"Letter to Hong Kong" by Secretary for Health and Welfare

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The following is the full text of the "Letter to Hong Kong" delivered by Mrs Katherine Fok, Secretary for Health and Welfare, on Radio Television Hong Kong this (Sunday) morning:

No one, who lives in Hong Kong, can seriously claim that life is dull here. In recent weeks, community attention has focused on the Harvard Consultancy Report on health care reform.

The debate on the need for reform of our health care system and some of the options available to us have been extensively covered in the media and in a wide variety of other forums. As Secretary for Health and Welfare, I am particularly pleased by the degree of enthusiasm shown by all sectors of the community in responding to the debate by attending various seminars which we have organized and by writing to me. Many of the comments that I have received are thoughtful as well as thought-provoking. A number of questions about the reform proposals have consistently surfaced and I should like to take a few minutes to address these in turn.

Questions have been raised as to whether a universal insurance scheme as proposed by the Harvard Team is required when it would be much simpler to raise taxes or user fees to tackle the financing of health care.

Let me state very clearly that this is not just a question of money. There are also fundamental problems in the present delivery system which must be addressed. I will return to this subject later on. Reforms in financing must go hand in hand with reforms in the organization of health care. To put more money into a system which has basic structural and organizational problems would mean only one thing : that is, spending more money but getting less and less value for our money. Such a simplistic approach would be both short-sighted and ineffective. Raising taxes redistributes wealth but does not allow sharing of risks. Raising user fees penalizes those who are sick at a time when they are most financially vulnerable. Given a projected increase in the incidence of chronic illness, the community's financial burden of providing for health care will become heavier and heavier. What is most often financially crippling is not a single acute illness but rather, the ensuing long term treatment which may last for years. As such, a universal insurance scheme spreads out the risk, ensuring that all patients

will have access to adequate health care.

Besides the availability of financial resources, we must also consider the even more important issues of how to allocate and utilize health care resources in the most effective way possible. Financing reforms alone will not even begin to resolve these problems. What is needed, in addition to changes in financing, is the development of primary and community based care, family medicine as well as minimizing service duplication, and improving continuity of care. These issues will become more and more critical as the Hong Kong population ages and the incidence of chronic conditions increases. Dependence on mainly hospital based services will not effectively cater for the future health care needs of the population.

I mentioned earlier that we need to address some fundamental problems in the present delivery system. Let me take you through these one by one. There are financial and organizational barriers which exist between our public and private health care sectors. To the public as users, this means choices are limited because they are forced to choose either one or the other. By removing these barriers, patient records and test results can be shared between public and private sector providers, thereby making the treatment process much simpler for patients. The fact that existing public health care services are mostly hospital based means that there are inadequate alternatives for those who do not necessarily need inpatient treatment. This is not only ineffective in meeting patient needs, but also drives up the costs. There are also opportunity costs for employees, employers and for the community as a whole, if hospitalization is the only available option because the requisite outpatient facilities are underdeveloped.

I hope that I have answered some of the most often asked questions. Now, I would like to ask you to consider certain questions which will help clarify the values which we feel are most important to our community :-

First. Do we, as a society, wish to take care of our members who are less capable of taking care of themselves; and if so, how far are we willing to go? Are we willing to be generous only if existing tax revenue is sufficient to achieve this, but firmly draw the line when we have to pay more?

Second. Do we want our health care system to be equitable, to be of good quality and to be affordable? If we had to rank each of these values, which one is more important?

Third. Do we espouse and embrace these values only when tax revenue is sufficient to make this possible? Or, do we believe in these values so deeply that we are willing to find ways and means of making sure that they can be sustained?

Fourth. With limited resources, do we wish to contain rising health care expenditure so that our spending on other equally important public programs, such as education, housing and social welfare, can be maintained?

These are difficult questions and there are no simple answers. But unless we, as a society, do some serious soul searching now, we will end up with a series of default decisions and compromises which may lessen the pain in the short term, but will surely prove ineffective in meeting our needs well into the next century. The community must decide the values and the reforms that we wish to adopt.

We wish to hear your views. Your input is valuable and will help to shape the future of our health care system well into the 21st century. Take up the challenge.

Finally, I wish to assure everyone that whatever reforms are to be adopted in the future, the Government remains committed to providing quality and affordable health care for all.

End/Sunday, May 16, 1999

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