The proposals for the future of Hong Kong's health services, released yesterday, should act as a wake-up call for the community. Our public health system is stretched to the limit and reform cannot sensibly be delayed any longer. This is not the first such warning. But the political will to make needed reforms has been lacking in the past. A similar failure now to tackle the serious problems will put additional pressure on our high standards and threaten a blowout in costs that are already among the highest in the world. The diagnosis is clear - over-reliance on a heavily subsidised system by an ageing population, at a cost that cannot be sustained. Urgent treatment is needed. So the broad proposals put forward by the Health and Medical Development Advisory Committee are welcome. They aim to relieve the strain on the system while maintaining high standards. Much more detail is needed before we can understand how the new system would work in practice - and how it would be financed. The plans include restricting public funding for cheap services to those who really need them, greater participation by the private sector, with more emphasis on prevention of illness and disease and promoting the role of the family doctor. A key part of the strategy is greater use of the private system by people who can afford it - in particular Hong Kong's burgeoning middle class. Public hospitals would still provide acute and emergency care to all. Health minister York Chow Yat-ngok acknowledged yesterday that similar reviews in the past have been shelved. One result is that the government is devoting $22 of every $100 in recurrent spending to health care. At this rate, without action on the latest proposals, we will be on track to spending more than half of taxpayers' money on health care by 2033 - an alarming prospect. The report focuses on delivery of services, with a further report on financing proposals to come towards the end of the year. That leaves the government a window for debate and consultation. This is an opportunity it cannot afford to miss to sell the case for reform, ahead of what is bound to be a more divisive debate on future health-care financing. People accustomed to getting quality health care at a fraction of its cost will not be easily convinced that they should pay more, no matter how much they can afford it. At public hospitals, the government subsidises about 97 per cent of the cost of treatment, with most patients paying just $100 a day. Comparable treatment at private hospitals could cost tens, if not hundreds, of thousands of dollars. Cheap services attract rising demand and they must eventually be rationed - either by price or by time, in the form of lengthening queues for treatment. If Hong Kong does not ration services by price, the queues will get longer. And as the population ages and medical costs continue to rise with technological advances, the problem can only worsen. The case for most people to pay more has been talked about for years but the government has never had the backbone for it. A reminder comes in the Harvard Report on our health system by 15 international experts, released in 1999. It, too, called for radical reform, including merging public and private health care while integrating primary services with hospital treatment. But the government rejected the key recommendations amid concerns about far-reaching financing proposals seen as likely to hit the middle class. The latest proposals are also ambitious and do not make reform any easier politically for the government. This time, the administration should get on with it and point the way forward to achieving the main aims. These are to ensure that people who cannot afford private care continue to have access to subsidised public services - and that those who can afford to pay for private services have access to them at a reasonable price. The report shows the way ahead. The challenge is to put the ideas into practice.