A change of ways for doctors and patients
Reform of the health care system has been around longer than political reform and has proved just as resistant to consensus on the way forward. Meanwhile, hospitals have become more overloaded, with long queues and waiting times for specialist referrals.
Finally there is a promise of some action. A government policy document to be put before lawmakers next week shifts more emphasis to prevention and management of illness through primary care by family doctors.
One-stop community health centres, beginning next year with one in Tin Shui Wai, will provide a range of medical and ancillary services for young and old. Public and private doctors will share treatment of chronic conditions, including oversight of more self-care, beginning with a subsidised pilot scheme for 22,000 hypertension and diabetes patients by 2012.
It is to be hoped the new commitment will add momentum to reform of financing, to encourage those who can afford it to pay a fairer amount and contain the unsustainable trajectory of costs.
The new policy is not a prescription for a broken system. Hong Kong has world-class, affordable health care. It is understandable, therefore, that many people ask why, if it is not broken, is there any reason to fix it or meddle with government funding.
There are good reasons, financial and medical. Our public hospital system continues to be accessible to all for a basic HK$100 per visit or day, which nowadays amounts to privileged middle-class welfare as well as social fairness for low earners, the needy and the disadvantaged.
If the government continues to fund the open-ended cost on the existing basis, there are questions about long-term sustainability, with implications for budget expenditure targets or spending on other services, such as education and social welfare.
When it comes to looking after our health, the city's secondary and tertiary - hospital based - services are advanced, but our primary-care services lag those in comparable societies. The working group of officials and stakeholders that produced the policy document rightly says that amid an ageing and growing population, development of preventive medicine through primary care is of the utmost importance. This remains beyond the reasonable expectations of a public system while the resources of the private sector remain walled off and largely untapped.
Integration means that both doctors and patients will have to change their ways. Doctors accustomed to autonomy may have to follow guidelines and meet standards to join primary care programmes and undertake continuing medical education to keep a listing in a proposed directory of primary care doctors, giving their qualifications, background and practice information.
Such a directory would uphold a principle of private medicine - a patient's right to choose their own doctor - and would soon supplement word of mouth from relatives or friends.
Patients must be weaned off hospitals as one-stop shops. Affordable, quality medical care for all must remain the overriding goal of changes to the delivery of services and financing. Because the government was unable to forge a community consensus on compulsory health insurance savings, it is important that negotiation on a voluntary scheme with the insurance industry is brought to an early conclusion. Hopefully, market forces will lead to greater choice and more effective targeting of insurance products.