This month’s breaking news must
be the announcement of the Financial Budget by the Financial Secretary. Started as an every-year-routine, Mr. John
Tsang did manage to make a big fuss out of it. Claimed to be a product of extensive
consultations (which included opinions sorting from a large number of primary
school students), the Budget faced loud voices of opposition from all walks of
life. The most controversial item was
the injection of $6000 into each MPF account with the objective of soothing
citizens from economic hardship. Mr.
Tsang was very firm at the beginning: "The budget has struck the right balance. I think the budget was not bad. I will continue to explain [it to the public]
and hope more people will come to understand it" (February 25). "We
can't take this part out and that part out. It is impossible. It's difficult." (February 26) However, this “take-it-or-beat-it” attitude made a sharp u-turn after
the threat of mass demonstration was foreseen to have of a good chance of
materializing. So the proposed Budget
was updated to give $6000 to each HK Permanent ID Card holder. On top of that, there would be 75% salary tax
rebate capping at $6000.
What I
would like to discuss is the “take-it-or-beat-it” attitude in relation to the
Healthcare Voucher (HCV) Scheme. Yes,
HCV again.
On
January 17, an official openly accused doctors of cheating and raiding
government subsidy money in the HCV Scheme. The HKMA objected firmly. Up to the date of writing this editorial,
there was no explanation or apology whatsoever. I would interpret that as the official and the
government showing the “I really mean it!” gesture. This was partially confirmed when I had the luxury
to meet an official unofficially one fine afternoon. I suspected that he was the arrogant official
who framed doctors opened but there was no way to confirm. He proudly presented to us his plan of
imposing more conditions on the use of HCVs by doctors such as the filling of
more detailed coding on-line and the amount of co-payment (why co-payment?) by
patients. He again emphasized the
objective of the HCV Scheme as the encouragement of preventive medicine and
health checks. However, he could not
provide an answer for why physiotherapists were included as providers as they
obviously did not provide any preventive measures to the elderly. I was interrupted when I tried to talk about
the grievance of general practitioners on the extra work on HCVs and the
adverse comments we received. What I
perceived subjectively (I have to be careful and fair to say this) was the “take-it-or-beat-it”
attitude. So my option was either to
join the scheme or not to. The terms
were clear and pre-set. They would not
be changed for you.
This
meeting reminded me of the Financial Secretary and the Budget: “Take it or
beat-it, or show me your power. I would
not hesitate to call your bluff.” However,
our government and officials are more careful than Mr. John Tsang. They had tested the limits of doctors before
with some open humiliations and harsh accusations. Seemingly, no too drastic actions were met. So they can proceed. This is what the Chinese saying of “testing
with a clay-pot by the thief”. Well,
they might be correct. Doctors including
myself do not like marching on the street. And general practitioners are used to looking
after ourselves in a submissive, non-united manner.
After
going through the whole matter again in my pessimistic mode, I in fact have to
thank the “take-it-or-beat-it” offer. This
is not the worst scenario, although it is bad enough to have your own patient
sold to you and then any official can openly call you a cheater and a liar
(maybe it is worse to be a cheater and a liar to the elderly). The worse to come is this: “Sorry, you are not
eligible to join our scheme.” Or maybe
when you have twisted your practices and hopefully not your consciousness to
join the scheme, one fine day you are told: “Sorry, you will be kicked out of
the scheme unless you do so and so.”
Maybe I
am pathologically cynical and pessimistic, but those senior (or old) enough
should have witnessed the growth of HMOs. With unequal contract terms that the doctors
had never taken part in the negotiation, HMOs got the market share. Then the terms are constantly changing to the
benefit of the organizations. Can you
remember how many years haven’t the consultation fees been raised by HMOs? How many times do you think they have raised
their charges against their clients? So
what? Take it or beat it.
Again, I
would like to end with some advice to myself. Stay healthy, both physically and financially.
Do some exercise and don’t overeat, or
over invest, or over spend. Always allow
myself the option of saying no to the take-it-or-beat-it offer. I don’t need to decide on the difficult
question of whether to encourage or disallow my sons or daughters to become a
doctor, as I don’t have any son or daughter I know of. Continue looking after myself. But if the situation is too bad (I am still
thinking whether being accused openly while I am taking some pain to endure the
unfair contract terms bad enough), maybe I shall go out and get united with the
mass. Maybe at that time, I shall get
back my patients without having them sold to me. Or maybe I shall get back my $6000 overcharged
by the government.
(Source: HKMA News March 2011)
