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Address to the Federation of Medical Society Annual Dinner 2005

Crisis & Opportunities

It is indeed an honour is be invited to address the Federation on your Annual Dinner. Let me take this opportunity to wish the Federation every success and that you all will have a wonderful X’Mas and a prosperous 2006.

Hong Kong has struggled through an economic crisis, survived the SARS onslaughter. From the look of things, the economy is improving, the unemployment rate is decreasing, we are moving from deflation into inflation, the society at large is again showing its vibrantcy. But are we complete out of the woods.

In the presence of representation of the different sectors of the Health Care profession I thought I would outline to you the possible crisis and opportunities that are or will be affecting the health care service if not the society at large. These are of course my personal news which many in the audience might not agree nor concur. If these views do upset anyone in the audience I do apologize.

Let me start by sharing with you 5 real crisis. These are by no means exhaustive, nor am I crying wolf, for the dangers are lurking and the crisis real :-

   ‧ Crisis of the aging population;
   ‧ Crisis of the collapses of the public medical service;
   ‧ Crisis of breaking down of health care professional/patient relationship;
   ‧ Crisis of emerging or re-emergence of infectious; diseases; and
   ‧ Crisis of an immature democracy.

Let me elaborate.

The crisis of the Aging Population

The life expectancy of HK people and for that matter round the world is growing rapidly. In the 50’s & 60’s the average life expectancy is 50 – 60 years old. Today, the life expenditure of males is in the region of 78 years and females 84. Whilst it is good that we all living longer, the crust of the matter is that the ratio between the young and the elder is moving rapidly to the elderly. Today, one in seven people in HK is over 65 years old. In 20 years time one in 4 will be 65 years old.

What then is the crisis. It is obvious that, there will be more and more elderly and by comparison less and less young people – Looking at it bluntly there will a decrease in number of tax payers and increasing number of retirees.

The leaders of today must start to look at this problem of social imbalances and consider ways and means to first maintain the public financial position and secondly how to take care of this enlarging elderly group to assure that they are well looked after, well cared for, maintaining their health and perhaps provide opportunities for them to resume work and gainful employ to cater for the society.

The problem not only confronts the leadership of Government but each and everyone of us, be it in a Governmental sector or in the world of business.

To wit, we might have to consider the issue of widening our tax base to booster Government’s public revenue. We might have to make alterations to our retirement age or at least make provisions for gainful employment for those beyond the set retirement age.

business opportunity if not an entire new enterprise.

The crisis of the Collapse of the Public Medical System

HK has a public medical system that is second to none. For a $100/day or less if you are assesses to be in financial risk, you could have the best state of the art investigations and treatment. Many, even have this amount waived. This is to honour government motto “that nobody should be devoid of care because of lack of means”.

Things are easy in bygone days when medical cost is cheap. Today medical cost is exorbitantly high drive by :-

Rapid rising cost of new medicine and new technology;

Aging populations (to wit over 40% of the HA beds are occupied by people over 65);

Demand of the patients and publics

So as medical cost soars, the public health care services will find itself difficult to make ends meet.

Figures shows that in 1990, about 85% of sick people who need hospitalization were admitted to the Hospital Authority. Today this figure stands at 95-97%. The Hospital Authority becomes a victim of its own success.

The end result is that the public medical service will collapse or at least the standards will drop for it would be impossible to maintain a high standard when one uses a finite budget to provide an infinite need and demand.

To avert such a crisis, leaders of today and tomorrow must look into way and means to remedy the situation either to enlarge the public budget for health care or make provisions for your staff and followers to take up medical insurance and seek private services to relieve the public service load.

It takes time to promote this culture but it needs to start now before it is too late. HK people deserve a high standard of medical services.

The crisis of breaking down of Health Care Professional/Patients relationship

Medicine today is complicated by 2 areas. The spiraling cost of medicine has led to the search for more cost effective medical practices. Overnight medical practice has assumed a business mode. Patients are now labeled as “clients” and “customers” or “consumers”. Overnight the “care and concern professional relationship” gave way to the courteous and cold “business relationship”. The service providers explore different ways to reduce cost, while the consumer every means to ensure that he is getting his moneys’ worth. Conflicts become inevitable.

Added to this is the fact that the 21st Century is being coined as a “knowledge society” era – Knowledge obtained from Reader Digest, Time Magazines, Gossip Columns and the web. Armed with such, perhaps half baked, knowledge consumers start to demand – demand why certain investigations are not done; demand to know other alternative treatment modalities; and demand for an accurate projection of the degree of success and the percentage of side effects. In HK this is further accentuated by the process of semi-matured democracy. Overnight the public was given a vote which to them becomes a right – a right NOT to help improve the society but a right to demand. Fuelled by some politicians whose sole aim is to get votes, HK assume a “blame culture”. Health Care Professional are in the line of the firing squad.

