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The Government today (March 13) launched a three-month consultation exercise on healthcare reform and supplementary financing options as the first part of a two-stage public consultation, aimed at building a consensus to reform the healthcare system and make it sustainable and more responsive to the increasing needs of the community.
Explaining the consultation document "Your Health, Your Life" at a press conference, the Secretary for Food and Health, Dr York Chow, said that over the years, Hong Kong had built an enviable healthcare system that provided high quality services. However, the ageing population, rising medical costs brought about by advances in medical technology and increasing occurrence of certain lifestyle-related diseases would cause health expenditure to increase rapidly and at a much faster pace than the economy. This would pose immense challenges to the sustainability of the public healthcare system which depended heavily on public funding.
In addition, there was significant public-private imbalance in the healthcare system, resulting in limited choice as well as inadequate competition and collaboration among healthcare providers in both the public and private sectors.
"Even with increased government funding, and even with sustained efficiency gain and service enhancement of the public healthcare system, we can only defer but not resolve the problem of declining level and quality of services. It is estimated that the continued growth in service demand could result in lengthening of waiting list and time for specialist out-patient services and special services, more overcrowding in in-patient wards and constraining investment in healthcare facilities and equipment," Dr Chow said.
"It is clear that we need to reform the healthcare financing arrangements, in addition to healthcare services and market structure reforms now," he said.
The vision of the Government was to achieve a healthcare system that improved the state of health and quality of life of people, and provided healthcare protection for every member of the community, with the provision of more comprehensive healthcare, more choice of services, and better protection.
Dr Chow said effective primary care would help improve the health of individuals in the community and reduce the need for hospital care. Primary care was not just about the curing of episodic illnesses, but should provide continuous, comprehensive and holistic healthcare. It also put emphasis on preventive care that promoted the well-being and improved the quality of life of individuals.
Outlining the proposed reforms in primary care, Dr Chow proposed to
* Develop basic models for primary care services for different age/gender groups with emphasis on preventive care;
* Establish a family doctor register containing relevant information about the family doctors including availability of service outside normal hours, contact arrangements in case of emergency and any backup arrangements;
* Subsidise individuals for preventive care through primary care voucher and with a certain level of co-payment;
* Improve public primary care by purchasing services from the private sector and incorporating preventive care in the public clinics for low-income families and under-privileged groups; and
* Strengthen public health function such as enhance public health education, public health promotion through community involvement as well as strengthen Department of Health's role in the development and standard setting of primary care services.
Promoting public-private partnership (PPP) was also one of the recommendations in the healthcare reform.
"We are exploring the feasibility of introducing PPP in the development of a hospital project in North Lantau and the setting up of multi-partite paediatric and neuroscience medical centres of excellence," Dr Chow said.
Consideration would also be given to the purchase of hospital services from the private sector and engage private sector doctors to practise in public hospitals.
The development of a territory-wide electronic health record (eHR) infrastructure was another crucial component in the healthcare reform, with a view to enhancing continuity of care as well as better integration of different healthcare services for the benefits of individual patients.
The Government would take the lead to take forward the initiative. A Steering Committee on Electronic Health Record Sharing chaired by Permanent Secretary for Food and Health was set up to consider funding the capital cost for the development of the sharing infrastructure, make available public sector know-how and consider ways to promote the benefits of health record sharing to patients and providers.
Dr Chow also pointed out that there should be room for strengthening the public healthcare safety net. The Government would explore the idea of a "personal limit on medical expenses" beyond which financial assistance would be provided to protect individual patients against financial hardship due to illnesses requiring costly treatment.
Dr Chow said that maintaining status quo to finance public healthcare solely through government revenue was not a sustainable option. It would result in continued increase in tax rates and expansion of public expenditure in the economy, which would be a departure from the small government principle and low tax regime.
The tax burden on the future generation would become greater as Hong Kong's demography changes to a smaller working population supporting a larger elderly population, with the proportion of elderly aged 65 or above doubling from one in eight in 2007 to one in four by 2033. Total health expenditure would increase from $67.8 billion to $315.2 billion between 2004 and 2033.
To meet the challenges to the healthcare system, Dr Chow said: "We need to reform the financing arrangements in support of the service reforms. Without reforming the healthcare financing arrangements, the increased government funding for healthcare is still expected to be outstripped by the projected healthcare needs of the community by around 2012.
"Government funding will continue to be a major financing source. What we need is a supplementary financing source for healthcare to supplement government funding to cope with increasing healthcare needs, and to sustain our proposed healthcare reforms, with a view to improving healthcare services."
Dr Chow urged the public to enthusiastically discuss the proposed options. Each option had its own pros and cons and the choice between the options was very much a choice of the community reflecting its societal values. "During this first stage consultation, we do not recommend any particular option. We look forward to hearing from members of the public," he said.
The six supplementary financing options are:
* Social health insurance: to require the workforce to contribute a certain percentage of their income to fund healthcare for the whole population;
* Out-of-pocket payments: to increase user fees for public healthcare services;
* Medical savings accounts: to require a specified group of the population to save to a personal account for accruing savings to meet their own future healthcare expense, including insurance premium if they take out private health insurance;
* Voluntary private health insurance: to encourage more individuals to take out private health insurance in the market voluntarily;
* Mandatory private health insurance: to require a specified group of the population to subscribe to a regulated private health insurance scheme for their own healthcare protection; and
* Personal healthcare reserve: to require a specified group of the population to deposit part of their income into a personal account, both for subscribing to a mandatory regulated medical insurance before and after retirement, and for accruing savings to meet their own healthcare expenses including insurance premium after retirement.
Dr Chow stressed that the proposed reforms were not designed to relieve the financial burden of the Government and shrug off its public responsibility.
"On the contrary, the Government's commitment in healthcare will only increase, and will not decrease. The Government is committed to increasing the share of healthcare expenditure from 15% ($30.7 billion) in 2008-09 to 17% ($40 billion) in 2011-12 of its recurrent expenditure. To demonstrate the Government's determination to share the healthcare financing burden with citizens, $50 billion has been drawn from the fiscal reserve to help meet the healthcare financing challenge," he said.
Although various healthcare reform and financing options were proposed, Dr Chow assured the public that the healthcare system would continue to provide an available and accessible safety net for the community as a whole. The Government would uphold its long-established healthcare policy that no one should be denied adequate healthcare through lack of means.
Dr Chow added: "Our future rests with our choice. Our healthcare system is important for each and every one of us, and is an important asset that we leave for our future generations for the protection of their health. I hope we can all seize the opportunity to build a consensus to reform the healthcare system to make it sustainable."
Copies of the consultation document and related information can be downloaded from the healthcare reform consultation website www.beStrong.gov.hk and are available for collection at district offices, public hospitals and clinics, and major public libraries.
The public can send their views on this consultation document to the Food and Health Bureau by mail to 19/F Murray Building, Garden Road, Central; by facsimile to 2102 2525; or by email to beStrong@fhb.gov.hk. The deadline for submission is June 13.
On the basis of the views received during the first stage consultation, the Government will formulate detailed proposals for the reform including those of supplementary financing arrangements for the second stage consultation.
Ends/Thursday, March 13, 2008
Issued at HKT 17:03
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