Re­vamp­ing our pub­lic health­care sys­tem is a daunt­ing job

China Daily (Hong Kong) - - COMMENT - R AY M O N D S O

Afew things about Hong Kong’s health­care sys­tem re­cently have caught my at­ten­tion. Look­ing at these is­sues to­gether, I have formed a not-so-rosy pic­ture about the fu­ture of our med­i­cal sys­tem. Hong Kong’s health­care sys­tem re­form has reached a crit­i­cal point. If we con­tinue to adopt a stay-put ap­proach, we are not just los­ing the op­por­tu­nity for fix­ing the sys­tem; it will also put an un­bear­able bur­den on our next gen­er­a­tion.

It is a well-known fact that Hong Kong has a grow­ing ag­ing pop­u­la­tion. How­ever, many peo­ple do not know that the sever­ity of Hong Kong’s ag­ing prob­lem is only sec­ond to that of Ja­pan in Asia. An ag­ing pop­u­la­tion is ac­com­pa­nied by ris­ing health­care de­mands. How­ever, Hong Kong’s health­care sys­tem is al­ready well be­yond its ca­pac­ity. Take the nurse-to-bed ra­tio, for ex­am­ple. The lo­cal stan­dard is set at 1:6; how­ever, the ac­tual ra­tio has nearly hit 1:12. We have also heard many sto­ries about the long work­ing hours of house doc­tors. A non-stop shift of 36 hours is con­sid­ered the norm rather than the ex­cep­tion.

It is un­fair to say that the gov­ern­ment The au­thor is the dean of the School of Con­tin­u­ing Ed­u­ca­tion at Hong Kong Bap­tist Univer­sity. does not know the prob­lem. In­deed, there are many health­care pro­pos­als put for­ward by the gov­ern­ment. For ex­am­ple, there are pro­pos­als on the im­ple­men­ta­tion of a vol­un­tary med­i­cal in­sur­ance sys­tem, the re­vi­sion of Ac­ci­dent and Emer­gency (A&E) charges by pub­lic hospi­tals and re­form of the Med­i­cal Coun­cil. These are some of the pro­posed ideas for re­form­ing our med­i­cal sys­tem. Hence, we should put these pieces to­gether to form a big­ger pic­ture about re­form­ing our med­i­cal sys­tem.

The idea of in­tro­duc­ing a vol­un­tary med­i­cal in­sur­ance scheme aims to en­cour­age the use of pri­vate health­care ser­vices and there­fore help re­lieve the pres­sure of in­creas­ing de­mand for pub­lic health­care. The ad­just­ment of A&E charges aims to re­duce the abuse of such ser­vices so that real emer­gency cases can be han­dled in a speedy way. The re­form of the Med­i­cal Coun­cil aims to ad­dress the rights of pa­tients. Nev­er­the­less, re­forms are of­ten un­wel­come be­cause they change ex­ist­ing par­a­digms. Re­forms nat­u­rally will at­tract dis­agree­ment and in or­der to se­cure the ac­cep­tance of the ma­jor­ity, some com­pro­mises are un­avoid­able. When con­ces­sions are made, the orig­i­nal aims of the re­forms may not be achieved.

For ex­am­ple, un­der the pro­posed vol­un­tary med­i­cal in­sur­ance scheme the gov­ern­ment has made it clear that it will not push through two con­tro­ver­sial re­quire­ments, namely the manda­tory ac­cep­tance by in­sur­ance com­pa­nies of clients at high risk and a cap on the in­sur­ance pre­mi­ums charged. These two con­tro­ver­sial re­quire­ments would have en­sured that no one would be de­nied to health in­sur­ance. Nev­er­the­less, it will be con­sid­ered un­wise if the gov­ern­ment in­sists on these two re­quire­ments. To the in­sur­ance com­pa­nies, if they are re­quired to ac­cept the high-risk clients and a cap on the in­sur­ance pre­mium they re­ceive, they will find it dif­fi­cult to be in this busi­ness as their pre­mium in­comes may not be enough to off­set the claims. Fur­ther, the vol­un­tary med­i­cal in­sur­ance scheme needs an in­jec­tion of funds by the gov­ern­ment, and ap­proval by the Leg­isla­tive Coun­cil’s Fi­nance Com­mit­tee is needed. Given to­day’s po­lit­i­cal re­al­ity and the con­tro­ver­sial na­ture of the vol­un­tary med­i­cal in­sur­ance scheme, the with­drawal of these two con­tro­ver­sial re­quire­ments makes senses. This is the strat­egy of do­ing the easy parts first.

Ini­tially, there was a pro­posal to in­crease A&E charges from HK$100 to HK$220. The Hos­pi­tal Author­ity says that the idea is to re­duce the abuse of A&E ser­vices. How­ever, the author­ity re­cently has changed its tone. In­stead of de­fend­ing the pro­posed $220 charge, the Hos­pi­tal Author­ity has said that it will con­sider the mat­ter at its open meet­ing. Cer­tainly any in­crease in A&E charges will not be wel­comed by the com­mu­nity. It could be the gov­ern­ment’s strat­egy to man­age ex­pec­ta­tions such that a higher charge is first sug­gested, then a re­vised lower charge is tabled so it will be eas­ier to get peo­ple’s ac­cep­tance. Nev­er­the­less, it shows that there are al­ways dis­counts on the orig­i­nal tar­gets of any pro­posed re­form. Like­wise, re­form of the Med­i­cal Coun­cil is not likely to make any real progress in the near fu­ture.

These is­sues seem to be in­de­pen­dent. But if we tie them to­gether, it shows that Hong Kong’s pub­lic med­i­cal ser­vice sys­tem is in­deed fac­ing high pres­sure. Given the cur­rent po­lit­i­cal re­al­ity, it is un­likely that the gov­ern­ment can make sub­stan­tial break­throughs in re­form­ing the sys­tem. Con­tin­u­ing to do things piece­meal may be more likely.

Re­forms nat­u­rally will at­tract dis­agree­ment and in or­der to se­cure the ac­cep­tance of the ma­jor­ity, some com­pro­mises are un­avoid­able. When con­ces­sions are made, the orig­i­nal aims of the re­forms may not be achieved.”


At dawn, two pas­sen­gers walk through shad­ows and sun­light at Hong Kong In­ter­na­tional Air­port.

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