Articles

22 July 2010

The University of Hong Kong Management Alumni Society

Speech delivered by Dr. C.H. Leong
22 July 2010

           Thank you for inviting me to address the HKU Management Alumni Society. When I first received the invitation, I did hesitate, what could I talk on Management.  As a simple practicing doctor, my management capability extends to managing a staff of 5 — 2 nurses, one maid, one secretary and one assistant.  I took the challenge because I believe this is the time that HK should consider 2 very important social issues.  How these could be properly managed in policy and what action will bring about a much more harmonious society in the future.  These 2 issues are:

  • Managing the public health care;
  • Managing an ageing population.

 

           Before I start, let me hasten to add that I have NO solution nor dare I say even the government.  What I intend to do is to throw out the problems, perhaps make suggestions, but more important is to hear your advices, either today or in the days to come.

Managing the future health care
            HK has a dual health care system – private and public.  The private system runs on a fee for services, it looks after 75% of patients who need primary health care and 5-7% of patients who need hospital services.  The public system is totally subsidized by government through general tax revenue, whatever charges imposed are only nominal, accounting to less than 2% of total public health care cost.  It looks after about 15% of primary health care, 93%-95% of hospital care.

           Let me analyze our public health care system.  HK’s public health care system is perhaps the envy of the world.  For $100 a day at the maximum, you can enjoy every possible investigations and treatments in line with the cutting edge of medicine.  Government’s motto is “Nobody should be denied of care due to lack of means”.  It could also be interpreted as “Everybody irrespective of your income bracket, can utilize this highly subsidized public health care”.  Government’s subsidy to inpatient services is in the region of 97%.

           Since public health care comes from general tax revenue, the end result is we are in fact “using a finite budget to deal with insatiable needs and demand”.

           I presume you will all say that in management principle, this will not work and I believe you are right.  With no change in this system, HK’s public health care system will not be able to sustain, definitely not the high standards.

            What is government spending totally in health care?  Government is spending up to 17% of its total annual expenditure.  This amount to some $35 billion per year.  This is about 3 % of the GDP.

            What has government done so far to cope with the impending problems?

           Government is trying to improve primary health care so as to ensure that through public health education, people will stay healthily and thus reduce hospital needs.  By improving primary health care too, many elderlies are taken care of outside the hospitals, and then hopefully cut down hospital cost.

           Government is attempting to improve private-public interfaces so as to shift patients from the public system to the private system through:

  • Introduction of a e-health system —
    • a system of share medical records.
  • A co-payment system —
    • elderly health care vouchers where those over 70 can use health care vouchers to subsidize fees at private clinics
    • subsidize specific treatment procedures, e.g. cataract surgery
    • pilot health care vouchers in Tin Shui Wai

 

           Yes, these procedures will help to a certain extend.  Yet, it would only touch the surface and unless and until government has the political clout of introducing a new health care financing policy, the long term health care will still be bleak.

           Government is as you all know, considering introducing a drive to promote “ voluntary” Health Care Insurance, so that the public will use their insurance coverages to utilize private hospital services.

            But, what is the incentive for the public to take up a voluntary insurance when there is NOrestrictions in utilizing the high standard, heavily subsidized public health services.  Furthermore, most insurance policies, do not totally cover the high cost of the current private hospital services.

               Meanwhile, health care costs are spirally due to:

  • Ageing population
  • Expensive modern medical and technologic tools
  • Demands of patients

           What are my suggestions? I believe government can look into a health care financial reform based on the following principles:

  • Government cannot and should not absolve itself    from providing health care services to the public and that the motto “ nobody should be denied of care because of lack of means” could not be waiver;
  • Public money should be spent for those who need it most;
  • With the finite budget and basing on the two above principles, government should practice “Target Subsidy”, i.e., the true financial needy and those patients whose conditions require a very heavily financial burden for treatment should get the highest subsidy.
  • Meanwhile, those who can pay/pays or those who can pay more should contribute more.

 

           I presume, it is here that management and politics become inseparable.  Your thoughts and advices will be vital if we are to have a sustainable, high quality and affordable health care for all.

Managing an Ageing population

           It has been said that the success of the 20th century brings on the burden to the 21st century.  Advance medical science, improving living conditions has extended the life expectancy in most part of the world.

           In HK, the average life span at birth in the male is 78 years old and 83 in female, and with the decrease in birth rate (less than 1 birth per marriage), we are facing a rapidly ageing population.  Today one in seven in HK is 65 years old and over.  The projections are that by 2033, one in 4 will be 65 or above.

           What problems will this bring:

  • There will be more and more elderly who
      • have no income — do not contribute to tax revenue;
      • they need to look after;
      • they will consume a major portion of health care.
  • There will be less and less young people
      • less people paying tax to look after more people not paying tax;
      • acceleration of the dependency ratio.

           What can be done?
                      I suppose there are only 2 ways:

  • Increase tax revenue through:
  • Increase the number of tax paying young people
        • more birth per marriage
        • attract contributing young people to come to HK
      • Increase general tax
  • Decrease the burden that elderlies create through:
      • Improve their independency;
      • Improve their health;
      • Promote gainful employment:
        • Extend retirement age?
        • Flexible retirement age;
        • Provide a new form of gainful employment — social enterprise.

 

           It is on this basis then the Elderly Commission has been promoting “Active Ageing” — keeping them healthy, involving them in the society through introduction of life long learning in our Elderly Academy.

               Dear Alumni, I have given you a general view of problems facing HK form major social issues.  I am sure these will be repeatedly debated in the days to come.  As Alumni of Asian No. one University, we do have a role in shaping the best for HK’s future.  Your input, your advice and your ideas are therefore most important.

              Finally, I mentioned that HKU is now ranked number one in the Asian Universities League table, this is something that we are rightly so proud of, but it is also an issue of concern.  For getting there may not be difficult, but maintaining the position is definitely not easy.

              Yet, maintaining it we must.  To do so, depends much not only on the senior management of the University, the professors, the researchers and the students, but also the alumni, and together WE CAN!

 

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