Press Release

29 December 1999

Eventful 1999 embraces hopes for Changes for the Better
in Health Care Scene 
Year-End Press Briefing by Dr Leong Che-hung

          THE year 1999 was an eventful year for the medical scene, marked by expected and unexpected changes in the field, said legislator Dr Leong Che-hung.

          These include the installation of a new Secretary for Health and Welfare -- the first ever with medical expertise; the introduction of a centralised mechanism for food and environmental safety; the passage of the law on regulating Chinese medicine; the publication of the health care reform consultancy report -- hopefully a prelude to the overall reform; and the appointment of a new Hospital Authority Chief Executive, to name just a few.

          "Whether our society can grab hold of these new opportunities to build a healthy Hong Kong for the next century would very much depends on the wisdom and vision of our officials, the politicians, as well as the medical and related professions," said Dr Leong, representative of the medical functional constituency in the Legislative Council.

          "Given the prevailing political climate and the civil service culture, I have certain reservation over whether the changes will bring on the desired goal," Dr Leong told a year-end press briefing today (29 December 1999).

Overall Health Care Reform

          Stepping into the last year of the 20th Century, Dr Leong said it is imminent for the Administration to expedite a solution for an overall health care reform. Yet, the recent reports on Government's proposed fees increases made him worried that the Administration might tend to use these as window dressing tactics to cover its feet-dragging in proceeding with a total reform.

          Lately, media reports had quoted high-level official sources as saying that by 2001, the Administration is to introduce charges at accident and emergency departments and drug fees at specialist out-patient clinics.

          Dr Leong hoped that these steps are only part and partial of an overall health financing policy, which must be that "those who can pay should pay; and those who can pay more should pay more" or "health care is a shared responsibility between Government and the users"; whilst ensuring every resident have access to reasonable quality and affordable health care.

          Otherwise, Dr Leong said the mere fees increase would do little to address the prevailing imbalance phenomena between private and public sector -- unbearable surging workload in the public sector versus a shrinking demand on the private sector.

          Dr Leong said unless the public is willing to put in more taxpayers' money into public health care -- probably at the expenses of other social services like education, welfare and transport, the public health sector must always face the reality of having limited resources. With limited resources versus insatiable demand, it would not be too long before the public having to put up with long queues or declined standard.

          More, it would belie any common sense in not putting the private resources into more efficient use. Dr Leong said one typical example is that people with medical insurance are still using public medical service at the next to free of charge. Also, some medical facilities could be of more efficient use should there be share between the private and public sectors.

Areas need to be covered in reform paper

          The Health and Welfare Bureau has promised to release a consultation paper on health care reform in the first quarter of next year. Dr Leong hoped that the consultation paper would not only put forth a visionary health financing policy; but also an updated health policy -- since the last one is already some 25 years old. He expected the policy paper to cover at least:-

¡P to whom and for what public sector serves

¡P shared responsibility between Government and the users

¡P proper public-private interface 

¡P role of Chinese medicine in the overall health care scene

¡P review of dental policy

¡P overhaul of the functions of the Department of Health

¡P development of Primary Health Care

          He urged Government not to procrastinate, at the same time he also urged politicians and the public to look beyond the benefit of this generation in deciding on a visionary health care and financing reform, rather than blindly opposing any "paying more" proposals.

New Health Secretary need concerted effort within Government

          Dr Leong said any health care reform must be forward looking and should not be just looking to make financial ends meet.

          He hoped that the new Secretary for Health and Welfare, being a member of the health care profession himself, could have deeper understanding of the problems and hence wider vision to bring proper reform into fruition.

          "That is the reason why I have been pushing, in the past decade, for having health care expertise serving in the health policy making level," Dr Leong said.

          However, it would still need the concerted efforts within the Government for any reform to bear fruit. "Whether the reform would gain the support and cooperation of overall civil service would be a litmus test of the sincerity of the Tung's Government towards putting in place proper health care and financing policies for the benefit of our future generations," Dr Leong said.

Hospital Authority

          Dr Leong said the saga of funding for Hospital Authority is a vivid example of Government's short-sightness in eyeing only on turning its account book black -- at any expense.

          The high-handed order to achieve a productivity gain of 5% in the next 3 years despite the hard fact that HA has already attained some 11% productivity gain on its own since 1992 without consideration of harming service quality is a typical example.

