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The following is the transcript of the question and answer session given by the Chief Secretary, Mrs Anson Chan, at the luncheon meeting of the Academy of Medicine today (Friday):

Question: I would like to begin by asking you, Anson, on a related topic, still on financing but not so much health care as specialist training. Some time ago the

Academy applied to the Secretary for Health and Welfare for funding for specialist training, which is, up to this date, largely non-existent. You will see that funding is only for service and there is very little, if any, funding for post-graduate medical training. If, one day, health care financing is really revamped, do you feel that there should be appropriate emphasis on funding for the Academy for this purpose?

Mrs Chan: That is a tough question. My understanding - I have to say that I am not fully briefed on this but I will look into this when I get back - but my understanding is, in fact, through the Hospital Authority there is a degree of funding for specialist training.

Of course, if in the future we are able to arrive at a formula that will ensure optimum use of resources to deliver quality health care at affordable prices, and to the extent that resources can be redeployed - and I do emphasise the object of the exercise is not to cut-back on government expenditure, we just want to make the optimum use of the resources that we currently spend - and if in that course it is possible to redeploy resources, then I personally do not rule out the possibility of looking at the need for and the feasibility of allocating more resources for specialist training.

I do notice that it is one of the aims of the Academy to promote specialist education and we will certainly be prepared to see in what way the government can help. But I do emphasise that at the moment, unless we are able to redeploy resources better and to use it better, the fact that our economy is maturing and growth in future is going to be considerably curtailed as opposed to very strong growth in the past, there is clearly a limit to how much additional expenditure can be allocated by government for health care and health care education.

Question: Maybe just a comment. Perhaps with the reform that is coming and has gone through, then there might be money to spare for the Academy. In fact I want to ask a question.

I think in the administration we go by figures and projections which you have done very well, Mrs Chan. But we also go by hunches. In the past we had attempts at reform but those have failed, I think, and what is your hunch this time?

Mrs Chan: I don't want to do any crystal-ball gazing. I think that I have sufficiently emphasised in my speech that this time we mean business, because I really do not think we can sweep this whole issue beneath the carpet any longer. You are quite right in saying in the past we made various attempts but for one reason or another none of the proposals have ever really taken-off. This time it is clear to everyone that there needs to be reform. I think what we are discussing, and I hope we will have a constructive debate, is in which direction reforms should move.

Question: I would like to comment on doctors' charges and fees. What are your impressions, especially when you have a family of so many involved doctors, so I am sure you are familiar with fees charged. I especially speak for primary care doctors and I think the fees charged by the primary care doctors are probably amongst the lowest in the world. And so with the sort of adverse reports that we have been getting about doctors overcharging, I personally think that there should be a revaluation of worth: whether doctors' consultation times should be maybe worth a bit more and I would like your comments on that.

Mrs Chan: First of all, I am glad to say that none of my family members charge me for medical care. Now, the whole question of charges, whether it is value for money, whether it is too high, is of course a hotly debated subject. And I think even amongst members of this esteemed profession, I think you will acknowledge, if not publicly at least privately, that some charges on the face of it seem rather unreasonable.

I think I can say that if the free market was operating and operating well, then clearly the market will dictate what the charges should be. But a lot of people suggest that in the provision of health care by the private sector, the market forces do not operate in a genuinely free and open manner. If nothing else, people allege that patients and the consumers are often at a disadvantage because they have clearly not as much medical knowledge as the medical practitioner and moreover, it is very difficult for patients on their own to determine what is a reasonable charge and what is not a reasonable charge.

So speaking personally, but I emphasise this is not government policy - we have yet to determine a policy on this if, in fact it is necessary - is that if the profession as a whole was able to regulate your members so that at the very least you publish a schedule of the range of charges, then at least the patient when shopping around for services, can decide for themselves whether the charge levied by an individual practitioner is reasonable or not.

It is imperative, I think, for the profession as a whole to demonstrate to the public that it acknowledges the concerns and that it is prepared to do something to address these concerns. Because if you don't, then the pressure on the government will be that much greater to regulate charges and in accordance with our free market philosophy it is not something that we would gladly do unless compelled to do so.

End/Friday, April 30, 1999

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