We refer to your editorial of April 26 headlined, 'Health check-up'. We must emphasise that the majority of general practitioners do uphold a high standard and put the welfare of patients first. The 'substandard' accusation by the Harvard Report has no valid basis and the report has been widely criticised as being unscientific and poorly researched. Hong Kong's health indices rank among the top in the world, well ahead of those of the US.
Our achievement owes nothing to Health Maintenance Organisations (HMOs) and existed well before the Hospital Authority appeared. The Harvard Report's main criticism of doctors was that they gave only two days' worth of antibiotics, but that is because many patients do not accept more and believe in a follow-up with possible change in medication. HMOs do not give more. Antibiotic resistance stems from the indiscriminate selling of antibiotics at drug stores without prescriptions and their widespread use in livestock feeds.
The report said doctors overcharged. This is absolutely not true. The average fees for general consultation ($150-$170 including two days' medicine) in Hong Kong are much less than those in the US, that is, US$22 (about HK$176) not including medicine). The report exaggerated the average income of doctors by at least three times. In fact, doctors earn less than lawyers and chartered accountants. Physiotherapists' charges are 1.5 times those of doctors while chiropractors charge three times as much.
HMOs do not give a better service, because they use the same doctors, but only pay them later and pay them less.
However, patients now have much less choice. HMOs flourish purely because patients' employers save on administrative fees, while hoping to control sick leave. HMOs have to answer to shareholders and make a profit by cutting doctors' pay and restricting service to patients, at the expense of quality. HMOs engage special teams to approach corporate clients while doctors legally cannot.
HMOs' offices are no more attractive than government out-patients' clinics or doctors' clinics, since the HMOs offices are their panel doctors' offices. Nothing has changed; only the doctors now work for the HMOs.
