Imperial College
Roundtable discussion –
“ Community Based Integrated Vascular Healthcare Pathway”
Speech by Dr. C.H. Leong
17 October 2011

Prof. Wood, Dr. Lau, Colleagues, ladies and gentleman:

      Let me begin by thanking Prof. Wood of the Imperial College for organizing this Round table discussion in Hong Kong and inviting me to address the gathering.  Let me also thank Dr. Lau for her over sumptuous introduction.

      When Prof. Wood first approach me to attend this meeting, my natural response is to say NO for my knowledge in Cardiology is next to zero.  When he turned round to ask me to address you on the Health Care Policy in Hong Kong, it is an offer I cannot refuse.  I would therefore attempt to trace with you the Evolution of Health Care Policy in Hong Kong, some health care reforms in the last 30+ years and some hopes for the future.  Hopefully there may shed light on some of the discussion on Integrated Vascular Healthcare Pathway.

      Hong Kong has one “overarching” health care Motto, “ nobody should be devoid of care because of lack of means”.  In short, for a sum of HK $ 100 a day, anybody can get access to the very high standard of medical care that Hong Kong can offer.  Many may even have this $ 100 waived.  Looking at it in another way, no matter whether you are, a billionaire, or some one on public assistance, you can enjoy the services of a very heavily subsidize  high standard public health care.  Today, the subsidy from government, i.e., public money is in the region of 97%.

Yes, this is an honourable policy that we should forever defend and government should in no way detract from it.

Yet, looking it in a negative way, it amongst to “using limited resources to provide unsatiable and unlimited needs and demands”.  After all, government spending on health care has to have a limited and with the increasing cost of health care through ageing population, through expensive high end technology, one wonder whether our public healthy care can sustain or at least sustain with high standards.

If the policy is to be sustained, there is only one method  — increase the total health care budget through

• increasing tax (general revenue)or;
• increase contribution by each user of the health care.

Over some 30 years, government has come up with numerous Health Care Financing Reform proposals, i.e. Health Care Insurance or Health Care Personal Savings.  All of these have NOT met with the public support, for whatever formula would only means that the public have to fork out more to maintain high standard, cheap and affordable health care.

      In an attempt to ease the tension, government has come up with a different direction — let us cut down on Public Health Care Spending and the following has been proposed and taken on board.

The Creation of the Hospital Authority

      The concept of the Hospital Authority (HA) was conceived by an Australian consulting firm to corporate public health care services by entrusting an independent statutory body under government to run all pubic hospitals (initially and later all health care services) on a yearly agreed budget financed totally by government.  The principle is to apply proper management concept to ensure total cost effectiveness and to eradicate all bureaucracy that would exist in any government services.  The hope is to provide better and more efficient health care services both in quality and quantity, and it did.  Regrettably, better service generated more demand.  In essence, therefore this body becomes a “Victim of its own Success”.  Government health care spending has increased almost some 10 times since the HA was established in 1990.  Admittedly the public did acquired better health care services.

The Promotion of Proper Primary Health Care as a Gate Keeper for Hospital Needs

      Hitherto all illnesses were admitted to hospital either because illnesses were discovered too late or proper primary cares were non-existence.  Furthermore, regular follow ups even of chronic illnesses like diabetes or hypertension were all done by specialists.  Health care costs were expected to be thus high.

      Primary Health Care, which deals with illness at the early stage, the move is to “promote health”.  In short, it is not good enough to say “Prevention is better than care”, we should move one step backwards to say “staying healthy is better than the need to prevention”: On this basis, there has been a constant and sustained drive for healthy life style: anti smoking, healthy food, adequate exercise etc.  Only time will tell whether sustaining these health promotion would improve health indices and thereby decrease health care costs.

Private and Public Interface

      Hong Kong’s health care services are peculiar in that while public and private health care services runs parallel to one another, there has been no coordination nor interplay.  Public services runs on heavy public subsidy and more or less on a free basis, yet the patients has NO choice of service providers nor time for services, often times, there is a long queue.  Private services runs on entirely on fee for service with total choice. Standards of profession care are similar, both very high.  Often time, it is marginally higher in the public because of better teamwork.

      Because of the lack of communication and the high cost of private care, the tendency is for the less well to do and those with major illness to patronize public service increasing Public Financial Burden.  Attempts are therefore made to improve Public/Private interface, hopefully some patients will move to the private and decrease the public burden.  The ehealth record system recently introduced that links public and private is an excellent attempt to share information.  Subsidizing public patient to seek private investigation tests because of long queues is another successful private public partnership.  Networking, private GP with public hospital, so that there GP can take over the follow up of long term care chronic patient will not only lighter the workload of highly paid overwork hospital specialized consultants, but promote a family medicine concept.  Of late government has also introduced a health care voucher for elderlies which they can use to seek private medical services.

      Prof. Wood, I mention all these not to claim credit.  Actually, it is all the people that are here today that have made it work.

Are these measures useful? Or are these measures enough? To be frank, they are all effective, they are all essential in providing an even better health care services, yet in my mind, they are only acting on the fringe.  Much work need to be done to identify a proper health care and health care financing reform to ensure that our revered health care standards and services could be maintained.  No matter what formula we adopt should not deviate from some basic principles, and they are:

• Public Money should be spend on those who needed it most.

On this basis, while the motto of “Nobody should be devoid of care because of lack of means”, there will be some which need support more than other, and I propose any subsided should be targeted.

• Any responsible government must provide a safety net, yet government should not and could not be asked to be responsible for anything and everything.

I believe in health care, it should be “those who can pay should pay, and those who could afford more should pay more.”
Thank you.