rate below 10 per cent and diagnostic test referral rate below 5 per cent.

'According to these terms, if a doctor has 100 patients only 10 can make repeat visits. As for doing tests, if a doctor has 20 patients, only one patient can undergo the tests. This is totally unacceptable,' Dr Fang said.

The council will send a letter to all registered doctors to remind them to scrutinise medical contracts and schemes to ensure that they are ethical and in the best interests of patients. It also warns doctors that joining these schemes with such constraints may infringe on their profession's code of conduct.

'Doctors should be reminded that contractual constraint is not a defence to disciplinary proceedings for provision of substandard medical services to patients. Their licence might be revoked in serious cases,' Dr Fang said.

The council, the Hong Kong Medical Association and the doctors' union urged doctors who have signed such contracts to review the terms with their health insurance companies.

Damien Marmion, managing director of BUPA Health Insurance, said the contract terms were not restrictions.

'These are only indicators used for performance measurement of our doctors. Doctors can treat patients with their own judgment and choose not to follow these terms, and they will not face penalty. These terms are unrelated to medical ethics,' he said.