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Following is the English translation of the "Hong Kong Family Letter" delivered by the Secretary for Health and Welfare, Dr E K Yeoh, on Radio Television Hong Kong this (January 20) morning:
Dear Eng-kin,
As you may know, the Consultation Document on Health Care Reform was released last month and I have been meeting various sectors of the community to explain the reform proposals and listen to their views.
Many people ask why the consultation document is issued at this time of economic recovery. In fact no time is a good time for introducing reforms. However, the road to reform is very long and the community has to start the discussion early since the health system is there to serve them. We do not intend to rush through the reforms. That is why they are now put to public consultation. Subject to the public views received, we will phase out the implementation and will conduct regular evaluation and review.
When we look at health care systems all over the world, we are not alone in search of a viable option towards achieving long-term sustainability. Many factors contribute to the problem of financial sustainability. First, the population is aging. It is estimated that, in 2029, the elderly population will reach 20% of the total population. This means that the future health care bills will on one hand become more expensive as more elderly require more intensive medical and rehabilitative services. But on the other hand, if there are inadequate retirement income protection, these bills will be borne by fewer people. Furthermore, technological advances enable health systems to treat illnesses and disabilities hitherto to which no curative option was available. New technologies are generally labour intensive and tend to be financially expensive. Lastly, community aspirations add further pressure to cost. People always tend to ask for more and better health care services as society gets more affluent. Despite these pressures, the public health care system should continue providing equitable and quality services for the general public; but at the same time, it should be able to sustain in the long term.
In 1999, the government-commissioned Harvard Consultants studied into and analysed the weaknesses of our health care system. In particular, they highlighted the questionable financial and organisational sustainability problem; and suggested some major recommendations. However, these recommendations were not well-received by the community. In spite of this, these recommendations and the community views formed the building blocks for our comprehensive review of the health care system. We have reviewed the three main pillars - the organisation and provision of health services, mechanisms to assure the quality of health care provided, and the funding and financing for health care services - and proposed 11 strategic directions and 33 initiatives to improve our present system so that the future one will be able to meet the demand and aspirations of the community.
So, what then we want to achieve? At the macro-level, we hope to protect and promote the health of our community and further upgrade the health status of our population through, for example, the wider application of Health Impact Assessment in social and economic issues. As to the individual level, the two health agencies, the Department of Health and the Hospital Authority will each have different but complementary roles to play. The Department of Health will focus on preventive care and become an individual's health partner by implementing health programmes for all ages. Individuals will be encouraged to take an active part in health-promoting behaviours, such as regular exercise and health diet; but to refrain from health-threatening activities such as smoking. On the other hand, the Hospital Authority will take care of the sick by providing lifelong holistic curative and rehabilitative care. In doing so, the Hospital Authority will continue investing in new medical technologies and promote the introduction of traditional Chinese medicine. All these will be reflected in improving the quality of life of the community. Through these reforms, health care services provided by the public sector will be of quality, affordable and accessible by members of the public.
Apart from changes to the approach in the provision of services, we also propose to tackle the problem of sustainability from the financing aspect. Here, I must stress that the proposals are based on the premise that government is committed to financing the public health care system and we would expect continued allocation of public resources into health services having regard to community needs and economic growth. However, government resources are limited, and like other public services, health services have to compete for allocation from the General Revenue. Any increase in allocation for health services would mean cutting the allocation for other equally important public services such as education or welfare. And such increase alone is insufficient to invest in technology and advances in medical care.
The financing options we propose are a three-pronged approach which should be implemented in parallel. First, we will continue the cost-containment measures that are effectively being adopted in the Hospital Authority. Second, we will conduct a comprehensive review on the fee structure in the public sector. We hope that the revised fees will reflect the relative priorities of services. However, any adjustment will be moderate and the fees will remain affordable. We believe public funds should be channeled to assist lower income groups and to services of major financial risks to patients. For the lower-income groups, we will ensure their protection through the second safety net.
Much has been said about the last prong - the Health Protection Account. We must bear in mind that it is only one of the initiatives under the financing pillar of the health care system and is only part of the many reform proposals, which will amalgamate and improve the whole health care system. The savings in the Health Protection Account is meant to be a protection for an individual to pay for medical expenses after retirement; and is meant to relieve the burden of our next generations. Details of the proposal can be further fine-tuned based on the views of the community.
There are about less than two months before the public consultation period closes. I really hope that Hong Kong citizens will support the directions for reform and share with me their views on the health care system. It is vital in the interest of members of the community that we should have a high quality and affordable health care system.
Wish you good health in the Year of Snake.
Yours,
Eng-kiong
End/Saturday, January 20, 2001
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