In September, I joined a trip to experience driving in the desert in Dunhuang. Driving in the Gobi desert was definitely a new experience. I had prepared to share with you in this issue the exciting trip and the new techniques I learned and practised to climb over a high sand dune of soft sand. I had also extrapolated the philosophy behind these new techniques to our daily lives. However, I changed my mind after attending a briefing session on public-private-partnership and reading the consultation document on Voluntary Medical Insurance Scheme. There was an urge to write something else.
On
September 28, the Voluntary Medical Insurance Scheme was endorsed by the Executive
Council. This Scheme was the result of the previous
Healthcare Reform Consultation Document: Your Health Your Life. In Your Health
Your Life, the scene was set that our healthcare system might not be
sustainable because of the aging population, the increasing chronic illnesses
and the rising medical costs. A change
in our healthcare system was needed. It
seemed that the Voluntary Medical Insurance Scheme was meant to be the change
intended to solve the problems and to make our healthcare system sustainable. However, as more details of the Scheme were
disclosed, devils really crept out to get prepared to celebrate Halloween. In a press release on October 11, the HKMA
described the Scheme as “poisonous pills in sugary coating”. I would leave the analysis of the Scheme to
our President and other Council Members. I am going to write about
public-private-partnership.
Public-private-partnership had
also been discussed in Your Health Your Life. In Chapter 3, it stated that: “We believe that it is also
worth pursuing in Hong Kong as it will not only help redress the mentioned
imbalance between public and private healthcare services, but will, more
importantly, result in an overall improvement in the quality of care for
patients, make better use of the resources available in the community, and
facilitate training and sharing of experience and expertise, thus helping to
ensure sustainability of the healthcare system…” So
public-private-partnership had been described as promising as the Scheme to
solve the healthcare system problems. It
was also a fact that the Hospital Authority had launched various
public-private-partnership programmes, though of dubious results. It might be of some predictive value on the
attitude of the Government and the Hospital Authority towards the Scheme by
looking into how it performed in public-private-partnership.
I was invited as a family doctor
to attend a forum on the Community Health Call Center Service. It turned out to be an occasion for the announcement
of the launching of the Call Center. It
was because no matter what the attendants said or felt about it, the Call
Center would be launched several days later. The idea of the Call Center is to tag discharged
patients who are over the age of 60 and who score over certain points in a
scale of readmission risks. Then there
will be a community nurse from the Call Center to call the patients in regular
intervals. The patients, on the other
hand, are encouraged to call the Call Center whenever they encounter problems. There is no rolling out mechanism for tagged
patients.
This Call Center Service
obviously creates two problems. First,
since there is no rolling out mechanism, it is highly likely that eventually
the Call Center will recruit all the old age people in that district under its
care. This is frankly going towards the opposite
direction of Your Health Your Life, as well as putting a mechanism in place to
make the Hospital Authority financially not stainable.
The second problem is that the
Call Center in fact employs a community nurse to substitute the patients’ own
family doctors. Pilot results may be
promising just because there will be more consultations for the studied
patients. Thus they tend to have more
medical care free of charge. Patients
are “stolen” from their family doctors. Instead
of going back to their family doctors for follow up and management of whatever
problems, patients are actively approached by a nurse on the phone, or asked to
call the nurse when they encounter problems. The nurse will provide twenty odd options for
the patients, among which there are very attractive ones like home nursing and
early appointments for GOPC and SOPC. It
is after all the screenings and among all options that the option of going back
to the patient’s own family doctor is found. There is no financial incentive, but just a
reminder (may be for those patients with dementia) who their family doctors are.
The patients can always insist on other
options.
The punch line is the emphasis on
a “selling point” in this arrangement for family doctors. It is referred to as support and back up. In the rare occasions when patients are referred
back to their family doctors and the doctors find that their patients need
specialist care or admission, then the doctors could discuss with the community
nurse and see if she would make such arrangement! And of course the decisions lie with the
nurse. Sorry, no further comments.
For true partnership, there must
be respect for family doctors. A single
nurse in a district could not replace the role of the patient’s own family
doctor. The Call Center is again using
price differential to ruin family medicine. Where is the relation that is emphasized in
family medicine? Where are the
opportunities for screening? Why should
there be early appointments for GOPC and SOPC? How could the patients’ family doctors have
complete records of their patients? What
are the costs of Call Centers compared to private family doctors? This wrong concept and arrangement should not
be allowed to perish with the support of public money. A simple version of this scheme is, instead of
building another white elephant, just to give the financial incentive to
patients and encourage them to have extra consultations with their family
doctors.
You can describe this scheme by
any terms. It could be true passion to
help patients but with wrong and unskillful methods. It could be expansion of public tertiary care
to erode private primary care in disguise. It could be just a fuss to spend public money.
However, whatever you call it, don’t
call it public-private-partnership. Private
doctors are not that stupid.
(Source: HKMA News October 2010)
