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Challenges and Opportunities of Hong Kong's Future Health Care
at IHPSR Annual Dinner in Hong Kong Club
on 17 January 2003
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by Dr C H Leong
Chairman, Hospital Authority
May I express my gratitude to the Institute for asking me to speak at your Annual Meeting.
I was asked by your Chairman to talk on Challenges and Opportunities in the Health care system.
I suppose the most immediate challenge for the Hospital Authority now is the problem of one liver transplant centre. However I will disappoint you and will not be talking on that, suffice it to say that I am confident that the two medical schools together with the Hospital Authority has only one heart - to do the best for the patients we serve. I am grateful too that the two deans, the chiefs of services are together pushing for this purpose. We all want Hong Kong, and I stress Hong Kong, to be the world's leading liver transplant centre.
On the longer term basis the budget deficit and the decrease in Hospital Authority funding must be Hospital Authority's greatest and perhaps an insoluble challenge and since the Hospital Authority is undeniably the biggest health care provider in Hong Kong, challenges in Hospital Authority will pose challenges for other health care sectors.
Yes financial constraint must be the hub of challenges and problems, but let us look at the changes in the health care scene in the last 10 years. Hopefully we can gauge the challenges and opportunities in the way forward.
Firstly and foremost whilst Hong Kong has existed amicably with a duo health care system - private and public from the word go, the market share has notably shifted to the public sector in the recent 5 years. This is a lose-lose situation and one of the challenges must be to rebalance this shift.
When I was a medical student and for quite sometime, medical service is "treatment" orientated, worse, "treatment" must be in a hospital. Even as a student of medicine I was so taught by my teachers. Today the concept is entirely changed, stress is on "disease prevention", "staying healthy", and even when one is sick the emphasis is to be treated on a community basis rather than going to a hospital. We have therefore seen a mushrooming of the need for the specialty of Family Medicine.
My mentor in surgery, is a very powerful man indeed, who believe that he is master of all trades. The then medical service is very much a "person orientated" and "self heroism". Surgeons are suppose to be able to do anything - from a craniotomy to limb amputation, and they can. Today the whole concept of medicine has changed. Team work is the rule other than the exception. No heroic surgeon would attempt a liver transplant without a perfusionist, an intensivist, a radiologist etc and the whole team. When the Queen Elizabeth Hospital was built, it was a gigantic hospital, the biggest in Southeast Asia with all specialties and providing all forms of care. It was a glory for Hong Kong. Today such big institutions are notably difficult to manage and experts are moving towards smaller centres of excellence.
To the medical profession, like it or not there are changes. The health care service in the past was very much a professional dominance game. More, it is the medical professions game. The aim is to get a patient well irrespective of cost. Nothing basically wrong with that. Today with all the expensive modern technology, with increasing patient expectations, proper management to produce cost effectiveness is essential. Not only are our aim to get a patient well but we have to ensure that the process is most cost effective and that other patients and conditions will not be jeopardize along the way. Talking about the health care professional, they will have to take another "beating". This applies more to doctors. In the past there is a strong doctor / patient relationship. Treatment is built on a complete trust between the two sides. The health care professional provides their "Quality service" all to his conscience and to the best to the patients. Today with patient rights, with better knowledge obtained from the Internet, the public and the patients become more critical. Fueled of course by a very cynical media. There is nothing wrong with this, for it keeps all of us health care workers on our tip toes. Regrettable we are being forced to provide a "patient satisfactory service" which will jack up the health care costs and corner every health care professional to practise "defensive medicine". A lose-lose situation at the end of the day.
All these are change in culture quite different from medical scenario and medical practise of the 60s or even 70s and 80s.
Yet if the health care system is to progress this culture has to be accepted by all - policy makers, health care professions and managers. The public has to change too. Gone should be the days when health care is completely dependent on Government or the health care professions. Instead health care should be a shared responsibility between the tax payers through the Government, the users, and that remaining healthy is everyone's own responsibility. The recent A&E charges in my mind is a first step in that direction. Yes revenue generation for the HA is abysmal but it is a message to the public that the user has to bear some of the health care cost.
It is obvious therefore that the health care team and the health care management and the policy makers be it in the private or public has to face the following challenges.
- Challenges of Budget Balancing;
- Challenges in properly managing patients expectation;
- Challenges in easing staff disgruntle and boaster up their morale;
- Challenges in managing an aging population.
But with these challenges, there comes opportunities.
Because of the budget constraint, Government would have to properly look at its health care policy and defined what heavily subsidized health care is for, and for whom. The principle of "target subsidy" would have to be taken on board as quickly as possible so that given a finite sum, the money could be used to help to subsidize those that need it is most.
The public sector must define properly its role. I would call for the HA, for example, to provide "some services for all" and "all services for some". Emergency and urgent cases should be seen immediately and standards should never be compromised. Yet non urgent cases could expect a much longer waiting time.
With the public sector providing only "all services for some", a percentage of its work would have to be channelled into the private. There is no need for both the private and public sector to have equivalent high technique equipments especially those that are not used that often. There is no reason why the private and public should not cooperate, with the public purchasing services from the private and vice versa.
With the possibility of a better public private interface, the private sectors should organize themselves better. There should be better transparency of charges, a proper auditing system to assure the public that a private hospital is acting as the patient's agent or advocate to monitor the health care staff. The private sector should coordinate into teams to be ready to take over and run any services that the Government is willing to purchase from the private sector. There is no reason too that the private sector should not do its conjoin effort to attract patients from north of the border given that the border will be open for 24 hours.
With the establishment of a target subsidy scheme there will be people who would realize they will need to pay substantially for medical services and they would have to consider a saving account or to take on a health care insurance. Yet the insurance industry must also put its house in order to give the public that much confidence when they are in need - something which many of us in private practise feels unhappy when making claims for their patients.
My Chairman, for many years Hong Kong has proven to have produced many high calibre health care professionals which are very much wanted outside Hong Kong. In the last 10 years since the Hospital Authority was established we have also produced many excellent health care managers and administrators. We have also produced a good health care management system unique to Hong Kong. Today we are blessed with the fact that we have a vast hinterland, our motherland that requires a lot of these expertise. Opportunities abound in the mainland, and to the younger professionals and managers I would therefore say to them "Go North, Young Man".
Ladies and gentlemen, I personally believe that challenges and opportunities abound in our environment, many paradoxically are brought on by this economic gloom. We should revert crisis into opportunities. Yet to have this take effect the whole health care stake holders will have to work in close cooperation. Internal conflict, any mudslinging will denigrate the confidence our patients have on us. The silver lining is just round the corner if we are willing to take control.
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