25 December 1999

Mere fees increase no solution for overall health system problem

(Keywords: A&E charges, specialist clinic, health financing)

          The recent suggestion by the Government to introduce charges for patients attending emergency and specialist out-patient departments of the Hospital Authority (HA) raised many questions -- in particular whether this is a stop gap measure or whether it is part and partial of a forthcoming complete health care reform.

          Few would disagree that the public accident and emergency service is heavily abused, to say the least. Many attend are for the sake of convenience or because there is no charge.

          Yet, is a simple introduction of a fee, irrespective of the amount, the be all and end all solution? Unless other provision of health care services are available after office hours or at night, it would be improper to deter any sick persons from attending the sole available health care service by imposing a charge when the majority of the public do not have the knowledge to determine the degree of urgency of their illnesses. On the other hand, if the levy of charge is for income generation, unless the charge is substantial, the total income may well be an insignificant one in the total HA budget.

          The introduction of a fee for attending the specialist out-patient clinics should be considered in the same light. If the aim is to boast resources, the amount is again a drop in the ocean. If the exercise is to cut down over-surging attendances, the Administration is barking up the wrong tree, for few would be deterred by a one off attendance charge when the subsequent admission to hospital for treatment is next to free.

          The gist of the overstrained public hospital services must be addressed. In essence, our public hospitals, since the taking over by the HA, is that of a "cheap, efficient and patient-satisfactory service".

          For the price of a tram ride, the public is being carried around in a chauffeur driven Rolls Royce. Worse, under the misconception that adequate resources has been allocated to the HA, the public is continuously "asking for more". Foolishly, the HA has unrelentlessly complied, never raising any resistance, often times surrendering to the Administration at the drop of the hat. Little wonder that the HA is now a victim of its own success.

          All these "good works" have been achieved through a continuous process of insatiable productivity gain by the HA. It has worked initially through the streamlining of management. It has worked for a while by urging the staff to work even harder until now it is at the point of whipping a dying horse. Patient attendance number, are forever increasing. Yet staff numbers have remained static. Service standards irrespective of the dedication of the staff are bound to deteriorate.

          There is yet another angle. Many patients hitherto could afford private health care are now using public service taking advantage of the heavily subsidised efficient care. The private market has become significantly lean. Few in the public service will thus be attracted into the private market albeit the heavy workload of the public hospitals.

          More, the low staff turnover rate, in particular doctors, leaves very few openings for promotion and new employments resulting in the lack of training posts for new graduates.

          A total revamp of the public health care services, in particular the introduction of a shared responsibility between service users and the Government, is thus in dire need. The concept that "those who can pay should pay and those who can pay more should pay more" must be the way ahead.

          Let us hope the introduction of charges in the relevant public hospital services is the beginning of a step in this direction.

(Hongkong Standard)