Message from the President, G. Tang, April 2007

Dear Fellows,

May I wish you and your family a healthy and happy Year of the Pig!

The beginning of a calendar year is the start of a year of medical indemnity insurance payment. Fellows working in the private sector will be acutely aware of the sharp rise in the insurance premium they have to pay. I am concerned about the soaring premium, for I fear it will stifle the development and sustainability of certain specialties.

Prior to 2002, the medical indemnity insurance of the Medical Protection Society (MPS) ranged from HK$5175 in the public sector to HK$17 470 in the private sector. From 2002 to 2007, the highest insurance premium for obstetrics has increased 21-fold to HK$250 380. Other than obstetrics, specialties have been regrouped into “super high risk” (cosmetic/aesthetic surgery, neurosurgery, plastic and reconstructive surgery, spinal surgery), “very high risk” (gynaecology, trauma and orthopaedic surgery), “high risk” (cardiothoracic surgery, general surgery, ophthalmology with laser refractive surgery, otorhinolaryngology, paediatric surgery, urology, vascular surgery), “medium risk” (accident and emergency, anaesthetics, cardiology, oral and maxillofacial surgery, radiology, radiotherapy), and “low risk” that includes 21 other specialty categories. The amount of the premium paid by Fellows will depend on where their specialty is placed in the risk groups by the MPS.

Obstetrics has a glaring medical indemnity premium which has not reached its ceiling yet. In fact, there is no ceiling. The premium is calculated based on the amount of claims that have been made, and the projected claims to be made for a long period of what is called the “long tail nature of personal injury claims” after a baby is born. This period spans over at least 2 decades. Survey by the Hong Kong College of Obstetricians & Gynaecologists showed that some 50% of trainees would not wish to pursue the specialty because of the high premium. The high compensation paid in obstetrics also affects the premium in other specialties. It is an actuarial exercise and MPS, being a non-profit organisation, has to ensure that there are enough funds for compensation in future. It has happened that such insurance organisation has ceased to function because of the high compensation, and in turn, obstetricians had to cease working because they became uninsured.

Is there anything that can be done to curb the premium rise, for a high premium will ultimately backfire on the health care of the community? Many jurisdictions have similar experience as early as the 1970s, such as Ireland . Tort law reform and government assistance have been the strategies. Whilst external factors may help to lower the premium, it is the view of the MPS that the profession can also contribute by improvement on communication with patients. Communication is a buzzword. In my view, communication is not merely information giving. It has to reach a level that doctors know what is in the mind of their patients, and hence can manage their expectations. For example, parents expect perfect babies, injured expect complete recovery, and the beauty following cosmetic surgery is subjective. One will then understand why the indemnity premium for obstetrics, orthopaedics and cosmetic surgery is high.

I am in the process of gathering information and having dialogue with the MPS. I hope to open the discussion with the government on medical indemnity premium as soon as possible for the sake of the profession and the Hong Kong community. But I need all the Fellows to work together to do what we can on our part in containing the rise in the premium. When we ask for help, we have to help ourselves first.

I shall keep you informed of the progress. I do not wish to see any specialty being stifled or disadvantaged in its development, and in the provision of quality service to the community.

Professor Grace Tang
President