          Another example is Government's wit in applying pressure from misled public to exert pressure to reduce the remuneration of HA staff.

          "Regrettably, HA Board surrendered without a fight and promptly act to cut the staff's remuneration package accordingly," Dr Leong commented. So far, not many Board members have come out to explain to the public that the gist of the problem actually lies in Government's unreasonable demand for HA to shoulder the unbearable burden of coping with the ever surging public demand.

Saga over Two-Tier Clinical Supervision system

          All these have resulted, at least in part, to the latest controversy over the implementation of two-tier clinical supervision system, which has been suspiciously and mistakenly pegged with the remuneration review. Dr Leong reiterated that the relevant committee of HA has in fact ruled out the linkage.

          In fact, the two-tier system is just a performance pledge that services are provided under the mechanism of specialists supervising trainees (full fledged doctors yet to attain specialist status). It can be achieved even under the present structure comprising consultants, senior medical officers and medical officers. Some hospitals and departments have actually already worked within present structure the two-tier supervision system.

          Dr Leong said given the manpower constraint, there is no urgency in implementing the two-tier supervision system in full at all levels in all hospitals at once. He urged HA to consider taking full implementation step by step. Furthermore, this has to be cogwheel in with Government's direction on health care reform, which might have a significant impact on service provision and thus manpower demand in public sector. Only by then could HA address the issues of how to work out a two-tier system totally amongst not only doctors but also other health care grades; whether there are sufficient manpower; and what is a realistic pace of phasing-in implementation.

          Dr Leong said the recent saga demonstrated a serious lack of communication between the frontline staff, the HA executives and the HA Board.

          "It is most unfair to put an accusing finger to the new Chief Executive alone. The HA Board also has its share of blame. The Board should be more accountable to the public and the staff by working more openly and monitoring the HA work more closely. The Board members must bear in mind that it is a managing board for public hospitals by statue, rather than an advisory one," Dr Leong remarked.

Chinese Medicine

          Dr Leong welcomes the promise of health officials that the forthcoming health care reform consultation paper would also cover Chinese medicine.

          With the passage of the Chinese Medicine Ordinance in July this year, Dr Leong believed that the public has all justification to demand for public Chinese medicine service. But he warned Government against simply slicing the current already shoe-string public health budget to put into Chinese medicine.

          Other than being primary health care providers at out-patient settings, Dr Leong believed that Chinese medicine could also function as a department in hospitals, just like any other existing clinical departments. That would enhance the communication between Western and Chinese medicine, while ensuring continuity of care for the patients. In fact, some public doctors have already been cooperating with Chinese medicine practitioners in the care of patients, like cancer or diabetic sufferers.

          With the passage of the relevant law, Dr Leong urged the Administration and the Chinese Medicine Council to expedite not only registration for Chinese medicine practitioners, but also working out details for monitoring the use of herbal and proprietary Chinese medicines for protecting public health.

          Dr Leong is disappointed that registered Chinese medicine practitioners are yet to have their deserved voice in the legislature. He hoped Western and Chinese medicine professions would be broadminded enough to work towards mutual understand and cooperation for public benefit.

Food Safety

          While the abolishing of the municipal councils must be a historic event in 1999, it is hoped that the establishment of the new centralised food and environmental safety machinery could really turn a healthy new page in the new century for Hong Kong.

          However, Dr Leong said the medical profession has reservation on whether the proposed new structure could handle surveillance and control of infectious diseases efficiently and effectively.

          He explained that in future, infectious diseases would be handled possibly by two departments and two bureaus -- those related to food under the new Food and Environmental Hygiene Department and the new Environment and Food Bureau; whilst others under the Department of Health and Health and Welfare Bureau.

          The medical profession believe that food safety should come within the remit of the Department of Health under a Health Bureau for better coordination of all works related to health. Also, the monitoring of food (including those self-claimed health food), drugs and medical appliances should be put under one centralised mechanism. Dr Leong said he would continue to push this ideal. In the mean time, he is confident the legislature would put in all efforts to closely monitor the duties of the new governmental mechanisms.

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Possible Areas of Questions from the Press

Hospital Authority

Food Safety

Chinese Medicine

Smoking

LegCo Election