4 April 1999

Health Care System Reform needs all parties concerned to act positively
("Letter to Hong Kong", Radio Television Hong Kong)

(Keywords:- health financing, Harvard Report, reform, hospital clusters, quality control)

          The imminent publication of the Health Care Financing report from the consultant from Harvard has brought on another wave of discussion and debate on health care reform in Hong Kong. This is downright timely, if not already too late, as the latest Government health care policy paper for this otherwise advanced metropolis is at least a quarter of a century old. This is downright essential as the Government and the public are finally dawned to the fact, albeit too late that the quality health care cost is rising to a state that it will soon be unsustainable.

          The fact remains that the age-old time-honoured mission of Hong Kong that "nobody would be devoid of proper care due to lack of means" has often been abused and interpreted as "anyone can take advantage of the heavily subsidised public health care irrespective of your wealth". The subsidy is indeed high in the region of 97%. Yet public health care funding is limited. The resultant limited budget to provide an unlimited and insatiable need and demand has pushed our health care system to a point of near collapse.

          The Harvard consultant report, though not yet made public, as reported in the media, is very critical of the health care system in Hong Kong, citing that it belies the belief that we have world envied health indices, our system ranks worse in the Region. We were purported to be just marginally better than that of India.

          Similarly, as reported, the consultancy report has been critical of the medical profession, accusing them of working in a "black box' and that the close shop attitude of Hong Kong doctors trying to maintain a colonial elitism, coupled with a culture of protectionism has landed the Hong Kong health care system of today into such a pitiful state!

          No, as reported, even the Government has not been absolved from blame for the attitude of "benign neglect" leaving the policy decision to the doctors.

          Much of these allegations are obviously be downright erroneous and that the misunderstanding of the Harvard consultant must be brought to light so that the good name of the profession be redeemed from being overtly tarnished.

          Yet, there is no smoke without a fire. Whilst facts must be made straight, the medial profession should have the courage to eat the humble pie, admit its inadequacy, take stock of the complaints, and pledge an even more dedicated and devoted service to the patients we treat.

          In accordance with the demands of the terms of reference, it has been widely reported that the consultant has come up with his workable option for health care financing of the future: setting up an insurance programme and a saving programme, both being run by a "funding body"

Grab hold of last chance for reform

          Whether these options are workable, let alone viable, is for Hong Kong to deliberate, suffice it to say that both the consultant and the Government are oblivious to the fact that the current public health care funding system will not sustained, and that in the long term, health care cost must be shared by both public coffer and the users.

          It is imperative, therefore, that Hong Kong must analyse the report from a positive angle once it is made public. We will base on the spirit that those who can pay must pay, and analyse the practicality of the consultant's options, and at the same time make workable suggestions albeit different to those of the Harvard report to reform Hong Kong health care system for the future.

          This is our last chance; our opportunity of a life time to influence, to corner the Government to take a political stand on a best way forward for health care in Hong Kong. Allow the opportunity to slip, we can kiss goodbye to an effective health care reform to the next decade and more.

          Yet, any health care reform should not be the end all and be all. Much could be done to improve our current health care provision and to benefit the end-users in the mean time.

Hospital Authority should streamline cluster services

          As a start, the Hospital Authority which runs all the public hospitals, consumes an almost $29 billion budget and take on 90% of the market share of in-patients, can definitely streamline its service and simultaneously contribute effectively to productivity gain. This can be done via proper re-organising the cluster network concept which has been under consideration for some time. This must be put into action without delay. Under this cluster scheme, each network will be assured of providing an adequate and comprehensive clinical management services for the population of that region through sharing of work amongst the different hospitals in that cluster. Efficiency is thus gained and money is saved through minimising of duplication of work.

          Meanwhile, the Chairman and the Board of the Hospital Authority must take on a more active leadership role and negotiate with Government the role the Hospital Authority should play in the spectrum of health care. It is also the duty of the Board to come to terms with the public their expectation with the amount of funding provided. Leadership role too demands the Chairman and the Board to stand by the staff in times of needs and to take ownership, albeit unpalatable criticisms, of any problems or mishaps of the Hospital Authority. Such regrettably has not been visible in the action of the Board to the comfort of the staff.

          Proper monitoring and management of the Hospital Authority is the prerogative of the Board by statute. Let the Board Members take note that the Hospital Authority is a management body, not an advisory one.

Department of Health must redefine its role

          Again, much could also be done to the Department of Health where its role must be properly redefined. Currently the department takes on a role as the defender of health through disease prevention and health education. This rightly so must be its main job. Yet at the same time, it takes on half-heartedly a curative function in primary health care through running the general out-patient clinics.

          With the intended move to centralise the control of food and environmental hygiene, it only stands to reason that these jobs be placed with the Department of Health, so that all public health and disease control come under one roof. Needless to say, consideration must be made to hive off the curative element of primary health care and to re-designate them to either the Hospital Authority or to the private sector.

Medical Profession to act on quality control

          The medical profession must also play its part. The days when doctors are demi-gods are over and rightly so. It is not good enough any more for doctors to satisfy his or her conscience by providing the best he or she possibly could. It is essential that the service be quantifiable and subject to quality control.

          The medical profession should thus consider setting up a system within its own on health care quality assurance. These should be no delay, lest non professionals would set in to control the profession, and professional autonomy will be forever eroded.

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