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The medical profession has failed to stamp out the practice of doctors taking kickbacks for patient referrals - payments that can amount to 25 per cent of a specialist's fee and which may compromise the quality of care. 
The chairwoman of the Medical Council, Professor Felice Lieh Mak, admitted kickbacks among doctors existed but said the watchdog could do little because of its limited resources. 
The arrangement appears to be more prevalent among doctors in Kowloon, where competition for business is intense, than among the elite circle of expensive practitioners in Central. 
At least three doctors have told the South China Morning Post their peers  offered payments for patient referrals.  The amounts involved ranged from 5 per cent to 25 per cent of the specialist's fee, they said.
Several other doctors said the practice was an open secret in the profession and common in Hong Kong. 
The latest confirmation of these financial transactions comes with the Medical Council still dragging its feet over a five-year-old complaint against such malpractice.
Lieh said  the council had to rely on the Independent Commission Against Corruption to act on the crime. 'It is wrong for doctors to offer or receive payments for referrals. We condemn such acts. We know it exists but this is an invisible crime. We don't have the resources to investigate it, we have to rely on the ICAC,' she said.
She said patients should ask their doctors about the fees charged and whether they were split with others. 
Under their professional code of conduct, doctors cannot offer or accept any financial inducement for referring patients and  may not  share their  fees with anyone other than   partners of their  practices. 
A young general practitioner in the New Territories said he had been approached by various groups  of specialists four or five times since he set up a private clinic eight years ago.
'Not long after I started my clinic, some specialists told me I could get  5 to 10 per cent of their medical fees if I brought patients to them,' the doctor said. 'This practice is very common in the profession - it is rooted so deeply, it is an open secret. Such transactions are not easy to spot because sometimes they are made  in cash over the dining table.
'General practitioners are the first line of contact with patients. Specialists have to rely on them  for referrals so they can make a lot by doing all kinds of investigations and operations.'
A doctor in private practice described being  approached by colleagues  who perform  'very profitable' medical procedures such as endoscopic investigations of the stomach and intestines. These 'procedures-based practitioners' had offered 25 per cent commission for referrals. 
'There is a group of young doctors who are frustrated with the public sector and  eager to make quick money. They concentrate on  doing a certain kind of investigation or test for profit,' this doctor said. In one case, he was told he could earn about HK$1,000 per person sent  to a specialist for an endoscopy. 
'Of course, I rejected all these offers. I can't  take part in such an unethical practice. Doctors should not let financial incentives interfere with medical judgments, including referrals,' he said.
A third doctor, a specialist in Central, described how the arrangement sometimes works.  
'In some circles, a surgeon will come to a general practitioner's clinic to work on a simple medical procedure so that he can share the fee. The surgeon pays the GP the kickback for such referrals,' he said. 
The doctor blamed the Medical Council for the fact the practice of paying kickbacks had continued. 'We are disappointed by the inaction of the council over this misconduct. It has done nothing to enforce the code,' he said. 
In October 2006,  surgeon Darren Mann won a court order to have his complaint over kickbacks  reinvestigated by the Medical Council, which had  rejected his complaint  the previous year. No disciplinary hearing has been held over  the case.
The practice appears to be more common in Kowloon.
'It is rather rare in the upper market among the Central elites. They don't bother to make this money and risk ruining their names,' one  doctor said.
Some general practitioners have been offered HK$100 for each patient referred. 'This is a small sum for doctors with good business, but for those  who are struggling to survive it amounts to 50 per cent of their normal  fee,' an informed party said.
A former president of the Hong Kong Medical Association, Dr Choi Kin, said kickbacks were common 10 to 20 years ago, but they were  getting rare now.
Tim Pang Hung-cheong, a spokesman for the Patients' Rights Association, said kickbacks would compromise a person's chance of getting proper care. 'When doctors only eye the rebate, the referral may not be the best for patients,' he said.
Patients should ask  for more information about a referral.
'Patients should be clear about how a referral can help them. They should ask about the doctor's competency, experience and qualifications and make sure the doctor is good at what he is doing,' he said.
The practice of paying kickbacks was highlighted in guidelines jointly published by the ICAC and the Medical Association in 2003, which  say  that offering and accepting illegal advantages in the course of clinical practice can  'compromise the doctor's professional judgment, erode patients' trust and impair the interest of his employer'. 
They also say referrals to medical specialists should be based on individual competence and ability to perform the services needed.  A doctor  should not refer a patient unless he is confident that the services provided  will be performed competently.
An ICAC spokesman said it organised talks on anti-corruption laws and integrity issues for medical students.
The advisory services group of its corruption prevention department also provides free and confidential  advice to private medical practitioners on request, the spokesman said.
Industry ill
A kickback of HK$1,000 can be earned from an endoscopic examination
The percentage of his fees a specialist doctor is willing to pay to a general practitioner for a patient referral: 25%



Doctors still pay kickbacks for patient referrals