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How it all started -- Hong Kong Doctors vary their charges by the class of the room.

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    shri's Avatar
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    How it all started -- Hong Kong Doctors vary their charges by the class of the room.

    This was one of the things that inspired us to create geobaby.com as a community site for parents in Hong Kong and beyond.

    I am writing this letter to express some opinions about news items published in the SCMP over the last month, related to layoffs and pay cuts in some of the private hospitals in Hong Kong.

    We had a baby delivered a month ago and I was left filled with respect for the nurses at the Adventist. They treated us with utmost professionalism. Having heard how loudly my son can cry at times, I have, in hindsight, developed a healthy respect for these nurses who have to deal with several newborns at the same time. Unfortunately they are left facing paycuts and layoffs, while most of the doctors are left unscathed.

    When the layoffs at the Matilda were announced, I read with a lot of amusement, complaints from the private hospitals that they were under pressure from the government hospitals and their subsidies. I would like to recommend that these hospitals look inwards and study the problem, which in my opinion is the fact that they do not know who their customers are. Are their customers the doctors who bring and refer patients to the hospitals or are they the patients. In the IT industry, we would term them as systems integrators and end users. We protect our end-users and work hard to make sure that the systems integrators provide our customers with the best possible service at reasonable prices.

    The private hospitals in Hong Kong allow their doctors to double and quadruple their rates depending on the type of room the patient has elected to stay. If a doctor charges, HK$10K for surgery to a patient admitted to a ward, this charge could well go up to HK$50K if you have elected to stay in a private room. This is apparently standard practice here in Hong Kong and we were shocked to hear about this.

    This practice that the hospitals facilitate, is in violation of the medical council's code of conduct that clearly states, "A doctor should not charge or collect an excessive fee. The Medical Council will consider the following factors as guidelines in determining whether a fee is excessive: the difficulty and special circumstances of the services performed and the time, skill and experience required; the average fee customarily charged in the HKSAR for similar services; and the experience and ability of the doctor in performing the kind of services involved."

    Changing the class of the room has got nothing to do with the doctor?€™s skill, difficulty of the procedure and the average fee charged for similar services. In the commercial world (excuse my leap of imagination), if I asked for a non-smoking seat, the cost of my dinner would be quadruple that of the person sitting in the smoking section with his cigar lit up. The hospitals do not do anything to prevent this and neither does the medical council or the consumer council (who have not answered my queries from over a month ago on this issue) and I fear this is because they do not acknowledge their patients as customers in a business context.

    These medical institutions that are now complaining about the lack of customers should look inwards and answer the following questions. Are their real customers the doctors or the patients? Are they doing everything possible within the guidelines set out by the law and best practices in an international context to fully protect and provide fair service to their customers? Is their main competition the government or the price discrimination by the doctors?

    It is time that the patients start behaving like customers of a business. They need to start educating themselves, evaluating their options and questioning the necessity of the procedures and medications the doctors prescribe and putting a fair dollar value to these services. After all, how many times have we complained loudly about the ?€œtea charge?€? that the restaurants add on and how many times have we ignored the excessive antibiotics and MRIs that the doctors prescribed us?

    I would like to welcome doctors and patients to share their views and opinions on this issue with me on this issue at .

    Shriram Chaubal

    HKIndians.Com
    Last edited by rani; 10-14-2009 at 12:27 PM.

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    A Dr Robert Law from Central responded and opened up a can of worms with this ....

    Shriram Chaubal commented on the so-called ''outrageous private hospital charges'' in Hong Kong (South China Morning Post, August 26).
    What most people do not realise is that the price differentiation in private hospitals between the three different classes of beds is essential to ensure people do have some real choices.


    Take, for example, a surgical procedure that requires a hospital stay of one week with a total bill of $30,000 for a third-class bed. If the doctor's fee and other hospital charges remained the same and the patient was only charged the difference in the price of the bed, then the corresponding total bill for a second-class patient would only be about $32,000 and $35,000 for a first-class bed. Under these circumstances, it would be impossible to find second-class or first-class beds for those people who really wanted them.

    A good analogy is the price of business- and first-class return tickets to London. Currently, the economy fare is about $10,000, $30,000 for business class and $60,000 for first class. If you calculated the ''worthiness'' of an airline ticket according to the space occupied by any passenger on the plane and, for example, the quality of the food, the corresponding price of a business-class ticket should really be about $12,000 and that of a first-class ticket about $14,000. Just imagine if such a pricing structure existed. It would be extremely difficult to get a business- or first-class ticket.

    I have heard many people groaning about the ''unreasonable'' cost of business- and first-class tickets to London. These are people who want to travel first class, but cannot afford it. What they really want is to be able to go first class and pay just a notch over the cost of an economy ticket. If that happened, all those people who always travel first class would be up in arms, as it would be very difficult for them to do so in the future. This is a case of supply and demand.

    As long as the consumer is fully aware of the price and is willing to pay for it, there should not be any complaint.

    Dr ROBERT LAW
    Central

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    My response to him which was never published... and appropriately as there were two more responses from others.

    I appreciate Dr Robert Law's candid response (Aug 13, 2002) to an earlier letter published by me, complaining about the price discrimination in the Hong Kong hospitals. Unfortunately, Dr Law seems to have confused the issues up. I have no problems with the hospitals charging different rates for different room types. My problem lies with the doctors charging different rates depending on room types, more than often without having taken explicit consent from the patients.

