Fix public health care first to revamp system

PUBLISHED : Wednesday, 13 October, 2010, 12:00am
UPDATED : Wednesday, 13 October, 2010, 12:00am

It's an undeniable fact that Hong Kong has an ageing population. In order to ease the increasing financial burden on public health care and address the long-term imbalance between private and public health care providers, the government has proposed a voluntary medical insurance scheme.

It is hoped that the latest health care reform can encourage those who are financially capable to sign up for private health insurance. The scheme is undoubtedly well-intended, but the problem is that we have talked about overhauling our medical system for more than 10 years with little result.

In 1999, we had the Harvard Report for radical structural reform, and then, in 2005, the discussion paper from the Health and Medical Development Advisory Committee on the future service delivery model for Hong Kong's health care system, with a suggestion to cap public health care financing.

Judging from the proposed health care financing reform in 2008 to today's voluntary medical insurance scheme, it's obvious that the line of thinking of Secretary for Food and Health York Chow Yat-ngok is to privatise health services. He seems to believe that the government can offload a big chunk of the responsibility to the private sector.

The provision of medical services is one of the fundamental welfare services for our citizens. Hong Kong prides itself on its first-class and affordable health care. Our health care expenditure is estimated at about 5 per cent of gross domestic product, far lower than the average 8.1 per cent of the Organisation for Economic Co-operation and Development member countries.

If a system has worked well for so many years, there is no reason to change it. And if there is any decision to do so, it shouldn't be taken lightly.

In the long term, we need to address the fundamental issue of health care financing. Key to any revamp is the structural relationship between the public and private sector - and the allocation of medical resources.

If the government cannot increase resources for the public health system to tackle the shortage of medical and nursing staff, and the worsening quality of care, any fancy proposals on financing and medical insurance will not be supported by the public. If the government insists on going ahead without proper consultation and general support, it will risk being accused of colluding with insurance companies and private hospitals.

Our health chief seems to have contradicted himself. Two years ago, Chow fully supported public health care financing. He even wrote newspaper articles to question the possible moral hazard created by private health insurance schemes. The problem is that insurance companies not only restrict the standard of medical services covered in their policies, they also use health risk assessment to deny services to high-risk groups.

Chow now wholeheartedly embraces the voluntary medical insurance scheme and seems to have forgotten all those arguments. He has underestimated the potential risks in subsidising the insurance sector or private health care groups. One thing is for sure: the government is desperately trying to shirk its responsibility to provide good public health care.

We need to look at the situation realistically. First, we must keep the best people in the public health system. So, instead of spending HK$50 billion on subsidising an insurance scheme that's likely to be unpopular, we should give the money to the Hospital Authority to expand services and raise staff benefits.

Pushing ahead with an ineffective scheme will not cure the ills that afflict our public health system.

Albert Cheng King-hon is a political commentator.