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Introduction

Professor Jean Woo, Professor Rance Lee, Professor Albert Lee, Distinguished Guests and Fellow Healthcare Colleagues, Ladies and Gentlemen,

            It gives me great pleasure to participate in this Family Medicine Symposium.  I note from your two day programme the great range and diversity of topics to be covered.  Your valuable discussions in the next two days will add to the wealth of knowledge to help Hong Kong develop a key healthcare resource – a comprehensive primary care service.

            In my talk today, I will cover :

(a)                Public-Private Collaborations : The Global Perspective

(b)               Present Challenges in Hong Kong

(c)                Proposed Initiatives to Enhance Public-Private Collaboration

(d)               The Way Forward 

(a)        Public-Private Collaborations : The Global Perspective 

            As noted at the 2002 International Health Summit on Public-Private Partnerships (“PPPs” for short) there is growing global interest and expertise in the development and management of successful PPPs for enhanced health sector performance.  By developing cooperative relationships – formal and informal; local, national or multi-national – that are dedicated to maximizing health gain for individuals, families, communities, and nations, PPPs are increasingly seen as a way to take advantage of the good things the private sector has to offer, while simultaneously ensuring that the values and goals of the public sector remain at the forefront of any initiatives. 

            The underlying rationale behind PPPs in health is relatively simple.  Health is too important, too complex, and too expensive to be entrusted to any single sector of a society or its economy.  Maximizing health requires mobilizing the creativity and resources of many organizations.  Government agencies; non-governmental organizations (NGOs); foundations; and commercial enterprises all have information and resources that need to be mobilized to improve a population’s health.  All these players need to leverage and coordinate their talents and finances through carefully planned and operated partnerships for health gain.   

            It was Louise Frechette, Deputy Secretary General of the United Nations, who said that : “Governments today readily recognize that they can’t do it all, that a society’s goals can only be realized through the combined efforts of civil society groups, private sector businesses, philanthropic organizations, and others …” 

            In mentioning the above points, I have deliberately not started my talk by saying that we should have more PPP, because the governments of the world are increasingly running out of money to bear the responsibility of solely, or even being the major provider, of a service as necessary, but as increasingly expensive, as healthcare.  This is to make the important point that there are good philosophical reasons as well for promoting a healthy public-private balance in the provision of healthcare. 

            Having made that first point, however, we also have to face the increasing challenges of ensuring a sustainable health service for ourselves, our children, and our children’s children. 

            Across governments and borders, affecting both rich nations and poorer ones, the rising costs of medical care and health programs are an international trend.  Factors include : aging of populations, rising levels of consumer demand, political pressure to increase health spending, the pull of new technology, and increased costs of labor and supplies, especially pharmaceuticals.  Many different solutions are currently being employed, but none seem completely effective. 

            A rapid rise in health expenditures is a global phenomenon.  The World HealthScan panel predicts a surge of health spending, increasing by 25 percent from $2.9 trillion (2000) to $4 trillion in the year 2007.  A recent forecast of health expenditures for the U.K.’s National Health Service predicted a rise from the current 68 billion pounds to between 154 to 184 billion pounds in twenty years (2022-23), at an average annual rise of 4.2 to 5.1 percent in real terms (Wanless 2002).  Health expenditures have been rising in Australia at 2.7 percent per year, despite putting in place a “raft of cost containment programs” (European Observator of Health Care Systems 2002). 

            So Hong Kong is not alone in its predicament!   

            As countries struggle with limited resources and in-house capabilities, there are hopes that the private sector may provide additional services, whilst the available limited public resources are spent as efficiently and effectively as possible. 

            The healthcare canvas is however very broad, and this conference may therefore be particularly interested in the results of a web-based global survey carried out by the International Health Summit, asking nearly 200 healthcare leaders around the world where in the range of healthcare services they felt the most promising areas lay for developing PPP.  You may be interested to know that in the list of opportunities for healthcare services, primary care clinics topped the list. 

            So even in the eyes of healthcare leaders, primary care is a rich opportunity for PPP collaborations. 

(b)       Present Challenges in Hong Kong 

            One of the unique cornerstones of Hong Kong’s relatively successful health care delivery system is our dual private and public system.  The provision of a strong publicly-financed health delivery system is the ultimate safety net for most Hong Kong people.  This is not only limited to the economically underprivileged, but also for other people in case of catastrophic illness.  However, I believe that with the pressures of economic downturn and future financial constraint, the public system has to better focus its resources for the public with diseases of greater financial risk and urgent and acute illnesses, with individuals taking up more responsibility for their medical needs in the primary care and elective situations.  This can then be complemented by the private sector where most of the primary and health promoting services can be provided, as well as the expansion of options for individuals who can afford to pay for better privacy and personal choice. 

