Former Hong Kong health chief slams medical voucher scheme for the elderly as lax, flawed and ‘not cost-effective’
- Nearly 80 per cent of elderly residents still use public health care, which does not help city’s overcrowded hospitals
- Government has earmarked HK$4.2 billion for the plan in the 2019-20 budget
A voucher scheme that gives elderly Hong Kong residents HK$2,000 a year to use for private health care has failed to ease overcrowding at public hospitals and not been cost-effective, the city’s former top health official said on Monday.
Professor Yeoh Eng-kiong, now head of public health and primary care at Chinese University, said even years after the programme was adopted, 78 per cent of elderly patients still went to public clinics, while 73 per cent did so before the vouchers were introduced.
Yeoh, who led a university study of the programme between 2015 and 2018, said the government needed to overhaul the voucher scheme to better help the elderly get health screenings and manage chronic diseases – the best long-term ways to promote health and cut hospital visits.
The government earmarked HK$4.2 billion for the plan in the 2019-20 budget, a 33 per cent increase from the year before.
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“Now that we have been lax, it is already too difficult to go back and bring in more restrictions,” Yeoh said. He added that political concerns also complicated the issue.
“Most elderly [residents] only used the vouchers on acute conditions such as treating flu, or for seeing optometrists for glasses. These could help them in some ways, but did not serve the purpose of the scheme, nor was it cost-effective.”
He continued: “But you cannot blame the elderly for using the vouchers this way when the government’s design was faulty in the first place.”
Hong Kong’s medical system is tilted heavily towards the overloaded public sector, which employs about 40 per cent of doctors but treats an estimated 90 per cent of inpatients.
The voucher scheme was introduced on a pilot basis in 2009 and regularised in 2014 to encourage residents aged 65 years and above to choose private health care. The goal was to boost their primary health care and lessen the heavy load on the city’s public health system.
But you cannot blame the elderly for using the vouchers this way when the government’s design is faulty in the first place.
Hong Kong residents aged 65 years old or above are on average six times more likely to require hospitalisation than those younger than 65, according to the government.
By the end of 2018, the government said 7,941 health care providers had signed up to accept the voucher in 18,726 facilities across the spectrum of health services – doctors, traditional Chinese medicine practitioners, dentists, nurses, physiotherapists, occupational therapists, radiographers, medical laboratory technologists, chiropractors and optometrists.
“Nowhere in the world do you have such a complicated voucher scheme that covers so many types of service,” Yeoh said. “How did the government expect the elderly to choose services that served the purpose of the government?”
The Chinese University study, which polled 974 elderly residents and reviewed their public hospital records, found that more than 90 per cent of those surveyed never used the vouchers to treat chronic disease, and 70 per cent did not use them for preventive care.
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The median cost per claim the group spent on doctors hovered between HK$200 and HK$300 from 2015 to 2018. The amount they spent at dentists, physiotherapists and heath screenings was between HK$550 and HK$1,166.
The survey showed that the group spent the most on optometrists, and that amount increased from HK$1,650 in 2015 to HK$1,951 in 2018 – an uptick perhaps explained by the purchase of prescription glasses.
The study, which included a focus group of service providers, found that the vouchers were sometimes used for questionable purchases, such as expensive dried seafood from traditional Chinese medicine practitioners.
Such purchases could be a reason that, although the percentage of elderly residents who used vouchers rose from 28 per cent in 2009 to 94 per cent in 2018, the scheme failed to bring down the number of public hospital visits.
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“The scheme now only encourages [the] elderly to use more health care services,” Yeoh said. “In the future, if the government is raising the value to more than HK$2,000, they should come up with ways to restrict the use to focus on a few diseases that pose a danger to public health.”
He said a portion of the vouchers’ value should be assigned to disease prevention, such as screenings for diabetes, which affects one in 10 Hong Kong residents – though half of those are unaware they have the disease.
Yeoh said it might be helpful to implement a new voucher programme to help younger residents screen for diabetes because people as young as 40 could develop the disease.
