Replies to LegCo questions

LCQ3: Professional indemnity insurance for medical practitioners

Following is a question by the Hon Li Kwok-ying and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (March 2):


Question:


It has been reported that the premiums paid by private medical practitioners for taking out professional indemnity insurance have risen considerably in recent months, with the premium payable by obstetric and gynecology doctors rising by up to 92 per cent. Some private medical practitioners have indicated that they will consider ceasing the provision of the high-risk obstetric service in order to reduce insurance premium expenses. In this connection, will the Government inform this Council:


(a) given that those medical practitioners who have turned to private practice soon after completing specialist training in public hospitals may not have a sizable income at the early stage of practice, whether it has assessed the impact of the increase in the insurance premiums on them, and whether it will offer assistance in this respect;


(b) Whether it has assessed the implications of some private medical practitioners' ceasing to provide obstetric service on the demand for that service in public hospitals, and whether there will be a shortfall in obstetric service in the future as a result; if so, of the assessment results; if not, the reasons for that; and


(c) given that one of the factors contributing to the substantial increase in the insurance premiums has been the huge amounts of compensation awarded to several medical negligence claimants in recent years, whether it will consider legislative amendments to set a statutory ceiling on the amount of compensation for claims in medical negligence incidents, to curb the increase in the insurance premiums?


Reply:


Madam President,


There are a few commercially operated professional indemnity insurance (PII) schemes available for medical practitioners (MPs) in Hong Kong. They are arranged through various medical professional bodies, i.e. the Hong Kong Medical Association (HKMA), the HK Public Doctors' Association and the HK Doctors' Union. The PII scheme managed by the Medical Protection Society (MPS)(Note) through HKMA is currently the only scheme available to MPs practicing in high-risk specialties including Obstetrics and Gynecology (O&G), neurosurgery, cosmetic surgery etc.


Operating solely by subscription of its members, MPS provides its members with indemnity against legal costs and damages in case of negligence claim or other medical-legal challenges arising from their professional practice. Claim frequency and claim size vary among different specialties owing to different inherent risks associated with the practice of the specialties. The specialists working in areas of higher risk therefore face higher premiums. The Administration is aware of the concern of the medical profession about the rise in the premium for the PII scheme provided by the MPS, especially for the high-risk specialties, and noted that the rise is mainly attributed to the increasing number of claims and the amount of compensation awarded.


MPs practicing in the public sector are covered by a master policy arranged by their employer to cover liability arising in the course of their employment. Nevertheless, many of these MPs also choose to take out their own PII, and are offered standard rates by the MPS regardless of their specialties at a level much lower than that offered to those in the private sector.


(1) and (2) In the past five years, the number of MPs turning to private practice after completion of specialist training in O&G at public hospitals ranges from 1 to 4 each year. The Administration has not made an assessment on the impact of high insurance premium on the practice of these specialists, and whether there is consequential impact on the demand for O&G services in the public sector.


It should be noted that at present, there are over 360 O&G specialists in Hong Kong and about two third of them are in private practice. Owing to the large number of O&G specialists in private practice, we do not consider that any cessation of service provision by individual O&G specialists because of high PII premium would necessarily lead to an increase in the demand for O&G service in the public sector.


The Administration noted that the HK College of Obstetrics and Gynecology of the HK Academy of Medicine is setting up a Task Force to assess the impact of the premium level on the practice of its members, including their willingness to continue to perform high-risk procedures, through an opinion survey to be conducted among the College members.


The Administration will keep in view closely the outcome of the study to be conducted by the College, and any change in the demand pattern for O&G service in the public sector.


(3) Any rise or fall in premium, claims and compensation for professional indemnities in the medical profession may be the result of a myriad of intertwining factors, such as inherent risk of medical practices, communication between the medical practitioners and the patients on the risk of medical practice, the changing litigation culture, etc.


In Hong Kong, our law recognises that the victims of personal injuries, including medical negligence, are entitled to be awarded by courts full compensation for loss attributable to the fault of the tortfeasor. In assessing the award of claims under common law damages related to medical injury cases, the principle is to compensate the victim in such manner that his original position can be restored in so far as this can be done by the payment of money. Save in exceptional circumstances, the damages awarded are purely compensatory, instead of punitive. The common law also recognises the sense of fairness that wrongdoer should be responsible for the consequence of his acts or omission. From a legal point of view, capping compensation therefore seems to be inconsistent with such common law principles. It will have read-across implications upon other compensation-seeking situations. Capping of compensation may also lower deterrence of medical malpractice and erode the responsibility for risk management by MPs. All these implications would need to be carefully and thoroughly studied before a decision on capping should be taken.


The PII scheme for MPs seeks to protect them from legal problems arising from their professional practice, and the service recipients against malpractice and negligence. The medical profession has a responsibility to bear the cost incurred by the risks associated with their practice. To lessen the frequency and severity of claims, and consequently lower the financial burden of MPs to subscribe insurance protection, controlling, managing and reducing the risk of medical practice through good medical practice, developing trusting doctor-patient relationship, and timely clarification, response and handling of unfavourable clinical outcome by MPs constitute to a more pragmatic approach to address the issue.


Note: MPS is not an insurance company but a mutual medical protection society operating in over 40 countries by subscriptions. In case of a negligence claim, members of the MPS will be provided with complete indemnity against legal costs and damages awarded on a discretionary basis according to the track record of the members.





Ends/Wednesday, March 2, 2005

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