Ref : CB2/PL/HS

Members Present :

Hon Michael HO Mun-ka (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon Cyd HO Sau-lan
Hon CHAN Yuen-han
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung
Dr Hon TANG Siu-tong, JP
Hon LAW Chi-kwong, JP

Member Absent :

Hon HO Sai-chu, JP


Public Officers Attending :

All items

Mr Gregory LEUNG
Deputy Secretary for Health and Welfare 1

Miss Linda SO
Assistant Secretary for Health and Welfare

Dr P Y LAM
Deputy Director of Health 2

Item III

Miss Eliza YAU
Principal Assistant Secretary for Health and Welfare (Medical) 1

Dr K H MAK
Consultant (Community Medicine), Department of Health

Miss LAM Kam-fung
Senior Education Officer, Education Department

Miss Ann LAU
Assistant Director, Social Welfare Department

Dr W M KO
Deputy Director (Operations), Hospital Authority

Item IV

Miss Eliza YAU
Principal Assistant Secretary for Health and Welfare (Medical)1

Item V

Mr Eddie POON
Principal Assistant Secretary for Health and Welfare (Medical) 3

Dr W M KO
Deputy Director (Operations), Hospital Authority

Attendance by Invitation :

Item V

Dr LAM Ying-ming
Estate Doctors' Association

Clerk in Attendance :

Ms Doris CHAN
Chief Assistant Secretary (2) 4

Staff in Attendance :

Ms Joanne MAK
Senior Assistant Secretary (2) 4

V. Hong Kong's health care system and the direction of future reform
(LC Paper Nos. CB(2)2266/98-99(05) - (07))

The Chairman informed members that the Hong Kong College of Family Physicians (HKCPF) had already provided a submission (LC Paper No. CB(2)2266/98-99(06)) to this Panel and it would send representatives to attend the special meeting scheduled for 28 June 1999 to give their views on the Harvard Report.

2. The Chairman suggested that the views of both the management staff and the board members of the Hospital Authority (HA) on the Harvard Report should be sought. He would further liaise with the Clerk on the follow-up arrangement.

3. Referring to the proposed outline of topics for discussion (LC Paper No. CB(2)2266/98-99(05)), Dr LEONG Che-hung considered that non-medical health care professionals such as nurses should also be invited to send representatives to attend the meetings on the Harvard Report. The Chairman said that the arrangements had been made for them to attend the coming meetings.

4. The Chairman welcomed Dr LAM Ying-ming representing the Estate Doctors' Association (EDA) to attend the meeting. At the Chairman's invitation, Dr LAM briefed members on the salient points of the EDA's submission, highlighting that the EDA was concerned about how to improve the professional standards of private medical practitioners and how to enhance the transparency of their fee charging.

5. The EDA supported that private medical practitioners should be encouraged to undergo Continuous Medical Education (CME) as a way to improve their professional standards. It took the view that the Government should subsidize the practitioners to attend the CME courses and that the practitioners should be allowed to undergo CME on a voluntary basis.

6. Dr LAM suggested that in order to increase the incentives of private medical practitioners to pursue CME, attendance of CME courses should be made more rewarding. Dr LAM suggested that, for example, the qualifications obtained on completion of CME courses should be "quotable", that is, these qualifications could be displayed at clinics or shown on the name cards of the practitioners concerned. He noted that there was a post-graduate diploma course on family medicine organized by the Chinese University of Hong Kong (CUHK). However, on completion of the course, the participants were advised by the Medical Council of Hong Kong (HKMC) not to quote this diploma as their additional qualifications because the HKMC considered that the course was a relatively simple one. Dr LAM commented that this was disappointing to the participants as the course could not help to enhance their qualifications. He took the view that there should be better coordination between the HKMC and the universities in designing the curricula of CME courses to prevent recurrence of similar problems.

7. For the benefit of raising the overall quality of health care, the EDA supported strengthening primary health care and promoting the development of family medicine. These measures, as pointed out earlier on by the Hong Kong Council of Social Service, would help reducing the need for hospital admissions and thus the public expenditures on hospital services. Dr LAM considered there was a need to increase the number of family physicians as there were only about some 100 of them in Hong Kong against a shortfall of about 3 000. Moreover, he considered that it was inadequate for the HA to provide only 20 placements in public hospitals each year for the training of family physicians and there was an urgent need for allocating additional resources to train up more family physicians.

8. To facilitate private medical practitioners to receive training on family medicine, Dr LAM said that the practitioners should be given on-the-job training so that they needed not give up their private practice while receiving the training. He opined that the duration of training for family physicians should not be six years which was unreasonably long. He favoured the old system under which a private medical practitioner could become a family physician by passing a qualifying examination. This system could save a medical practitioner the time that he/she had to spend, as required under the current system, on clinical training by attaching to the HA and to an assigned clinical centre. Dr LAM considered that the duration of the current training could be shortened from six years to four years without compromising the standards of the graduates. He further pointed out that no other countries in the world required medical practitioners to undergo such a long period of training in order to be family physicians. To substantiate this point, Dr LAM quoted the articles written by Dr David FANG and Dr LO Wing-lok who had also made similar points in respect of the appropriate duration of the clinical training required for family physicians. At the Chairman's request, Dr LAM agreed to provide the quoted articles to the Panel for reference.

(Post-meeting note : the EDA had provided a paper entitled "How to tackle the shortage problem of family physicians" which included the above quoted information. The paper was circulated to members under LC Paper No. CB(2)2666/98-99(01) on 6 August 1999.)

