President’s
Jottings
HMOs (Health Maintenance Organizations) and Radiologists
After
over a quarter of a century of unfathomed “profit oriented” debut in the
United States, the deleterious effects of middle-man profiteering
business-oriented HMOs are becoming more and more obvious.
Presently there is increasing withdrawal of both patients and doctors
from such HMOs, related lawsuits and in many states, legislation is enacted to
control their operation.
In
Hong Kong, the problems arising from HMOs are not new, but it is only in the
last couple of years that the whole profession and the public are showing their
concerns in a big way.
HMOs,
no doubt, can fulfil certain society’s primary healthcare needs and may to
certain extent, achieve cost-containment. However,
harmful effects of those HMOs operating with capitation, regrettably directing
both to the patients and the service providers, are also obvious.
When a “client” is offered ‘unlimited” medical service and
treatment for a fixed contribution, and yet the HMO has to make a good profit to
support the Chief Executive Officer, the administration and management
structure, and to satisfy the shareholders, there is only one approach to such
end – contracting the service to doctors at a “low” price.
Worse, it is understood that without the prior approval of the HMO
management, most contracted doctors are not allowed to provide complicated
services, nor to request for expensive investigations.
Thus both the patients and the doctors may be deprived of their best
options, and the doctors’ professional autonomy is eroded.
On the other hand the attending doctors have to bear the responsibility
when patients are not treated properly. Meanwhile
the middle-man HMO is walking away with the profit.
Facing
the possible mushrooming of these HMOs in Hong Kong, how would radiologists and
their professionalism be affected? It
may, therefore, be opportune to appeal to our Fellows – those who have
encountered the “imposed restriction” of HMOs; those who have been
“involved” with HMOs; those who have heard of the harmful effects from their
colleagues – to come forward to tell their experience.
Hopefully, through the data collected, your College could more forcefully
express our concern to the profession, the people of Hong Kong and the
Administration and urge each party to take the very much needed actions.
In
the absence of data, let me postulate one of the possible scenarios.
In a direct way, for those involved with HMOs, because of the capped fees
for investigation and radiological examination, our Fellows might be forced to
limit the comprehensive scope of examination to cut cost, thus possibly missing
less obvious radiological abnormalities/pathology.
In an indirect way, because of cost-monitoring by these HMOs against more
costly but essential investigations, requesting of costly essential procedures
by our colleagues, like CT and MRI, for the appropriate management, will be
omitted. In both cases, the
patients stand to suffer, being denied the full benefit of modern high tech
diagnostic tools – all for the requirement of the HMOs’ desired profit.
What
can we do? In a recent
communication with the Government, our Legislative Council representative has
submitted his views and urged the Secretary for Health and Welfare to introduce
laws to prohibit HMOs from interfering with the medical profession’s autonomy.
The Academy has supported this and will voice out her concern.
Your College should do likewise. Yet
there must be other solutions to maintain our professionalism and to provide the
best service to our patients. Your
views are therefore most significant.