    The analogy of doctor’s fees with flying first class on an airline is
    flawed. One flies first class because one arrives in better shape and gets better service. As a healer, I am sure Dr Law does not discriminate while providing services to his patients depending on the rooms that they are in. Room rates have no connection with the level of service provided by the doctors. The analogy is further flawed by the fact that the airlines practically invented and continue practice price discrimination. Do hospitals charge
    their patients as discriminately as airlines? Do they list their surplus capacity on priceline.com and let patients bid on them? No.

    Dr Law also brings up an excellent point when he mentions full disclosure. Most doctors in Hong Kong do not practice full disclosure. I would bet that I would not be able to get more than half the doctors in Central to give me their pricing structures on or before the first visit that I make to their clinics. Doctors in Hong Kong have to give up their "if you have to ask how much you cant afford it" attitude and practice better disclosure.

    Finally, I would once again like to point out that there are indeed some extremely competent doctors in Hong Kong, that do justice to the Hippocratic oath. I know these doctors would not hesitate to treat a patient for free or with their own funds, if it meant healing. Unfortunately, they are slowly turning into an extinct species.

    Regards,
    Shriram Chaubal

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    The first response was from a Dr who saw the flaws in Dr Robert Law's logic.

    I read with interest Dr Robert Law's letter (South China Morning Post, August 31) regarding charges for different classes of beds in private hospitals.
    He said the pricing structure enabled patients to have ''real choices''. I interpret the situation differently. The pricing (or over-pricing) for the luxury of a first-class bed, just like for a Rolex watch, a Tai Tam address and first-class air travel, is above all a matter of status symbols. It is a matter of choice only if you can afford it.


    The pricing policy is a business decision aimed at profitability, and is justified because business is business. Dr Law stated that it was a case of supply and demand; that much I agree.

    However, Dr Law's letter opened up a can of worms. We can see why private hospitals and airlines want to charge exorbitantly for their first-class clients, but what are the justifications for doctors to surcharge their patients when they stay in first-class beds?

    In theory, doctors treat all patients equally, rich or poor. Then why charge those in third-class $800 per day for hospital visits, but those in first-class $3,000? Why charge $10,000 for surgery for third-class patients, but $30,000 for first-class patients? Are we sending the message that we provide better service to first-class patients? Unlike airlines and private hospitals, where surcharges in luxury classes may be needed to subsidise losses in the overall operation, for doctors it is matter of making enough money - or a lot more. Making $800 per patient per day for hospital visits or $10,000 for a couple of hours in the operating theatre is not exactly charity work.

    It goes to show that doctors are no different from everyone else, in that given the opportunity they will want to make as much money as possible. And it is possible because patients and insurance companies let us get away with it.

    DR FENG CHI-SHUN
    Causeway Bay

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    The second response was a bit more direct.

    Dr Law's analogy involving the price of business- and first-class air tickets defeats me. There is surely no argument that private hospitals are entitled to charge for differing classes of accommodation, although they should be more transparent in these charges. But my understanding is what is being challenged is why doctors, who are generally independent of hospitals, are charging wildly varying fees, depending on the class of accommodation occupied, for providing essentially the same service.

    I suggest that a more appropriate analogy would be if one is accommodated in the presidential suite or the basement of the Peninsula Hotel, one would not expect a different price for the same meal in Gaddis.

    DOUGLAS MILLER
    Tai Po

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    Dr. Law’s logic is bizarre at best.

    Following the metaphor, if the hospitals or airlines want to charge extra for a service they provide, I agree that’s their business. We are free to choose the class of SERVICE that we want to pay for and receive.

    But the doctor charging more is like the airport charging a higher exit tax. The airport doesn’t provide a different service depending on my class of ticket, but the airline does. It is just an example of a “luxury tax.”

    Law is obviously trying to rationalize his “tax.”

    Now, what can we do? We are consumers in a free Capitalist economy. We can vote with our feet and go to doctors who don’t make this extra charge. Who are they? I don't think the hospital should be held liable for the doctors actions. It is the doctors themselves that seem to be the issue.

    Maybe we should gather together this community of ours to make a bigger noise with the councils and government groups that oversee these issues. I have time on my hands until June, and would be happy to work with others on this issue. Please contact me off-list if you are interested.

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    Since the original letters I've spoken to a lot more people and have casually researched this issue. Some random and unorganised thoughts...

    -- The doctors can charge whatever they want, IF and ONLY IF they have made full disclosure and let you know about this before you accepted the service.

    -- Most doctors in HK negotiate packages with you. I would like to highlight the word negotiate as there is price discrimination between paitents. We know of people who work at some of the big brand name investment banks who have gotten charged more than some of us who... well .. have to work for a living.

    -- Medical council guidelines state very speciifcally that a doctor can base his charge on the complexity of the service and the market rates for that service and his experience. The problem is that there are few guidelines or definitions on what market rates are.

    -- There are some celebrity doctors who can and will get away with inflated charges.

    -- I would also like to stress that there are a fair number of doctors who consider themselves as healers and not service providers. Ask people why they go to their doctor and you'll find the rare gem when people respond "because they cared", as opposed to "best equipment", "everyone goes there", "famous doctor" etc.

    -- The issue of pricing discrimation based on the type of room you're in, is a very difficult one to take to the public-court of opinion as many people I have met (spoilt and uninformed expats and locals) have accepted this as a fact of life and are complacent. People tend to view doctors with awe and are not ready to question them.

    -- I ask my friends and colleagues .. how much time did you spend researching the last high-end item you purchased.. they'll spend hours and hours on that. Do you research medical conditions and treatments before you go to the doctor? The answer is frequently ... "no".

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    I agree it is ridiciulous that doctors should charge according to the class of room of their patients. I am due to deliver in January and my doctor, sigh...like others charges according to accommodation class. Does anyone know a good doctor who does not follow this business trend ?

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