Safeguards are needed to prevent private doctors from exploiting their enlarged role outlined in proposed changes to health care, the health minister said yesterday. 'Doctors could be very cunning' in finding loopholes in the system, Secretary for Health, Welfare and Food York Chow Yat-ngok said. But whatever measures are put in place, 'we must give doctors reasonable profits', he said. His comments followed the release of a discussion paper on Tuesday that put forward a new model for what has become an unsustainable health-care system. The reforms call for the role of family doctors to be expanded to encourage people to visit them before hospitals. The proposals also include greater collaboration between the private and public sectors. The document, Building a Healthy Tomorrow, was prepared by the new Health and Medical Development Advisory Committee, which Dr Chow chairs. Concerns were raised that by expanding the role of private medicine, private doctors would sharply raise their fees, overburdening the middle class. Dr Chow said the government would put medical and service audits in place, and lay down requirements on qualifications and continuing education. About $30 billion of the estimated $53 billion spent on health every year goes to funding the Hospital Authority, with the remainder coming from medical insurance premiums, Dr Chow said. That meant the government seemed to be using the $30 billion more efficiently than the private sector. Dr Chow also said only three options existed to finance health care: personal savings, a regulated insurance scheme, or a combination of both. A report on health-care financing is to be announced by December or early next year. Meanwhile, the head of a working group on the advisory committee said private hospitals could develop centres of excellence, while existing centres in the public sector should be consolidated. 'We want to pool resources so that we can be working at a high international level,' said Dennis Lam Shun-chiu, who chairs the working group on tertiary and specialised care. 'We are consolidating the concept and we are laying down the criteria, principles and conditions for such centres.' The government would continue to 'heavily subsidise' these tertiary services in the Hospital Authority, which cater for cutting-edge technology and procedures for catastrophic illnesses, he said. Development of such private medical centres would also be encouraged so that Hong Kong can become a referral centre for the region.