9. To enhance transparency of private medical practitioners' fee charging, Dr LAM pointed out that the EDA encouraged doctors to display a scale of fees at their clinics. It also advised doctors that they should inform patients well in advance of any additional charges that might be incurred by services like laboratory tests, small operations or the prescription of special medicines for the patients. The EDA suggested that the media should publicize that patients were fully entitled to enquire about the scale of fees charged by doctors. It also proposed that the Hong Kong Medical Association and the Consumer Council should jointly conduct a survey on the scale of fees charged by individual hospitals and publish the findings.

10. Mr LAW Chi-kwong noted that the HKCFP had recommended to implement an assessment exercise involving the issuing of a "Certificate of Primary Medical Care" to private medical practitioners who managed to meet the required standards. He invited Dr LAM Ying-ming and the Administration to give their views on this new measure of the HKCFP. In response, Dr LAM said that he did not consider that the plan would help to improve the overall standards of medical practitioners in Hong Kong. Moreover, as the participating doctors would have to bear the cost incurred by the assessment exercise, which was estimated to be about $20,000 for each doctor, he believed that doctors would not be interested to take part in it. In addition, he commented that the name of the Certificate might even mislead patients to think that the doctor concerned had only completed basic health care training.

11. Deputy Secretary for Health and Welfare 1 (DS(HW)1) said that the Administration would have a meeting with the HKCPF soon to look at the details of the proposed assessment exercise and it had no comments to make on the exercise for the time being. Regarding the name of the Certificate, DS(HW)1 said that the Administration was more concerned about whether the exercise could achieve its aim in enhancing the standards of medical service rather than the name of the certificate to be issued. As regards the difficulties faced by private medical practitioners in their pursuit of training on family medicine, DS(HW)1 undertook that the Administration would review the situation with the HKCPF. He said that the Department of Health (DH) and the HA would make every effort to improve the provision of training opportunities for doctors as far as resources allowed. As regards the suggestion that the Government should subsidize doctors directly to undergo CME, he said that the Administration would have to consider the proposal very carefully in view of the complexity of the matter involved and its implications on other professions.

Adm

12. Miss Cyd HO Sau-lan asked Dr LAM whether medical practitioners in general considered that there was a genuine need for them to undergo CME if it was not made a compulsory requirement for them to do so. She would also like to know on average how much they were willing to pay for CME and the duration they considered as appropriate for it. In response, Dr LAM believed that the majority of private medical practitioners were interested in pursuing CME to enhance their professional knowledge. However, he believed that each doctor had a different view on the appropriate cost/duration of CME and it might be necessary for the EDA to conduct a survey first in order to answer the questions. He personally considered that some CME courses served more as an occasion for social gathering instead of the purpose of enhancing the professional knowledge and standards of the participants. In fact, some recognized CME courses were actually sponsored by some pharmaceutical companies and they served to introduce and promote their products. He pointed out that there were many ways to enhance the professional standards of medical practitioners. For example, they could gain up-to-date knowledge on medical development and health related issues from the Internet, medical journals and so on. Therefore, it should not be made a compulsory requirement for private medical practitioners to undergo CME since there were many alternative ways for doctors to seek improvement in their professional knowledge. These ways, in Dr LAM's view, would save doctors' time and achieve better results.

13. The Chairman questioned how to institutionalize the alternative kinds of CME as suggested by Dr LAM. In reply, Dr LAM pointed out that there were actually many CME programmes on the Internet and in medical journals. A doctor after studies could complete the questions set in the programmes and provide a copy of his answer to the HKMC for record and assessment. The Chairman requested the EDA to provide details of their preferred mode of CME and their views on the appropriate duration and cost to the Panel for reference.

14. Dr LEONG Che-hung agreed that there was a need to promote the development of family medicine. In response to Dr LAM's comments on the nature of CME, Dr LEONG pointed out that participants in CME could earn credits not just by attending lectures/seminars but also by completing CME programme in some journals or by attending post-graduate training. He disagreed that CME had been regarded as a social function and clarified that it actually consisted of different modes of learning activities. As to why private medical practitioners should be required to undergo CME, Dr LEONG explained that one of purposes of CME was to boost confidence of the public in the professional standards of doctors. Dr LEONG pointed out that this purpose could not be achieved if doctors enhanced their professional standards simply by self-studies without formal assessments of their standards based on objective criteria.

15. On the training of family physicians, Dr LEONG appreciated the difficulties faced by a medical practitioner who would have no earnings while attending the clinical training required for family physicians, except for the first two years in which the doctor was paid a salary by the HA. Dr LEONG drew the Administration's attention to this point which explained why many medical practitioners were deterred from pursuing the studies. As regards the "Certificate of Primary Medical Care", Dr LEONG explained that it was meant to provide a way for those who could not reach a fellowship level recognized by the HKCPF and yet could still practise as a family physician. He pointed out that this was already a compromising step taken by the HKCFP.

16. On the issue of transparency of fee-charging, the Chairman said he noticed that few estate doctors had actually displayed a scale of fees at their clinics. He requested Dr LAM to elaborate further the stance of the EDA on this matter and what resistance it had encountered from doctors. In response, Dr LAM said that the stance of the EDA was that it encouraged doctors to display a scale of fees at their clinics (but not outside the clinics). In response to the Chairman's further question, Dr LAM said that the EDA did not suggest doctors to list separate scales of fees charged for normal consultations and extended consultations. Dr LEONG Che-hung commented that he was against imposing additional charges on a patient for the longer time taken to confirm diagnosis and he considered that such practice was "unethical". In response to Dr LEONG's comments, the Chairman considered that whether or not such practice was unethical was open to discussion and no conclusion could be drawn now. The Chairman requested the EDA to provide to this Panel its comments on the post-graduate diploma course on family medicine organized by the CUHK and the assessment exercise recommended by the HKCPF.

17. The Chairman thanked Dr LAM for attending the meeting.

18. The meeting ended at 10:55 am.

Legislative Council Secretariat
7 September 1999