25 September 1999

Challenging problems on the plate of
the new Secretary for Health and Welfare

(keywords:- Secretary for Health and Welfare, health financing reform, elderly, social security allowance)

          The imposition of the new Secretary for Health and Welfare this week heralds a new era for health care in Hong Kong. For the first time in our history, a health care professional was appointed to take the helm of a policy making bureau, hitherto the untouchable realm of the Administrative Officers. The health care professions place an enormous hope in Dr E K Yeoh not only to work out a better health care system using his unchallengable expertise in the field, but also to set an example that the health care professionals "can".

          The new Secretary thus faces an inevitable and daunting task especially in these days of economic lean where Government insists a 5% productivity gain within three years. Worse, unlike some other bureaus, the two portfolio under Dr Yeoh are never for revenue generation. Instead, money is never enough to satisfy the insatiable yet essential needs for health care and social welfare. To wit, in 1999-2000, the two sectors together consumed one-third of overall government budget. Recurrent expenditure in social welfare and health have risen by 120% and 40% respectively in the past five years year -- much faster than other policy areas.

          In the context of public health care, it needs more than a hat trick to pledge for maintenance, if not betterment, of standards of services. It needs more than a pledge that no indiscriminate layoff is needed for achieving savings to maintain the staff's morale in the face of significant budget cut.

          Perhaps even more daunting for the new Secretary will be the way ahead for health care and health financing reform. Now that all the submissions in response to the Harvard Report are collected, the public demand to know Government's plans ahead. It will be a test for Dr Yeoh to come up with suggestions appealing to the public, politicians, health care professions and Government alike, and yet to be pragmatic.

          Given the ever aging population and surging social security payout, social welfare will inevitably be an even bigger problem in the new Secretary's plate.

          In Comprehensive Social Security Assistance, whilst the resources put into detecting abuses must be proven of its cost-effectiveness, Government should be careful in not instigating in the society a negative feeling or biased label onto all CSSA recipients. Other than placing the unemployed CSSA recipients in community services, there needs more concrete incentives and means to help them re-enter the workforce.

          On caring of the elderly, whilst the concepts of "continuum of care" and "ageing in place" have been affirmed repeatedly by Government as central to policy for years, little concrete progress could be witnessed.

          Many elders requiring residential services are still trapped in the "revolving door", being pushed around among various welfare and medical institutions. Some 70% on the waiting list for elderly residential places are not receiving any community care. The out-reaching health care teams are lacking resources to extend assistance to the many private elderly homes. The inter-departmental group within Government to work on accelerating supply of elderly residential places is yet to prove its worth.

          All these, tips of the icebergs, have already indicated a lack of coordination amongst various sectors. A well orchestrated, streamlined interface of services would not only serve our senior citizens better, but also ensure resources being used cost-efficiently. In the same token, a proper interface among the Department of Health, Hospital Authority and private sector is in desperate need, yet long overdue.

          It would require the determination of a visionary and energetic Secretary to tear down all these bureaucratic barriers!

(Hongkong Standard)