Subscriptions in Hong Kong

A member who has the good sense to stay within the limits of their training, skills and competence could be forgiven for thinking they are subsidising some of their less cautious colleagues. On the other hand, we are generally reluctant to penalise dentists simply because of the kind of work they do if they are doing it exceptionally well. It is never easy to decide where to draw the line between one category and another, and the boundaries need to be clearly defined and measurable.

Maxillofacial procedures

One of the most obvious anomalies we have addressed in recent years relates to oral and maxillofacial surgeons (OMFS), many of whom are medically as well as dentally qualified. Until fairly recently, there has been a wide difference in subscription rates, according to whether an OMFS has chosen to be a medical (MPS) or dental (Dental Protection) member of this organisation – a situation which obviously made no sense at all.

Many of the procedures undertaken by OMFS are quite unlike those carried out by general practitioners and we have already addressed this in countries like the UK, Australia and New Zealand, where OMFS typically pay a subscription which varies from 2.5 times to 4.25 times the general practitioner rate, according to the range of procedures undertaken. We approach each jurisdiction on the basis of our experience in that particular country, rather than looking for a ‘one size fits all’ solution.

On the one hand, it must be recognised that in many instances, potential claims against general practitioners who run into problems when undertaking minor oral surgery are averted (or their scale minimised) because of the timely expert intervention of an OMFS colleague who comes to the rescue. This is a mutual organisation, after all, and we need to balance our founding principle of risk pooling and sharing with the self-evident need for fairness and equity.

It is an established principle within MPS and Dental Protection that high-risk specialties should not be priced out of their ability to practise – all other members of the profession, and the public, benefit greatly from their expertise and its continued availability. At the same time, a ‘normal’ member, carrying out a ‘normal’ mix of lower-risk procedures, must feel comfortable and confident that they are not cross-subsidising those who carry out higher risk procedures.

Defined procedures

While it remains the case that a disproportionate number of claims are arising from general practitioners carrying out orthodontics, and because of the sharp rise in implant-related claims, we introduced a four-level distinction to take into account the extent to which members are involved in these specified procedures and in maxillofacial procedures as we define them.

Members who represent a special risk

It would be quite wrong to jump to the conclusion that every dentist who has a higher than average number of cases or who perhaps involves Dental Protection in a higher than average expenditure on claims, legal and advisory costs, must necessarily be a ‘bad’ dentist.  Some dentists face additional problems largely because of where they practise, the patients they treat or the kind of work they undertake. Some dentists go through periods in their careers where additional pressures are created by health problems, social/domestic upheavals, financial difficulties or other factors. As a mutual organisation our first instinct is to help and support our members through difficult times like these.

It is also illogical and unfair to suggest that any member who has a single large case should pay more. Sometimes it is a question of luck as to whose surgery door a particular patient knocks on. Making mistakes is a human failing and inevitable in clinical practice – what is more worrying is when a member keeps making the same mistakes or seems unable to learn from past mistakes. Dental Protection can and should have a role in helping these members to understand and correct whatever it is that they are doing wrong.

Not surprisingly, however, other members who make very few calls upon the services of Dental Protection will often ask whether they are effectively subsidising colleagues with a less favourable history of claims/complaints and other calls for assistance.

A lot of our legal costs in HK relate to the cases involving the Dental Council, and a small minority of members have had several such cases – especially involving advertising/canvassing – that have incurred very significant legal expenditure when dealing with them. Other members who respect the Dental Council guidelines may feel similarly resentful that they are somehow paying the price of those who choose to consistently disregard them.

In future, Individual dentists who (for a variety of reasons) are felt to represent a particularly adverse risk for the mutual fund will pay a higher subscription to reflect both this additional risk. For this purpose we have established four special membership grades.

Specific definitions relating to dento-alveolar surgery (including implant placement), oral surgery and maxillofacial procedures

Dento-alveolar surgery

Surgery involving the intra-oral tissues, teeth and tooth carrying bones, ie, mandible and maxilla only. This includes procedures such as:

• Exodontia (including wisdom tooth removal), apicectomies, periodontal surgery
• Minor cyst removal, dental cyst removal
• Minor pre-prosthetic surgery
• The full general practitioner rate includes any or all of these procedures.

The placement of dental implants is a specified procedure, for which special conditions apply (see below).

Maxillofacial procedures

Surgical procedures extending beyond the dento-alveolar procedures as defined above, and falling within the recognised specialty of oral and maxillofacial surgery – including (but not restricted to) procedures such as:

• Open reduction of complex fractures
• Advanced surgical treatment of malignancy and other pathology
• Osteotomies (maxilla and/or mandible)
• Surgery involving the salivary glands, neck, TMJ or orbital complex
• Rhinoplasty.    

Click here to view the Hong Kong subscription rates.