*************

Following is a speech by the Secretary for Health & Welfare, Dr E K Yeoh, at the Luncheon Meeting of the American Chamber of Commerce today(April 27):

Ladies and Gentlemen,

Traditionally, health care has been regarded as an expenditure which is a drain on the economy and a burden on the taxpayer. Furthermore, illness was considered to have a significant impact only on those who are sick, but has no important ramification for society in general.

Increasingly, however, governments are realizing that health, and by extension, health care, are crucial determinants of a nation's productivity and economic success. WHO reported that one third of per capita growth in a number of cross country studies was a result of improved health and nutrition. Other studies indicate that there is an additional 1% growth in GDP for every one-year increase in life expectancy.

Statistics such as these clearly tell us that health expenditure should not be regarded merely as an obligation, but as an investment in our society's economic success and quality of life. As a responsible government, we must spend within our means, but we should not lose sight of the fact that we are also investing in human capital and in our future.

Our vision is to develop and maintain a world class health care system, which can effectively support the individual's pursuit for good health and add value to the community's development. In realizing this vision, we see our role as follows:-

* improve the Hong Kong community in addressing health and health care issues in the context of the overall physical and socio-economic environment as well as the concept of personal wellness;

* engage the community to collectively and individually share responsibility in enhancing health status and maintaining a health care system which effectively serves its needs;

* to be able to allocate resources efficiently and effectively to ensure that health care is accessible, equitable and affordable to all, and that the public health care system is sustainable in the long term; and

* ensure quality and accountability from health care professionals who serve the community.

Addressing Health and Health Care in a Wider Context

Concepts of health and health care have moved beyond the realm of individual wellness. Health, as a contributor to national productivity and economic progress, must be viewed in a much broader context than simply the absence of physical pathology.

Our community needs to appreciate the fact that health is both an individual and a societal concern, and that factors which impact on the status of health start with the individual, such as health behavior and lifestyle, but also encompass external factors such as the general physical and socio-economic environment. We must plan and organize our health care services on the basis that these factors are mutually reinforcing and inter-related, and build both health and non-health related intersectoral infrastructures to set priorities and develop strategies to manage the full gamut of health determinants.

Empowering the Community

The responsibility for the pursuit and maintenance of health should be a very personal one, but as medical care and technology become more and more advanced, we find ourselves relinquishing this responsibility further and further to health care professionals.

The age of information technology has empowered us in many ways that none of us thought possible a few decades ago, but this has not taken place to the extent desirable or possible in the health care field. In fact, the historical asymmetry of information between patients and providers is being even further exacerbated by rapid advances in medical care and exponential growth in the available body of knowledge.

To empower individuals to take more responsibility for their own health, we need to provide public education and patient education which enhance community involvement and improves understanding of health and health care issues, while strengthening the collaborative relationship between patients and providers. Without appropriate information and an awareness of available options, there can neither be empowerment in decision making nor the capacity to accept greater responsibility for individual health.

The community, both individually and collectively, must also conduct themselves as active participants rather than passive onlookers in the pursuit and maintenance of their own health. At the same time, health care professionals need to foster patient relationships which are conducive to open discussion and facilitate joint decision making.

Ensuring Long Term Financial Sustainability

The issue of taking financial responsibility for our own health is always an emotional one. It conjures up anxiety filled scenarios of lacking the means to afford the necessary health care for catastrophic and prolonged illnesses or of low income individuals who may not even be able to afford basic health care services.

The fundamental role of the public health care system is to protect citizens from financial risks and to ensure accessibility to adequate services for low income groups. The key to fulfilling this role is to ensure the overall and long term financial sustainability of the public health care system through effective and efficient allocation of resources and identification of supplementary funding sources. As a responsible government, we must satisfy the health care needs of the community while minimizing the financial burden of future generations.

Through the effective and efficient allocation of resources, the government ensures that an appropriate range and balance of promotive, preventive, curative and rehabilitative services are available to the community. At the same time, resources are better targeted at the areas of greatest need while those who can afford to bear should share their own medical expenses. Individuals must make early plans for their long term health care needs so that both personal and economic gain from improved health status can be optimized.

