17 April 1999

Sustained Public Discussion vital in
pushing for thorough Health Care Reform

(keywords:- Harvard Report, medical profession, financing, structure, policy, debate)

          As expected, when the "Harvard Report" whirlwind into Hong Kong, health care reform was the talk of town -- filling up media coverage. Let us hope that the fire of enthusiasm will be kept ablaze, and that the discussion will metamorphose into suitable and pragmatic solution of health care reform to bring Hong Kong into the next century.

          Up to now, most responses appear to be off the cuff, not having "combed" the Report in detail. The focus of discussions of the community has been on the financing options, especially the Health Security Plan (HSP) -- a mandatory medical insurance scheme -- and the long term care saving account (MEDISAGE) so recommended by the Harvard Team. Much concern has been raised over whether the general public could afford to contribute more, over and above the levy to the Mandatory Provident Fund to be implemented by the end of next year; as well as the fairness of "risk pooling" concept to the middle class.

          To add to the panic is the scant revelation of what one could get out of such schemes. According to the Harvard Team, the 1% to the MEDISAGE throughout one's working life would only be able to cover a retiree's nursing home expenses for 30 months. More, to discourage abuses, people would have to co-pay some $5,000 out of pocket for a 7-day stay in hospital even with HSP coverage.

          Yet, the Report goes beyond suggesting health care financing models. It also calls for changes in our health care policy and structures beginning at the very top. It is thus imperative that a debate with greater width and depth on how to improve our health care structures and financing must be instigated. Public debate needs to be sustained. The $5 million consultancy cost would have been wasted if our community fails to grab this chance to push for a thorough reform.

          The worse scenario is to allow Government to utilize any excuses either to procrastinate or seek piece-meal window dressing changes, or simply shrug off Government responsibility -- financially or otherwise -- putting the blame onto the divergent views of the public.

          Yet, who is to steer future public discussion?

          As the party to commission the consultancy study, the Government should logically take up the task. Regrettably, health officials have pledged that they are to hide behind the shield of "we do not have predestined stance".

          What about members of the Steering Committee on the consultancy study? After all, they should help to "sell" the Report, some may say. Ironically, the final Report has never reached the Steering Committee before putting into print, let alone endorsed by it. Worse, when comments or input of Committee members have barely been taken into consideration nor even responded, how could the Committee take ownership of the product so produced?

          The professionals concerned, the academics and the pressure groups should therefore take up the societal responsibility of sustaining constructive public discussion on health care reform.

          Some might challenge the validity of doctors, nurses, health executives, insurance people, or any health care related personnels in taking a lead in the process of public debate, claiming that they have vested interest. Yet, should such logic prevails, any one in our society -- except those who have never had health problems -- would have to evade from expressing their views. In the course of debate, the society must treasure the expertise and trust the conscience of our professionals. In the same token, professionals should never be so narrow-minded as to safeguard their own interest at the expense of the society's long term benefits. Let the professionals show their worth and vision.

          Similarly, instead of eyeing only on the votes in elections in short run, our politicians should have the courage and vision in guiding the society for the best way forward.

          The reform of Hong Kong's health care for what it is worth is in everybody's hands!

(Hongkong Standard)