30 May 1998

Convince public of the need to change
by using adequate and unbiased informations

(keywords:- healthcare expenditure, Hospital Authority, surging workload, financing policy)

          The problem of ever lengthening queues for various services at our public hospitals and clinics has again sparked the argument of whether we need to further expand our public medical services; or whether our officials have used the lion's share of public money cost efficiently.

          With an apparent conception that money put in public medical service has jump by leaps and bounds over the past decade, it is not surprising for the general public to blame the Hospital Authority (HA) of being incompetent. Regrettably, such sentiment has been strengthened by the repeated yelling of Government officials that public healthcare expenditure has enjoyed vast surge. More, in an attempt to discredit our public medical system, some candidates of the recent legislature elections even chose to use the budget figures misleadingly.

          Yes, from the figures on the surface, public healthcare expenditure has grown from $4.3 billion in 1986/87 to $25.1 billion in 1996/97. Yet, without having compared like to like, it is far too dangerous to jump to the conclusion that such 4.8 fold increase in spending has been "wasted", given that accumulated inflation alone had already accounted for 77% of the "increase".

          For HA, its recurrent expenditure has grown from $11.6 billion in 1992/93 -- its first full year budget -- to $21.5 billion in 1996/97. Yet, let us not be fooled by the figures that HA budget has doubled. Instead, much of the so-called increase in HA budget are simply due to different accounting systems before and after HA's establishment. The fact remains that Government had stated categorically that the financial provision for HA would be as if public medical services was still run by civil service.

          Prior to HA's establishment, ex-subvented hospitals were being treated as sons of the concubine. Not only were their facilities poorer than their ex-Government counterparts, their staff were also receiving fringe benefits far below those in the civil service. To bring the facilities, staff strength and staff fringe benefit of ex-subvented hospitals to be in par with ex-Government hospitals requires considerable amount of investment.

          In the past, various fringe benefits of Government hospital staff, like pension, housing, education, were provided in kind. Yes, Government had to bear the cost -- some 16.5% of the recurrent healthcare expenditure then. Yet such hidden figures were never put in healthcare account book. With the setting up of HA, these have become explicit figures in HA budget.

          There were many others in the same hidden category. For instance, in 1996/97 alone, HA has to pay $90 million for government services (like water, printing, auditing) which were previously provided free to public hospitals. The taking over of the non-emergency ambulance service from Fire Services Department amounted to $50 million. The Electrical and Mechanical Services Department charges HA $538 million in 1997/98.

          If we are to compare like with like, basing on the same accounting method, total public healthcare expenditure actually accounted for 11.1% of total public expenditure in 1990/91 -- prior to HA's establishment. That has only risen to 11.9% in 1996/97.

          Instead, the budget increase for HA has actually far lag behind the rise in demand. Statistical figures in the past three years shown an increase of over 50% in casualty attendences; 45% in specialist out-patient attendences; 35% in in-patient discharges; to name just a few. Yet, the real growth for HA recurrent budget during the same period has been a mere 30%.

          Inspite striking hard to maintain quality services in face of surging workload, regrettably, HA doctors still face rising public criticism of earning too much and even rising advocacy of having their pay cut. No wonder staff morale is in the decline.

          To convince the public that we can no longer use limited resources to cope with infinite demand, we need to provide them with adequate and unbiased informations. It is time for Government and politicians to stop pulling wool over public's eyes, come forth with proper figures, and to establish a workable medical financing policy for Hong Kong into the next century.

(Hongkong Standard)