Strain on Hong Kong's health system increases as government dithers over reform

Hong Kong awaits report of latest study on how to fix the city's health funding ills, over 20 years after need for reform was first flagged

PUBLISHED : Sunday, 22 June, 2014, 4:30am
UPDATED : Wednesday, 26 October, 2016, 2:38pm

Late last year, Yim Man-fung, 72, had cataract surgery on her right eye - after waiting for treatment at a public hospital for 10 years.

She was finally able to afford to get treated at a private clinic, courtesy of HK$12,000 from the Society for Community Organisation.

"The surgery took no more than 10 minutes," said Yim, a welfare recipient who lives in Sham Shui Po. "I just do not understand why it takes so long for public hospitals to arrange surgery. The doctors kept telling me to return for a check every year, as if the surgery would not be required until I was blind."

It might sound like an impossibly long wait. But similar stories abound. The waiting time for cataract surgery averages 22 months, according to the Hospital Authority. A patient can wait up to three months to see an ear, nose and throat specialist at an outpatient clinic. And the wait for gynaecology services can stretch to 125 weeks. More than 21,000 patients treated by specialists last year had been waiting for three years. More than 1,000 others waited longer.

"Timely access to medical care is an enormous challenge for our health care system," said Tim Pang Hung-cheong, a patients' rights advocate with the Society for Community Organisation.

The government met half of the city's health expenses in 2007-08 - HK$39 billion out of HK$79 billion - according to a report released in 2011, with employer-funded and private insurance, and households, picking up the rest of the bill.

There is growing concern that waiting times and costs will rise as the population ages, prompting greater demand for medical care.

Officials believe the key to healing the system is a voluntary insurance scheme. That idea, which has been floated before, is expected to be a major part of yet another proposal to revamp health care.

The government wants people to buy medical insurance so they can afford private clinics and hospitals, taking the pressure off the public sector.

A much-anticipated consultation report has yet to be released. In a document issued to legislators last December, the Food and Health Bureau said the aim was to improve the quality of private health insurance to encourage people to make the switch.

Professor Peter Yuen Pok-man, dean of Polytechnic University's College of Professional and Continuing Education, said he was not optimistic.

"The history of health care in Hong Kong in the past two decades has been characterised by the repeated failure of reform bids," said Yuen, who is also a health consultant for the Bauhinia Foundation think tank.

In the 1970s and 1980s, the colonial government poured a lot of money into the public health system, making it almost free to all.

Spending rose from HK$1.15 billion in 1979-80 to HK$7.75 billion in 1989-90.

But some experts correctly anticipated problems such as rising and community expectations.

The government broached the idea of a voluntary insurance scheme in 1993, out of concern that the elderly needed help paying for their care.

After the handover in 1997, the government commissioned a team of local experts and public health specialists from Harvard University to study the system. It found that public health expenditure had grown, as a share of gross domestic product, from 1.7 per cent in 1989 to 2.5 per cent in 1996. It projected that spending could rise to as much as 4 per cent of GDP by 2016. By 2016, the study said, health care spending could gobble up 23 per cent of total public spending.

It concluded that the system might not be sustainable, "given the ageing population, increasing specialisation in medicine, and rising public expectations".

The study recommended the adoption of a plan that would require employers and employees to both contribute 1.5 per cent to 2 per cent of wages to a fund to cover in-patient services and some out-patient specialist services.

The study also recommended residents maintain long-term-care savings accounts, in which bosses and workers would both contribute 1 per cent of wages to the account.

But bosses and workers weren't happy about having to make compulsory contributions.

Business groups bleated that it would raise costs and reduce their members' international competitiveness.

Again, the government opted for the status quo. By then, the heath saga resembled a long-running drama series.

Another consultation paper in 2005 said the system needed more emphasis on holistic primary care. It said there was an over-reliance on public hospitals and a significant imbalance between the public and private sectors.

"The document presented a rosy picture of an ideal system without telling the public who was going to pay for it," Pang said. "It was like giving a customer a menu but no price list."

In 2010, knowing that the public would resist any mandatory scheme, the government suggested people voluntarily buy government-regulated private health insurance.

In the latest iteration, the government is planning to set up a HK$4.3 billion pool to cover the costs of insurers who take on high-risk patients. Patients with long-term illnesses would receive HK$7,200 a year to buy medical insurance and use private services. The government estimates 70,000 people would qualify for the programme by 2016.

Insurers would have to offer standardised medical plans, providing patients with enough benefits and reimbursement to ensure that they could access certain types of private care when needed.

Insurers could not reject applicants. Plans would cover patients with pre-existing conditions, and would accept high-risk clients through a high-risk-pool mechanism.

Advocates believe wider insurance coverage would take the pressure off the public system.

In accident and emergency departments, a five-hour wait is seen as normal. During the peak flu season last December, some patients waited for up to 40 hours before being admitted to a ward, a survey by the Democratic Alliance for the Betterment and Progress of Hong Kong found.

Insurance sector lawmaker Chan Kin-por has warned that the plan would drive more people to use public services, because private insurance would become less affordable.

"At present, many people opt for lower-premium products because they do not need broader coverage," Chan said. "The minimum-requirements approach would in effect force them to pay more for services that they might not need."

Chan said he doubted if such a scheme could win the legislature's approval.

His criticisms were echoed by the Hong Kong Federation of Insurers and private insurance companies, which have said the proposal could limit consumer choice.

"The introduction of [a health protection scheme] will only restrict consumers' choice and force them to pay 10 per cent more for medical insurance," the federation said. "The insurance industry proposes that existing medical insurance products continue to be sold alongside [the new scheme] to maintain consumer choice."

The federation said high-risk people would have to pay three times the cost of normal premiums.

Yuen wants the government to set up a public medical savings fund, financed by budget surpluses.

The fund could supplement public hospital funds, on top of the existing recurrent funding.

"This approach will not require individual contributions, making it politically much more feasible," Yuen said.

"In a sense, the public health system has been a victim of its own success," he added. "Hong Kong has an admirable health care system in terms of maintaining universal access at modest cost. People simply do not think there is a need to change."

Except maybe for long-suffering patients like Yim Man-fung.