Hospital Authority chief talks insurance and mega cities As a boy, Anthony Wu Ting-yuk wanted to become a doctor, just like his grandfather. While that did not happen, he ended up forging a successful 30-year career as an accountant - reaching the post of chairman of Ernst & Young Hong Kong, China and the Far East and becoming a member of the firm's global executive board. But he did eventually fulfil his boyhood dream of entering the medical arena, albeit in a different way. As chairman of the Hospital Authority, he manages 53,000 doctors, nurses, and other employees at public hospitals and clinics. People now assume he has medical training and mistakenly refer to him as 'Dr Wu'. With the government's planned health-care reforms in the spotlight, Mr Wu's job has become even more important. Facing an ageing population and rising health bills, the government last month started public consultations on the reforms that could include a compulsory savings or medical insurance scheme. Mr Wu also is chairman of the Bauhinia Foundation think-tank. Why did you become an accountant? I wanted to be a doctor when I was small. I was born into a family with three other brothers and a sister. My parents always wanted one of the children to be a doctor because my grandfather was one on the mainland. I was prepared to go to the United States to study medicine but changed my mind just two weeks before the course started. During a chat with a priest at my secondary school, Wah Yan College, he asked me: 'Why do you want to be doctor?' That made me rethink things and I realised I only wanted to do it because my family wanted it. My elder brother had opted for commerce and my younger brother wanted to be a lawyer, so I thought I should be the one to fulfil the family's mission. But then I realised I wanted to be a financial professional, so I chose to study accountancy at Teeside Polytechnic in Middlesbrough, England. After I graduated, I became the first Chinese to join Ernst & Young in Britain before moving back to Hong Kong and becoming a partner at 30. I became chairman at 46 and stepped down in 2005. Why did you quit accountancy to become chairman of the Hospital Authority? After being an accountant for 30 years, I wanted a change. I was asked by former chief executive Tung Chee-hwa to become chairman in October 2004 and found it was a time-consuming job. So I decided to step down from the chairmanship of Ernst & Young in 2005 but remain its senior adviser. Being the chairman of the Hospital Authority is a more challenging and exciting job. I jump every time my BlackBerry rings as I fear that it may be some medical incident or a case of bird flu. So you are back to your boyhood dream of becoming a doctor? Yes, the benefit of being the chairman of the Hospital Authority is that people now call me 'doctor' although I am neither a medical practitioner nor a doctoral degree holder. They all think I am a doctor and call me 'Dr Wu'. It continues the dream that I had 30 years ago. That is fate. How do you compare life as a chairman of Ernst & Young and chairman of the Hospital Authority? It was simpler to be the chairman of Ernst & Young. As the chairman of a private organisation, you need to focus on three objectives - achieve profitability and growth; recruit and retain talented staff; and provide quality services and products for clients. As the head of a public organisation like the Hospital Authority, I have to face a large number of stakeholders - doctors, nurses, unions, patient organisations, legislators, government officials, etc. It is hard to find a balance as proposals that may benefit some parties may hurt the interests of others. A friend told me when I took over the chairmanship of a public body that I could not make everybody happy, 'so do what you think is right'. It is so hard to strike a balance and many of the proposals are for the long term and you cannot see the benefit immediately. For example, if there is some illness that affects only 100 people and they need an expensive drug that costs HK$50 million a year, should I grant the funds to this group of patients or should I use the money for other drugs or treatments that can cure 10,000 patients? There is no simple answer. Why didn't you stay on at Ernst & Young then? There are more challenges in being the chairman of the Hospital Authority. After working in the accountancy industry for 30 years and expanding Ernst & Young's Hong Kong and China offices from 1,000 staff members to 6,000, the job became routine. Now I face new problems almost every day and it is more fulfilling and challenging. I have been a director of the Hospital Authority since 1999 and chairman since 2004. I witnessed how the doctors and nurses worked so hard during the Sars outbreak and I am happy to work with them. Since you are not a doctor, how can you head the Hospital Authority? Has your background at Ernst & Young given you any help? It is all about management. The chairman is the one to lead the organisation, to set clear objectives and visions. Everybody thought I was being appointed as chairman by the government to solve the financial problems of the authority. However, I found the main problem to be low staff morale due to the salary structure, work load and career progressions. My job is to communicate with the doctors, nurses and other employees to understand their problems. The morale is slightly better now. Which challenges do you handle the best? I think I am a good listener. I met with thousands of doctors when they demanded a pay rise last year. I also successfully convinced 95 per cent of doctors to accept a proposal for over-time payments. What is your view on the government's health-care finances? I think the proposed reform has a solid message - retaining the status quo is not an option. If we keep the current system, we would not be able to sustain it by 2033 when one in every four people will be over 65 years old. If nothing is changed, our next generation may not get the same medical treatment as we have. Which of the six finance options do you like? I prefer the sixth option that is a combination of a mandatory savings account plus an insurance scheme. This has a saving element for medical use after retirement while the medical insurance helps share the risk. This can help finance the system and encourage the public to have more options. We saw many complaints about medical insurance last year. Do you think private insurance can be part of these reforms? What happens if some people's claims are rejected or other people cannot buy any cover due to age or past diseases? If the government makes it mandatory for people to buy insurance, it must make sure there is a single premium and unique conditions in the policy. There should be no exemptions or rejections. I think the government may well end up insuring everyone and then it can have a reinsurance arrangement with the private sector. This would make sure everyone has basic medical insurance to provide basic needs. Those who want better treatment or better hospital services can buy the additional insurance cover. There are not many models overseas exactly like this but Singapore and Australia have similar arrangements. Some people say the Hospital Authority should better control its budget before the government thinks of new ways to finance health care. Do you agree? We have 53,000 employees and 80 per cent of the budget is staff costs. Of that, 99 per cent is for the doctors, nurses and front-line staff. The management staff only represent a small number of employees. The budget for the Hospital Authority is less than what it was 10 years ago. The authority has been running in a cost-effective way. Turning to your chairmanship of the Bauhinia Foundation - you have suggested Hong Kong and Shenzhen should combine to create a metropolis. How did you come up with such an idea? Hong Kong is a small city of only seven million people. We also have a very low birth rate. If we add Shenzhen's population, we would become 20 million people and the market would be much bigger. If we can work out some way to combine Hong Kong and Shenzhen under the 'one country, two systems' principal, such as merging our airports into a big airport by building a rail link, we will combine the energy of the two places. The stock exchanges of Hong Kong and Shenzhen could consider merging as well. There would be many technical and political issues that would need to be solved, but I do think this is the right way forward. Do you plan to retire? I want to retire some time in the future but I do not know when. When I was young, I thought I would be retired at 45. Now I am working many more years than I expected. Many of your close friends call you Fat Wu - have you ever thought about dieting? All the time but it is so hard. But I still weigh less than 90kg. I want to lose weight but it is very difficult as I love good food so much. I love everything, from beef noodles at the corner shop to the pasta in Italian restaurants. All of them are so tasty - how can I stop eating?