21 March 2000

Culture of Over-Reliance on Government brings worries

(Keywords: over-dependence, charges, health financing)

          It has been said that the Hong Kong public has adopted a culture of over-dependence on the Government. When a securities firm collapsed, those who placed their financial trust on it with their eyes open demand that Government should reimburse their loss in full. Yes, it must be the prerogative of any responsible government to provide a safe haven for the public to make a living, develop their interest, raise their family and be well protected by law. Yet, every individual must also bear their own responsibility on something they choose.

          The demand on health care services is no exception -- the public expect that health and health care be handed by Government to them on a plate.

          To wit, at the height of cholera outbreak in Hong Kong a couple of years ago, many people were still seen sucking away the meat and juice of uncooked cockles, the known source of the infectious disease. Their excuse: "Cholera is Government's problem, not mine." Such example regrettably is not an isolated one. Instead it signifies a culture that our public are not willing to take their own health into their own hands.

          Few would not subscribe to the fact that Government has the duty to curb infectious diseases. Yet, keeping oneself away from harms' way must be a personal responsibility, when the individual is still healthy.

          For those who are sick, their over-reliance on Government is no less, though in a different perspective -- to provide heavily subsidised public medical service for all illnesses and for everyone irrespective of their financial status.

          The turmoil that followed the suggestion to lay charges for services, currently free, in the accident and emergency departments of our public hospital served as a good example.

          Since the Hospital Authority took over the management of public hospitals in 1991, casualty attendance has increased by some 78%, reaching over 2.36 million in 1998/99. Worse, some 76% of these are far from being critical nor urgent.

          Many factors account for the inhumane workload -- the casualty departments provide one-stop services; there are no patient quota; and they are always open. Perhaps just as important, if not more, is that the casualty departments are completely free for all irrespective of the degree of urgency of the condition and wealth of the patients.

          Ever since the controversial idea to charge was "floated" out to test the temperature, political parties have been strong in raising objection. Politicians have called for 24-hour out-patient clinic service to solve the overcrowding of our casualty departments. Ironically, a survey has revealed that the peak hours of attendances at casualty departments coincide with the time when all government clinics and most private clinics are open.

          The over-dependence of Government in providing a free, or next to free, service must be one of the major factor for overload in our public hospitals.

          But is the public solely to be blamed? To be fair, Government's health promotion drive is blatantly inefficient. Nor has our Government been willing to set up Health Targets -- quantifiable goals to reduce the mortality and morbidity of certain prevailing preventable diseases during a set period of time -- so as to stimulate the public to take ownership of their own health.

          Similarly, whilst our public hospital services are using a limited budget to provide an unlimited demand, Government has yet to come up with a policy to define the financial role of affordable users when getting health care services.

          The consultation paper on health care reform is on the way. Hopefully, these and other daunting issues in health care will be properly and prudently addressed.

(South China Morning Post)