Our health care costs are expected to continue growing. Coupled with aging of the population, these pressures will be felt even more keenly in the years to come. At present, 10.7% of our population are aged 65 or above. This figure will increase to 13% in 2016 and 19% in 2025. The elderly require more medical and rehabilitative services. Without an appropriate balance of promotive, preventive, curative and rehabilitative services that are community based whenever possible, the pressure will be on inpatient acute care services to fill the need for care, resulting in inappropriate utilization of expensive resources which do not meet patient needs. At the same time, disproportionate increases in public health care expenditure will mean corresponding reductions in other equally deserving social programmes. It is unrealistic to expect continuing major increases in the allocation of public revenue to health care. While the enhancement of productivity and reduction of costs will contribute towards easing the financing pressure on our health care system, these measures by themselves are insufficient to meet future needs without identifying supplementary sources of funding. If we truly believe that health care is an investment in our quality of life and economic success, then we all have a stake in ensuring that we continue to have an accessible, affordable, equitable and quality health care system. Such a system cannot be maintained if the government remains its sole investor. The government, through the public health care system, will continue to subsidize those who cannot afford to pay for health care services and protect all against the financial burden brought by catastrophic or prolonged illnesses.

Individuals, on the other hand, also have a key role to play in this formula. If we subscribe to the notion that health is a personal responsibility and maintenance of health starts with the individual, then there should be little dispute over the need for each individual to make early plans for his or her long term health care needs. We cannot afford to ignore such needs, but yet there is always a tendency to procrastinate, particularly among those who are still young and healthy. They think they will not sick, and they don't need to plan for their long term medical need. But they all are ignoring one fact, the fact that one day - and it may be come sooner than they expect - they will get old. They too will get sick. They will need medical attention and their family members will have to devote considerable time and effort in looking after them. No one likes to think about it. But, no one can escape sure of these realities. By planning early for our medical needs, we are not only doing ourselves a favour, but more importantly, we can avoid putting an undue financial and mental burden on our next generation.

We, as a society, will have to invest a considerable amount of our resources in health care. We need to protect this investment by prudent management and sharing the responsibility for ensuring its survival, and improvement of the system.

Ensuring Quality and Accountability

The trust relationship between the community and health care professionals is the key to enhancing our status of health. It is also the foundation from which active community participation in the pursuit and maintenance of health is developed. The Hong Kong population is entitled to a health care system that can consistently maintain a high standard of service.

The government's role is to ensure that appropriate policy, regulatory and monitoring frameworks are in place, with protection of public interest and enhancement of a collaborative trust relationship between patients and health care professionals as priorities. However, how successfully we, as a community, are able to maintain a consistently high standard of service depends on a shared responsibility between government, health care professionals and patients. While the government provides the necessary policy, regulatory and monitoring frameworks, health care professionals must undertake continuous education to update their knowledge and to learn new skills and ensure that appropriate quality assurance systems are in place. At the same time, the community, individually and collectively, must exercise their right to choose and their right to information.

The assurance of consistent service quality must be collaborative rather than adversarial. Our efforts need to be coordinated and evidence-based, so that we are not relying solely on good intentions or emotions.

Due to the economic success of the past several decades, Hong Kong, as a society, has successfully made the transition from struggling for day to day survival to an affluent community growing increasingly and more concerned about the quality of life. An effective and sustainable health care system is fundamental in supporting improvements in the quality of life.

Despite Hong Kong's economic success and the affluence of the majority of its citizens, public health care remains heavily subsidized by the government. At the same time, a better educated public is asking for continuous improvement in both the quality and quantity of services.

Despite the government's best efforts, limited resources cannot meet unlimited expectations and demands. The only viable and acceptable long term solution is the sharing of responsibility between the government and the community, if we are to maintain an accessible, affordable, equitable and quality health care system. The pursuit of good health is both a goal and an investment. We all want to be able to enjoy our hard earned affluence and optimize the potential offered by increasing life expectancy. At the same time, we also want to take advantage of the fact that good health is a generator of wealth. Joint effort between the government and the community is critical in harnessing the benefits and gains promised by good health. In the end, we get the health care that we deserve.

END/Thursday, April 27, 2000

NNNN