LC: Motion debate on "Health care reform consultation paper"

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Following is the speech by the Secretary for Health and Welfare, Dr E K Yeoh, in the motion debate on "Health care reform consultation paper" in the Legislative Council today (June 14):

Madam President,

I would like to thank Dr. Hon. Leong Che-hung for moving the motion today and thank those members who have just expressed their views. Before I respond to members' comments regarding health care reform, I would like to take this opportunity to brief Members on the progress of our work on this important subject.

Progress of work on health care reform

After detailed study of our health care system, the Harvard consultants issued a report last year, setting out some reform recommendations for the community to consider. The release of the Harvard Report has generated considerable discussion in Hong Kong. During the consultation period, we actively solicited comments and suggestions from the public, and altogether received more than 2200 submissions from different sectors of the community.

Upon the conclusion of the consultation, we set up a working group to reappraise the recommendation made by the consultants and analyse the submissions received from the community. We have been developing options that can address the needs of the community and meet its expectations. We have also consulted various stakeholders regarding broad directions for our reform.

On several occasions, I have introduced the scope of our reform proposals. The review we are performing now is comprehensive. These include not only financing options, but also quality assurance and service delivery. We have also studied the health care systems of other countries. The reforms will widely cover reorganisation of primary care, promotion of family medicine, collaboration between private and public sectors, promotion of Chinese Medicine, strengthening of complaint mechanism, utilisation of information technology, continuation of cost-containment measures, and formulation of financing models. All of these have contributed to our formulation process in a constructive manner.

Members can be assured that, faced with these tasks with significant bearing to the well-being of every citizen, the Government has determined to proceed and will not forego the chance to step forward. Indeed, according to overseas experience, health care reforms that are as comprehensive as ours often takes years from their initial formulation to their full implementation. We have made the first step down the road. I believe that it has been worth our while to take more time to conduct studies and consultation.

Like many countries with the experience of implementing health care reform, Hong Kong needs to achieve several competing "health policy objectives" at the same time. We understand that any systems in this world are bound to be faced with trade-offs in the pursuit of these objectives. We need to juggle financial sustainability of our system with quality, equity, accessibility and affordability of services provided. These are indeed the highlights in Dr. Leong's motion and are the values that are cherished variably by different members of the society. Please let me explain our position with regard to these highlighted policy objectives now.

Affordability

Let me first talk about affordability. We have all along adhered to the policy that no one will be denied of medical care due to lack of means. In order to maintain fees and charges at a level affordable to the public, we shall refer to the indicator as to how great the proportion of monthly income of an average household is put on health care services and then formulate our policy accordingly. One of our fundamental guiding principles in formulating our reform proposals is that we will continue to ensure that those who cannot afford will, as in the past, be well taken care of. It is our firm conviction that the long-standing virtue of our system with respect to people's affordability will not be lost in this reform exercise.

Accessibility

We then turn to accessibility. In order to enhance its accessibility, a system would need to remove those barriers to available services. Such barriers may originate from geographical hindrance or waiting time factors. We can firmly reiterate that during the past development of the public sector services, we have paid immense regard to the issue of accessibility. The establishment of new hospitals, the development of outreach service and the initiatives in reducing new case waiting time well serve to reflect our achievement in this area. Simply put, accessibility will is a merit our community values and a virtue that we will strive to preserve.

Equity

The third objective is equity. This is indeed a term embracing a wide scope of concepts. Among these, the public's expressed views in these years have pointed to the wider adoption of two particular concepts. The first one is that those with equal health care needs should have equal access to care. Through its highly subsidized public sector services, the Government has all along made great achievements in this aspect. The second concept is that in the future we will have to better targeted our limited resources at those who are most in need. We are convinced that this concept has increasingly gained acceptance in the society. Surveys conducted have shown than 70% of the respondents support the underlying rationale of this concept. We are heading for such directions now.

Sustainability into the 21st century

Whether our system can maintain its financial sustainability into the 21st century is a great challenge to our reform. Our society needs to understand that without a strategic reform in the system, particularly the financing system, the strengths of our existing system can hardly be sustained as time goes by. When formulating our financing options, we have to foresee how the options would affect the demand for health care services as well as how much services the funds contributed can cover. We are fully aware that whichever financing models we choose should serve to maintain the long-term sustainability of the system.

Facilitation of professional development to meet the challenges

The last objective is to facilitate professional development. Health care professionals are nowadays faced with the challenge arising from advancing medical technologies, rising community expectation and the drive for Evidence-based Medicine. Continuous professional development is one of the important weapons against these challenges. The Government resolves on making a large step forwards in this aspect in collaboration with various professional bodies.

Response to the amended motion

Regarding the Hon. Micheal Ho's amended motion, I would like to make the following comments. According to the public response to the Harvard Report, a central medical insurance financing model has not received general support in the community. Against this background, we have paid due regard to the views expressed by the public, and are devising different financing schemes that better reflect community values, meet people's aspirations, and yet sustainable over time. We shall set forth in the consultation paper and actively seek the views of various stakeholders. Any new financing models will take considerable time to develop, fine-tune and commission before being put into actual use. We therefore will adopt an incremental approach in developing and implementing changes to our health care system. The actual implementation of any new financing scheme will take into account a host of factors, including the state of the economy. On the funding needed for carrying out reform measures, we will ensure that sufficient resources will be made available to implement individual reform recommendations through the appropriate funding mechanisms.

Conclusion

Madam President, I understand there are great public expectations on health care reform, but I hope that members could appreciate the complexity and the extensive nature of reform proposals, which take into consideration the values in our society, the concerns highlighted by different stakeholders, and the community's expectations. When we have completed the final stage of preparation, we will release the consultation document on health care reform for a thorough discussion by the community. I hope all of you as well as members of the public will actively express their views on the proposals when the document is released. Last but not the least, I would like to thank once again all members who have shared with us their valuable views and comments today.

Thank you.

END/Wednesday, June 14, 2000

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