PART III

D. Financial Arrangements

13. Fees

 
13.1  Consultation fees should be made known to patients on request. In the course of investigation and treatment, all charges, to the doctors' best knowledge, should be made known to patients on request before the provision of services. A doctor who refuses or fails to make the charges known when properly requested may be guilty of professional misconduct.
13.2  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 :-
  1. the difficulty and special circumstances of the services performed and the time, skill and experience required;
  2. the average fee customarily charged in the HKSAR for similar services; and
  3. the experience and ability of the doctor in performing the kind of services involved.
13.3  A doctor should exhibit a notice in his clinic informing patients about their right to know the fees involved.


14. Relationship between doctors and organizations

 
14.1  Medical services are offered to the public not only by individual doctors but by a wide variety of organizations such as hospitals, screening centres, nursing homes, medical scheme administrators, insurance companies, health administration companies, managed care companies and counselling centres. Such organizations may be providing the medical service itself directly or through middlemen; or may be acting as an agent or a middleman itself. Some of them advertise their services to the public and the principles and rules set out in paragraph 4.2 above, concerning the advertising of medical practitioner services, apply also to such advertising.

14.1.1  Doctors who have any kind of financial or professional relationship with such an organization, or who use its facilities, bear responsibility to ensure the organization's advertising conforms to the principles and rules set out in paragraph 4.2 above. This also applies to doctors who accept for examination or treatment patients referred by any such organization. All such doctors must therefore make it their responsibility to acquaint themselves with the nature and content of the organization's advertising, and must exercise due diligence in an effort to ensure that it conforms with this guidance. Should any question be raised about a doctor's conduct in this respect, it will not be sufficient for any explanation to be based on the doctor's lack of awareness of the nature or content of the organization's advertising, or lack of ability to exert any influence over it.
14.1.2  Doctors should also avoid personal involvement in promoting the services of this kind of organization, for example, by public speaking, broadcasting, writing articles or signing circulars, and should not permit the organization's promotional material to claim superiority for their professional qualifications and experience. Nor should they allow their personal address, telephone number, facsimile number or e-mail address to be used as an inquiry point on behalf of an organization. Professional fees should not be mentioned.
14.1.3  A doctor who recommends that a patient should attend at, or be admitted to, any hospital, nursing home, health centre or similar institution, whether for treatment by that doctor or by another person, must do so only in such a way as will best serve, and will be seen to best serve, the medical interests of the patient. Doctors should therefore avoid accepting any financial or other inducement from such an institution which might compromise, or be regarded by others as likely to compromise, the independent exercise of their professional judgement. Where doctors have a financial interest in an organization to which they propose to refer a patient for admission or treatment, whether by reason of a capital investment or a remunerative position, they should always disclose that they have such an interest before making the referral.
14.2  Contract medicine and managed care
A doctor who is an owner, a director or an employee of, or in a contractual relationship with, an organization which, either directly or indirectly, provides medical services or administers medical schemes, may only continue such association provided that the organization conforms to the following principles :-

14.2.1  The principles on advertising mentioned in paragraph 14.1.1 must be observed.
14.2.2  Doctors should exercise careful scrutiny and judgement of medical contracts and schemes to ensure that they are ethical and in the best interests of patients. Doctors should dissociate themselves from organizations that provide substandard medical services, infringe patients' rights or otherwise contravene the Professional Code and Conduct.
14.2.3  When administrators, agents, brokers, middlemen etc. are involved in a medical contract, information pertaining to the financial arrangements must be readily available to all parties on request.
14.2.4  Medical schemes and contracts often involve administrative costs. Doctors should do their best to ensure that these administrative costs are reasonable. Nevertheless, each doctor is to retain 100% of the professional fees which he charges the patient. Where payment is by credit card, remission/deduction of the amount due to the credit card company is acceptable.
14.2.5  Commercial pre-paid capitation schemes (whereby a doctor or a group of doctors undertake certain insurance-type financial risks) which may be incompatible with a high standard of medical practice should not be entered into.
14.2.6  Doctors in accepting contracts to provide service should avoid taking on unreasonable financial risk as in the case of low capitated payment. It will be unacceptable for doctors who provide substandard service to use any capitated medical scheme which they joined as their excuse.


15. Improper financial transactions

 
15.1  A doctor may not receive any payment by way of commission, rebate or otherwise from another doctor or organization for referring a patient for consultation or treatment. A doctor may not offer or pay any commission, rebate or otherwise to another doctor, person or organization who refers a patient to him for consultation or treatment.
15.2  A doctor shall not share his fees with any other person other than the bona fide partners of that practice.
15.3  A doctor shall not receive any rebate from diagnostic laboratories or similar organizations to whom he refers patients.
15.4  If a doctor has financial or commercial interests in organizations providing health care or in pharmaceutical or other biomedical companies, these must not affect the way he prescribes for, treats or refers patients.
15.5  A doctor, before taking part in discussion with patients or their relatives about buying goods or services, must declare any relevant financial interest or commercial interest which he or his family may have in the purchase.
15.6  The seeking or acceptance by a doctor from a hospital, nursing home, health centre or similar institution of any inducement for the referral of patients to the institution, such as free or subsidised consulting premises or secretarial assistance, is considered improper. Similarly the offering of such inducements to colleagues by doctors who manage or direct such institutions may be regarded as improper.
15.7  Sponsorship from commercial organization for participation in scientific meetings, or for educational and charitable services is acceptable provided the amount sponsored is reasonable and not excessive.


16. Relationships between the medical profession and the pharmaceutical and allied industries

 
16.1  Advertising and other forms of sales promotion by individual firms within the pharmaceutical and allied industries are necessary for their commercial viability and can provide information which is useful to the profession. Nevertheless, a doctor when prescribing should not only choose but also be seen to be choosing the drug or appliance which, in his independent professional judgement and having due regard to cost effectiveness, will best serve the medical interests of his patient. Doctors should therefore avoid accepting any pecuniary or medical inducement which might compromise, or be regarded by others as likely to compromise, the independent exercise of their professional judgement in matters pertaining to patients' management. The seeking or acceptance by doctors of unreasonable sums of money or gifts from commercial firms which manufacture or market drugs or diagnostic or therapeutic agents or appliances may be regarded as improper.
16.2  The medical profession and the pharmaceutical industry have common interests in the research and development of new drugs or appliances of diagnostic or of therapeutic value and in their production and distribution for clinical use. Medical practice owes much to the important advances achieved by the pharmaceutical industry over the recent decades. In addition, much medical research and postgraduate medical education are facilitated by the financial support of pharmaceutical firms.
16.3  It is improper for individual doctors to accept from a pharmaceutical firm monetary gifts or loans or equipment or other expensive items for their personal use.
16.4  Some exceptions can, however be made to grants of money or equipment by firms to institutions such as hospitals, health care centres and university departments, when they are donated specifically for purposes of patients' services, education or approved research.
16.5  Clinical trials of drugs and appliances

It is improper for a doctor to accept directly or indirectly payments from a pharmaceutical firm in relation to a research project such as the clinical trial of drugs and appliances, unless the payments have been specified in a protocol for the project which has been approved by the relevant local ethical committee. It is improper for a doctor to accept directly or indirectly payments under arrangements for recording clinical assessments of a licensed medicinal product, whereby he is asked to report reactions which he has observed in patients for whom he has prescribed the drug, unless the payments have been specified in a protocol for the project which has been approved by the relevant ethical committee. It is improper for a doctor to accept payment in money or kind which could influence his professional assessment of the clinical value of drugs or appliances. Payment by pharmaceutical companies for costs properly incurred in conducting approved clinical studies is acceptable.


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