Health care debate sidesteps basic issues

PUBLISHED : Wednesday, 09 April, 2008, 12:00am
UPDATED : Wednesday, 09 April, 2008, 12:00am

Lim Meng Kin, an expert on health care financing at the National University of Singapore, avoided the hard-sell treatment for the city state's National Health Plan during an international symposium in Hong Kong at the weekend.

'Context', he said, 'is the key.' Any place must take into account its historical, cultural, political and socio-economic factors when establishing its own health system.

Professor Lim was addressing participants at the conference on Hong Kong's health financing reform, organised by the University of Hong Kong's Medical and Health Research Network.

He remained non-committal on the pros and cons of the six options listed in a government consultation paper on health care financing. But the academic was telling the plain, simple truth when he said that 'nobody can help Hong Kong decide what to do'. Only its people, he said, could choose what kind of society they want, and what values define it.

William Hsiao, of the Harvard School of Public Health - who is better known as the key author of the government-commissioned Harvard health care report published for consultation in 1999 - made a similar point at the symposium. He said a key issue that needed to be addressed was equity: who would bear the burden of financing, and who would benefit from the system? Although they are vitally important, the issue of values, and principles like equity, have not figured prominently in the blitz of government publicity on the medical reform consultation paper.

In its paper, the administration went to great lengths to present a gloomy, long-term scenario of Hong Kong's health care system. Officials, confronted with a litany of challenges ranging from an ageing population to the costs of new medical technology and treatments, have sought to convince the community that time is running out for a solution to these problems, and that failure to come up with a new system soon would mean a delay of at least 10 years.

Those messages are in line with the problem-solving mindset manifested by Chief Executive Donald Tsang Yam-kuen in his policy address last October. Warning of a surging demand for health care services, he said: 'We need to plan ahead for these challenges so that Hong Kong will maintain its competitive edge.'

Asked about the government's approach in the ongoing health reform consultation, a former high-ranking official said: 'Mr Tsang is a problem solver, not a visionary.'

Whether it meant to or not, the administration has defined the issue of health care financing as a problem that must be solved jointly, by itself and society.

Specifically, that means choosing the best possible option from the six listed in the document, which include tax rises, higher medical fees, voluntary or mandatory saving schemes and an insurance system.

Discussions on the merits of the different options, however, will not get far without a broad community consensus on the fundamental values and principles of financing public health services.

Few people in the community would disagree with the principle that those who can afford to, should shoulder a heavier burden to help the underprivileged. The present tax system puts that scheme into practice.

But, when it comes to deciding who pays what for whose health care needs, a clash between individuals' interests and those of the community becomes apparent.

There is still a lack of trust and confidence in the government, and no real consensus on the right balance of responsibility between individuals and the community. So, it would not be surprising if citizens - in particular the middle class - preferred to find their own solution to longer-term health care protection, rather than bet on the risk-pooling system devised by the bureaucrats.

Chris Yeung is the Post's editor-at-large.




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