Over the past decade, a voucher scheme for private health care that began with HK$250 (US$32) given to each elderly resident annually, and rose to HK$2,000 five years ago, has become part and parcel of life for many. It is commonplace for users to get flu treatment or a new pair of eyeglasses in clinics and optical shops displaying a characteristic green sticker. So why is the government now imposing restrictions on the vouchers’ usage and how does that affect the elderly and practitioners? When and why were the vouchers launched? The vouchers were first introduced in the form of a pilot scheme in 2009 for the elderly to use private health services, including preventive care, to supplement existing public services. Five vouchers of HK$50 each were provided annually to each resident aged 70 or above. In 2014, the scheme became a recurrent programme and the annual voucher amount was increased to HK$2,000. In 2017, the government lowered the age threshold to 65. Last year, elderly residents also received a one-off additional voucher of HK$1,000. The arrangement will continue this year, according to the recent budget announcement. Do the vouchers serve their purpose? A study by Chinese University found 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. Former health secretary Professor Yeoh Eng-kiong, who led the study, 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. Critics have long highlighted the potential for misuse of the vouchers, such as unnecessarily expensive eye tests and spectacles, or even exorbitant prices for dried seafood products at Chinese medicine clinics. Hong Kong’s ex-health chief slams voucher scheme for the elderly What is going to change? On Monday, health officials proposed a HK$2,000 cap every two years on the value elderly residents can spend on optometric services using their vouchers. The idea, according to Secretary for Food and Health Sophia Chan Siu-chee, is to discourage users from spending all their vouchers on a single service, and to ensure a decent balance is kept for more pressing services, such as body check-ups and chronic illness prevention. Why is the optometry profession being targeted A recent review found that more than three quarters of claims above HK$4,000 were made at optometrists last year, a worrying trend that could undermine the scheme’s effectiveness in promoting a more diverse use of primary health care services. The median claim at optometrists from 2015 to 2018 was between HK$1,600 and HK$1,951, compared with HK$550 to HK$640 at regular doctors. And out of the 235 complaints received in this period, 46 were directed towards optometrists, a figure which Chan said was also relatively high. Overworked doctors urge Lam to cut hospital red tape in meeting Does the proposal solve the problem? If not, what are other stakeholders calling for? The Society for Community Organisation welcomed the proposal, but was concerned the move would reduce the flexibility of how some people were able to use their vouchers. Vincent Ng Sheung-shun, vice-president of the Hong Kong Society of Professional Optometrists, said it was unfair to set a ceiling for optometric services – which many elderly people needed – and not other areas covered by the scheme. He suggested having the voucher scheme to just cover examinations and exclude the purchase of spectacles. Civic Party lawmaker Dr Kwok Ka-ki urged the government to limit the use of vouchers on other “inappropriate” health care products and services, such as dried seafood, so as not to let services other than optometry off the hook. Yeoh believed there should be more focus on a few diseases that pose a danger to public health. This could be done through assigning a portion of the vouchers’ value to disease prevention, such as screenings for diabetes, which affects one in 10 residents. Dr Lam Ching-choi, chairman of the government’s Elderly Commission, said more should be done to educate the elderly on how to use the vouchers wisely or check their remaining account balance.