Health Care Reform -- Consultation to No Where ?
：View Point； -- Radio Television Hong Kong
22 July 2001
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by Dr C H Leong
President, Hong Kong Academy of Medicine

          The recent announcement of the Government on further directions of our health care reform is at best a let down, if not disappointment, to the many in the forefront pushing for reform for decades -- though it comes as no surprise.

          In essence, under the disguise of the ：outcome： of public consultation, Government is shelving the two major areas of reform - health care financing and improvement to the system of quality assurance in health care - or at least have them put in further, if not permanent, limbo. History will show that it took decades of numerous consultations -- both locally and with consultants from abroad, multiple medical mishaps and recurrent staff disgruntle to push Government to accept that problems do exist. With the mood of health care reform to face the challenges of the 21st century mounting to a crescendo, the Government decision to further procrastinate is thus insensible, if not irrational. The thousand dollar question right now is: can Hong Kong・s health care wait?

          To be fair, the Health and Welfare Bureau will be pushing for some changes. To wit, there will be an expected charge at the accident and emergency units, possible charges for drugs at clinics, strengthening of preventive care, transferring general out-patient clinics to the Hospital Authority, developing family medicine and community based integrated services, and, of course, introduction of Chinese Medicine into the public sector.

          All these are no doubt vital. Yet, at best, they are skirting the peripheral of a very much needed total health care revamp. Without touching the core issues of health care financing and ways and means to improve quality assurance, Hong Kong is only seeing the trees but is unable to grasp the view of the forest.

Public Health Care on a Time Bomb

          Government has repeatedly refuted the claim that our health care situation is at the brink of a crisis. Yet facts speak for themselves. Attendances at our casualty units has surged 81% compared to 10 years ago when Hospital Authority took over all the public hospitals. Correspondingly, attendances at specialist out-patient clinics increased by 95%; in-patient admission 66%. Yet, in the same period, there has been an unparallel manpower increase of only 46%, versus a stringent budget increase and an across the board demand of 5% productivity gain in 3 years. Such a principle of stretching finite resource to provide an ever enlarging need has placed our health care situation on a time bomb.

          Government should realize too that any health care financing reform takes years to mature and materialize. The realization of the Mandatory Provident Fund Scheme is an obvious example. We are obviously late, but we must begin.

          To be fair again, Government has not vetoed any possible major reform. Instead, it has suggested that further consultancy be engaged overseas to study charges and impact of fees restructuring on the utilization of public and private health care services; advice will be sought from a panel of overseas experts on reform matters and policies; a working group will be set up to look at interface between the public and private sectors; another task group will be formed with the insurance industry to identify financing options. All these are useful to guide the future. Yet, haven・t we done these time and again in the past decade? Worse, with a continuum of such consultation exercises and engagement of consultants, Government would soon have exhausted itself of new consultants to be appointed and new consultation bodies to be established.

Government must come up with its Clear Direction

          Yet, no consultants, irrespective of their experience, no consultative bodies, irrespective of their commitment, will be able to offer any concrete, rational and meaningful advice and direction that are implementable in local context on a blank sheet, unless Government is willing to come forth with the backbone direction for our total health care policy.

          The crux of the matter, therefore, lies in the lamentable state that Government is still unwilling to define ：the role of heavily subsidized public health care； and ：what it is for and to whom it is for；. Whether heavily subsidized public health care is to provide all service for all, or to be a safety net for the essential services, the poor and the needy would certainly induce stark difference to the overall health market. This is a central policy which no consultant nor consultative body can provide. It is a political decision that any Government will have to decide, determine and stand firm.

Expectation for Wisdom from all Factions

          With all the controversial responses from the public, the politicians and the health care profession, it may be said that Government・s move is in line with public sentiments. Whilst democracy is always to be revered, there are times when Government has to take a leadership role and push forward with policies for the good of the society into the future generations, even in the face of ripples. This is what accountability is all about.

          Let us hope that the various political factions and interest groups in Hong Kong would be mature and visionary enough to strike for the benefit of overall Hong Kong now and beyond, rather than just eyeing on votes and sectoral interests.

          Let us hope that Government・s move this time is not an indication of procrastination, nor a sign of shirking responsibility; but an exhibition of wisdom to prepare the society for a more thorough reform in an evolutionary process, and to wait to strike when the iron turns hot.

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