20 June 1998

Government should set health financing policy
before putting cap on health care

(keywords:- health expenses, user pay, HMO, capitation)

          The media report that public health care spending might have to be curbed -- at least increase in recurrent expenditure will have to be cut to below actual fiscal growth -- is regrettably not just a rumour but a distinct possibility. Amidst the economic downturn, financial officials appear to be sending out the air balloon, claiming that the share of revenue devoted to health and welfare have already been a "phenomenal rise".

          Unfortunately, it is the poor, the needy and the burdenful front line staff that will suffer most. To the poor and needy, yes they will still get the care and treatment they required albeit after an ever lengthening queue. To the service providers, they will have to face the unfair criticism of not cutting short waiting time, something they themselves cannot control facing the insatiable demand.

          The accusing finger must be point at Government. The Administration cannot absolve itself from blame for this public health service crisis as it is entirely due to the lack of foresight and forward planning. As early as the mid-eighties, the medical profession has repeatedly warned the Government that whilst the policy that "nobody should be devoid of care because of lack of means" is essential, unlimited heavily subsidised health treatment for any conditions irrespective of financial status will not be sustainable. An update health policy and health funding policy must be instigated. Regrettably, all words have fallen on deaf ear. Bureaucratic inertness and lack of political determination was the order of the day.

          Instead, during the time of plenty -- the economic boom of the early 90s -- more and more money from the public coffer was pumped into health care to attempt to catch up with the increasing demand. Worse, in the light of rising patients' aspiration, the public health care services were providing not only a "quality service" as determined by the service providers, but a "satisfactory service" as requested by the patients.

          It does not take a very experienced soothsayer to predict that in the time of lean, the public health system will face impending bust! For with the appetite of the public wetted for an all embracing "satisfactory" public health care service; with more patients moving from the private into the public sector; coupled with the diminishing increase of recurrent health care budget, even Houdini could not pull this hat trick.

          Had the Government been more visionary, had the Government the clout to lead, it would have realised that health care should consist of two parts -- a part that is welfare for which Government must be fully responsible; and another part which is a service for which a fee must be charged. For those who are needy, the Government pays for them. For others, it should be "those who can pay, pays" and "those who can pay more, pay more".

          Had the Government been bold enough to have this implemented in the time of plenty, the health service funding would not be so critical and there would have been a better balance of funding for both the public and the private sectors.

          Yet the Government must still be responsible for its shortcomings, and before a workable health care funding policy be introduced, its established mission of "nobody should be denied of care" stays. Furthermore, the Government must be warned that it cannot hide behind the shield of economic downturn, slash or even cap health care budget and leave the Hospital Authority to handle the "hot potato".

          Nor is this an excuse for Government to quietly introduce profiteering Health Maintenance Organisation (HMO) into the private sector. It should not pull wool over the public's eyes that HMO is a high quality service with financing capitation, for it could never be to the interest of the patients nor the service providers to have a profiteering middle-man in between!

(Hongkong Standard)