To the ordinary health care provider in the street the easiest thing to do is to succumb to whatever the patient demands, perhaps bend over backwards to do more and practise “defensive medicine”. Overnight “opinion based physician led” medical service has given way to “patients demand” and “public led” health care services. The trust between a health care provider and the patient is at all time low and the time honoured doctor – patient relationship shattered.

The Crisis of Return or reemergence of Infectious Disease

For some 50 years with the improvement of public health and better nutrition and sanitation in many parts of the world, it was thought that we can say goodbye to most infectious diseases. SARS has woke us up that we were wrong, for new infectious disease are always lurking round the corner.

In 1997 HK was struck by Bird Flu (Avian Flu). Fortunately it did not get of hands as we quickly kill all the chicken and yet Avian Flu is still very much with us. The recent discovery that the same virus was found in dead bodies the killed millions of people in the “flu” epidemic of 1918 only showed that old infectious are awaiting to make a come back.

Leaders in Government and those in public health must therefore be prepared not only to prevent a major disaster in HK but to be ready should HK be hard hit. Other leaders must be alert too. Sick employees produce deterioration of services or prediction standards. Whilst public health to a large extend is Government’s responsibility, yet each one of us must do our part to be responsible for our own health and to ensure at all cost to prevent ourselves from getting sick. The culture that health is everyone business must be instill into the people.

Finally the Crisis of Immature development of democratization

When HK was under colonial British rule, there was no democracy. So when progressive democratization was introduced in the late 80’s it was welcoming news.

Regrettably democratization in HK is still very much in a development stage and dare I saw immature. Yes, the ultimate of democracy is a right to vote. Yet this is a right more for one to vote to improve the society at large rather that a vote to promote your own demand. Similarly politicians are voted into the Governments system to help to shape the society and not to perform for the sake of getting votes again for the next election.

Such immaturity has thus slowed down government’s decisions and progresses and dare I say many in private arena too. No, do not get me wrong, I am all for democracy, for transparency, for getting proper and adequate public opinions. Yet I strongly believe that leaders are there to lead – through good communication, open mindedness and through making difficult decisions rather then to stir up controversy for the sake of controversy.

Mr. President, Colleagues, it has been said that where there are crisis there will be opportunities.

Let me elaborate.

The government via the HMDAT has recently produce a consultation document in it the problems of the Health Care services are listed. Many will say that there is nothing new for all these problems and others have been voiced and repeatedly for over 20 years. Furthermore nothing was mention of the mode of health care financing.

My analysis is simple. Government is willing to embark on a complete health care reform and Government has no clue now what is the best way to bring the issue of health care financing forwards.

Here lies the opportunity.

Is the current mode of practise where Government is the fund provided and the HA the sole and only service provides the best model. Should government also purchases services from other providers than the Hospital Authority.

Is the structure of the Hospital Authority or its mode of operation the best way to suit the current needs. Is there a need to have a total review of the HA now that it is in its 15th years of operation.

Much has been said of the need and the benefit of public private interphase. Yet how could this be implemented. Firstly, is the private market mature enough to take over a major market share from the public medical service? To wit there has been no significant increase in private hospital beds or even hospitals for some 20 years. Secondly the fact that most private hospitals do not have on established clinical audit system, a matured teamwork and a transparent fees and charges schedules are not conducive to improve the confidence of patients especial when major illnesses befall. The window of opportunity therefore is here is beef up the private hospital services to impose better control and standards for the benefit of patients.

Mr. President the fact that government is still uncertain of a workable health care financing mode should stimulate the insurance industry to come together, to work out on their own some formulae for government to consider instead of waiting of government to produces some half baked formulae to stuff down their throat.

Mr. President, for the last few months I have taken up the responsibility of the Elderly Commission and, nursing manpower or the lack of it in the Elderly homes is major problem. I have suggested as an interim to quickly train wore enrolled nurses or even is start on a new grade of elderly health care assistant. Understandable the nursing profession are up in arms. Their thoughts are honourable as they believe that we should upgrade the nursing care standard of elderlies instead of downgrading the standard. Few would disagree and I am with them. But is it not an opportunities to request for more degree nursing students in the long term and to open up a new grade, call it elderly health care assistant if you will, the ease to workload of registered nurses.

Mr. President, Ladies and Gentlemen, it has been said that opportunities are for us to seek not to be offered to us on a silver plate. “Ask and it shall be given to you” “Seek and you shall fund” as it is commonly said. For some many decades, Hong Kong people are so used to rely everything on government, we should somehow reverse the trend – advise government on what we believe is best for the Society.

The Federation as a coordinating body of health care professions should exert its leadership role and the time to act is now.

I thank you for your attention.