A compulsory contributory medical scheme was needed because of the rocketing cost of public health care, the Government said yesterday. The call meant that a user-pays health system moved a step closer. It came after a government-commissioned report predicted a 50 per cent rise in public medical expenses by 2010. The estimated budget for health care in 1998-99 has risen 5.6 per cent from last year to $31.4 billion. A Health and Welfare Bureau official signalled a centralised medical scheme which would require all taxpayers to contribute and to draw on the fund when in need. 'Young people who may not need the services so much can support the old,' the official said, 'And the healthy can support the unhealthy. 'The public may accept the plan since everybody may fall sick some day.' Another option is to make it mandatory for the public to contribute to a personal medical scheme. In either programme, the Government would be responsible for the central administration and would cover any outstanding expenses. But Dr Leong Che-hung, legislator for the medical constituency, was not impressed by the ideas. 'The Government is covering any outstanding expenses now,' Dr Leong said. 'The basic principles are that the poor will not be rejected for treatment because they have no money.' Democrat legislator Michael Ho Mun-ka, who represents nurses, said he would support a contributory scheme only if it would improve the accountability of the Hospital Authority. 'If the users are to contribute for the services, they should be allowed to choose the doctors, hospitals, what tests to be taken and medicines to use,' Mr Ho said. Ho Hei-wah, spokesman for the Patients' Rights Association, said the Government should not cap its medical expenses. 'This is to say the Government will put a limit in what it will finance and ask the public to pay for the rest.' The $7-million study, submitted by Harvard academic Dr William Hsiao, highlights the Singapore system, which allows people to contribute different amounts to a central fund. The fund is incorporated into Singapore's central provident fund, which requires staff and employers to contribute every month. But the official said the scheme should not be adopted locally. 'The Singapore model may not be suitable for Hong Kong,' he said. The official said public medical schemes in many countries eventually ran out of money. The Government is due to launch a public consultation on the health system by the middle of next year.