1. The Bauhinia Report1 has rightly pointed out that despite the publication of the four consultation documents: Towards Better Health2 , Improvinig Hong Kong's Health Care System: Why and For Whom3 , Lifelong Investment in Health4 , and Building a healthy Tomorrow5 , citizens still prefer to maintain the current tax-based financing system as the major source of health care financing. Politicians will agree with their voters unless there is convincing evidence to the contrary. The huge injection of public funding into the subsidized public health care system in the nineties to create the white elephant in the form of the Hospital Authority has attracted more and more citizens to rely on the Government to take care of their health, resulting in a paradigm shift between the private and public sector health care system since then. Many experts however have voiced out that the current system is vulnerable and non-sustainable, particularly when the Government has repeatedly posed a limit to the budget despite an unlimited demand for services.
2. The Hong Kong Medical Association formed a Committee on Health Care Reform to review the Bauhinia Report. Subsequently, the Hong Kong Medical Association Council agreed to the following points.
3. There is no need to create one more pillar (Pillar 2). We are concerned that the Government will tend to shift more pillar 1 services to pillar 2 and turned originally subsidized services to partially subsidized services. We are concerned that certain anti-cancer drugs and anti-leukemic drugs and stents for angioplasty which are not readily affordable by most remain non-pillar 1 items when world trend wise it should be so. We heard from the representative of the Bauhinia Group on the air that Pillar 2 should include items like minimal invasive surgery for gall bladder removal when currently laparoscopic cholecystectomy is the norm rather than the opposite. These suggestions raised serious concern for us.
4. We agree that public subsidized services should, as suggested by the HMDAC report, mainly be confined to the following areas:
5. Public funds should not be used to expand the subsidized services beyond these four areas. The recent suggestion of 24 hours general out-patient clinic by a certain executive of the Hospital Authority is exactly the opposite of what HMDAC suggested.
6. We agree that citizens should save to meet their future needs, be they health, housing or otherwise. The proposed medical saving account scheme is not welcome because of its inflexibility and its control by a third party. The recent revelation that the administration fee of the Provident Fund should caution us of wastage if a medical saving account scheme is administered. The level of contribution will be a crucial factor for the success of the scheme. The current climate in Hong Kong will not allow a reasonable rate of contribution, which will result in the doom of the scheme.
7. In whatever way health care is financed, except by public funding, patients should be allowed to opt for the kind of services most suitable to them at the advice of their own doctors. There should not be any 'middleman' to act as the 'purchaser' or to pick 'qualified provider' on the behalf of the patients. The Hong Kong Medical Association has put up a 'primary care register' a year ago but the name was rejected by the Medical Council of Hong Kong. It is a surprise that the Bauhinia Report would propose the creation of the same for certain organization to exert inappropriate control over the profession. Doctors in the General Register but not the Primary Care Register or the Specialist Register will be at a loss of what should be their role in Hong Kong. Private primary care services should be available to all as easily as possible. Barriers like extra certification requirements and primary care register with restrictions would serve no purpose except unfair competition amongst service providers.
8. The golden rule is for 'money to follow the patient' like what is currently happening in the private market. The concept could be extended to the allocation of public health care funding by means of redemption of services by medical coupons.
9. There was no mention of how the private health insurance industry could be improved to help health care financing. Private insurance could be a better choice than medical saving accounts as it offers free choice of services with more flexibility. Citizens should be encouraged to take up their own medical insurance policies at a younger age. Any savings in any financing scheme should be allowed for purchase of private insurance for citizens' usage at an age younger than 65. There should be tax-exemption for the purchase of private insurance policies to minimize the financial pressure on government.
10. To create incentives for any saving scheme, government should contribute to citizens' savings, dollar for dollar. This is the way to demonstrate government's commitment to the health status of the community.
11. The Hong Kong Medical Association would like to call for a careful and thorough review of what should and should not be done to reform the future health care system of the Hong Kong Special Administrative Region, as any move, in particular health care financing, will affect the welfare and wellbeing of every citizen. The dual system of public subsidized and private unsubsidized services should continue to exist. Nobody should be deprived of the right to health care because of the lack of means but for those who can afford it, there should be more choices with greater flexibility. Every citizen should save up for their future needs and should be able to purchase any services at his own choice. Government can help by providing tax incentives, true subsidy, a level playing field and ensuring market information transparency.
24 July 2007
The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts. The foremost objective of the Association is to safeguard and promote public health. The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world. In fulfilling these goals, the association hopes to better serve the people of Hong Kong.
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