            In December 2000, the Government released its consultation document on health care reform, “Lifelong Investment in Health”.  A comprehensive package of reform measures, including but not limited to alternative models of health care financing, promotion of private health insurance and a comprehensive fees and charges review, were put forward.  One of the key strategies in the total health care reform package being considered by the Government, aimed at ensuring sustainability of the current system, is to adjust the balance in utilization of public and private health care services.   

            Not surprisingly, however, there is resistance to “privatisation”.  Those who oppose it have legitimate concerns that private healthcare may put profits ahead of publicly held values, such as ensuring access to services for the poor.   

            Out of the diverse voices, and the complex political milieu in Hong Kong, I hope that a consensus may be reached that will enable us to set off on the long journey ahead. 

(c)        Proposed Initiatives to Enhance Public-Private Collaboration 

            The HA is in general supportive of comprehensive health care reform to ensure the sustainability of the health care delivery system in Hong Kong and the high quality medical services that is currently provided to the public. 

                        In this regard, the Hospital Authority has included in its most recent Annual Plan a number of initiatives to enhance public-private collaboration, including developing various collaborative service models, developing clearer and explicit referral protocols between the private and public sectors and enhancing information linkage between the two sectors and, in so doing, facilitate the freeflow of patients between the two sectors. 

            The Family Medicine specialty is also one of the most advanced in the HA when it comes to PPP initiatives, with private sector involvement in both training and service provision. 

            At present HA has recruited over 20 private part-time Family Medicine (“FM”) specialists who are helping HA to provide accredited supervision to HA's FM trainees.  As a pilot, our Kowloon West cluster has recruited 14 sessional GPs from the private sector to provide GOPC service.  Furthering of the pilot is being considered next year by developing a service contract-out program to contract out part or the whole of the GOPC operation for selected clinics to the private sector, beginning with KW cluster.  Further, with the extension of the Visiting Medical Officer/CGAT Collaborative Scheme, which has already commenced last week, we are glad to be able to welcome private colleagues to provide their valuable experience in the medical care of elderly residents in Old Aged Homes (OAHs). 

           I must here also recognise the valuable contribution of the private primary health sector during the recent SARS crisis, where some private family practitioners volunteered their services in HA’s GOPCs.  This selflessness, and the opportunities to further enhance PPP co-operation should SARS recur, is to be much commended. 

            Indeed, the HA’s direction is that the private primary care sector will play a pivotal role under the concept of “pluralistic primary care”, where the goal of the HA’s Family Medicine training programme is to develop well-trained family physicians for the community.  Trainees therefore leave the public sector to join private practice upon completion of training. 

            To prepare trainees to join the private sector, community-based FM trainees in their last year of basic training are being deployed to supplement HA's VMO scheme to support elders in OAHs.  It is hoped that by establishing working relationships with OAHs during the training period, those FM-VMOs will continue providing regular consultation fee-based consultation services to the OAHs when they establish private practices after leaving the HA. 

(d)        The Way Forward

            It has been said : “He who can foresee affairs three days in advance would be rich for thousands of years”. 

            Where do we go from here?  Will we, to borrow a term much loved by the economists in Wall Street, achieve a hard or a soft landing in our healthcare reforms.  A lot will depend on : 

(a)               how the nascent economic recovery in Hong Kong progresses in the coming years;

(b)               how committed, and united, our society remains;

(c)               the ability of our leadership to draw different ideologies together; and

(d)               the ability of the private market to respond to customer expectations. 

            What I am certain we shall need is : 

(a)         much more innovation and leadership – in both public and private sectors;

(b)         continued breaking down of the public-private barrier;

(c)          winning public support for increasing the proportion of resources committed by the community to health;

(d)           continued capturing of system efficiencies, through managed price and quality competition within and between public and private sectors; and

(e)            ensuring that we continue to carry with us the trust and commitment of our patients; because healthcare is, at the end – a people business; a patient doctor relationship, lose that, and an essential time honour element of our profession is lost. 

            I should also remind fellow professionals that we are now a part of China, with all that entails.  Vast new vistas will no doubt unfold over the years, as the economies and peoples of the 2 territories move ever closer together.  The breaking down of artificial geographical and professional boundaries will mean opportunities for PPI collaborations, not just in HK, but between Hong Kong and China. 

            So, in a world where paradigms, situations, circumstances, are ever-changing, I believe we must not forget a most fundamental strategy: that we must remain flexible, and alert, and ever prepared to adapt to changing situations – only then will we truly be ready for the challenge that awaits us.    Thank you.