Our health system still needs major surgery
As the government and people of Hong Kong look into the mistakes made during the Sars outbreak and consider the health reforms needed to make us better prepared in the future, it is helpful to flick through the pages of a long neglected document - the 'Harvard Report'. In the light of the flaws exposed in our health system by the rapid spread of the disease, it makes for sobering reading.
The government-commissioned report was released in April 1999 after a study conducted by 15 international experts. It recommended a radical shake-up in our approach to providing health services. At the time, the proposals were controversial and met with resistance from both the government and members of the medical profession. But problems highlighted by the Harvard team were thrown into sharp relief by Sars.
It is interesting to note that the Department of Health was accused by the Harvard specialists of not doing enough to promote disease prevention. That is one lesson which we have had to learn the hard way. But they also highlighted other, structural problems which came back to haunt us, in the form of Sars. The dominance within the system of the Hospital Authority was identified as a serious weakness, and the experts recommended that it be broken up and restructured. Merging the provision of public and private health care, while integrating primary services with hospital treatment, were also suggested. The system, according to the report, was outdated, fragmented, too focused on hospital treatment and lacking an overall policy for the organisation of health care. Major surgery was needed.
Unfortunately, the government rejected the report's key recommendations. One reason was that Hong Kong was adjusting to the economic downturn and there were concerns about far-reaching health-financing proposals which were seen as likely to hit the middle class. Instead, a watered-down set of proposals - which, if anything, boosted the Hospital Authority's importance - were adopted. Many of the problems the experts had identified were left untouched.
They have re-emerged in another report made public this week, into the failure to promptly report Sars cases at the private Baptist Hospital. Again the division between the public and private sectors loomed large, as did the lack of communication and co-ordination. The investigating panel concluded that the authority and the Department of Health regarded private hospitals as an 'unwanted problem'. There is no doubting the need for improved communication. Doctors at Baptist Hospital seemed to have obtained information needed for the treatment of Sars in the same way as the public, via the internet. They may have discovered the computer, but mastering the art of using the telephone might have been more useful.
Sars has shown that the health system cannot cope well with a crisis. However controversial reform might be, and whatever the opposition to it, action is needed if the same mistakes are to be avoided should Sars return in the winter. The system's fragmented nature, criticised by both the Harvard Report and, in the light of Sars, the World Health Organisation, must be dealt with. The barriers between the different branches, and between the public and private sectors, must come down. Speeding up the introduction of a centralised, computerised system to provide for the easy sharing of information would be a start.
There is always resistance to change. We do not necessarily have to adopt the Harvard Report's suggested approach. But the problems it identified must be tackled. The painful lessons learned from Sars must finally bring an end to what the report described as the government's 'benign neglect' of the health system.