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Following is the speech by the Chief Executive, Mr Donald Tsang, at the Combined Arthur Li and George Adlington Syme Oration of the Conjoint Award and Diploma Ceremony at Hong Kong Convention and Exhibition Centre today (May 12) :
Professor Yeung, Professor Sutherland, Fellows of the College of Surgeons of Hong Kong, Fellows of the Royal Australasian College of Surgeons, distinguished guests, ladies and gentlemen,
A warm welcome to you all, and especially to those who have travelled many miles to be here.
Hong Kong takes pride in hosting the first Combined Scientific Congress between these two Colleges. I regard it a great privilege of mine in being asked to deliver the Combined Arthur Li and George Adlington Syme Oration.
As we commemorate Sir George Adlington Syme in this Oration, allow me a moment to recall this pioneer of the surgical world. No doubt, Sir George would be pleased to see these two Colleges teaming up for this Combined Congress. After all, he dedicated much of his life to sharing knowledge and experience in his field of expertise. Sir George himself studied in Britain before returning to Australia to work and to teach the next generation of surgeons.
During an accomplished career he achieved world firsts in surgery. A gentle person, full of integrity and wisdom, Sir George paved the way for the establishment of the Royal Australasian College of Surgeons of which he became the first president in 1927.
In keeping with the combined nature of this Congress, the other name on this year¡¦s Oration is Arthur Li. Professor Li is well recognised for his own medical credentials. He led the development of the Hong Kong Surgical Society into a College in 1990. He has long been involved in strengthening links between surgical colleges in Hong Kong and overseas. And he has made signal contribution in many other areas of public service.
I am confident that this Combined Scientific Congress, with its comprehensive programme of events, will go a long way towards promoting excellence in surgical practice in the region.
I congratulate the new Fellows whose diligence and efforts are recognised today. The fine tradition of surgeons is well known. The common expression of ¡§surgical precision¡¨ speaks volumes about this. Here in Hong Kong, we have world-renowned surgeons excelling in various fields. These include esophageal cancer surgeries, liver transplant, minimal invasive surgeries of various kinds, orthopaedics and neurosurgery, to name just a few.
Although I have long admired the work of surgeons, I have no direct experience in your field, except in the receiving end.
One thing surgeons and politicians have in common is the need to gain the trust and confidence of the people we serve. For surgeons, that involves the truthful explanation of the medical problem, identifying the best remedy and articulating the healing effect to win the trust of a patient.
In public administration, we also have to diagnose problems at the earliest opportunity, explain clearly the implications, set out the various feasible options, and recommend the best remedy.
In the next few minutes, I will focus on a challenge that many governments, including ours, are facing when it comes to healthcare in the 21st Century. The challenge is to ensure quality healthcare for everyone at a time when costs are rising and populations are ageing.
Just as patients put their trust in your hands, people expect governments to provide high quality hospitals, well-trained doctors, as well as accessible and affordable services for all.
In Hong Kong, we are in the middle of a public consultation on healthcare reform, which was launched in March.
Our healthcare system has the trust of Hong Kong people. Over the years it has provided the city with universally accessible, affordable, and high quality health care. Our health indicators such as life expectancy and infant mortality rank among the best in the world. This owes in no small part to our dedicated team of healthcare professionals and the substantial investment in healthcare manpower and infrastructure over the years. Apart from our world-class surgeons, we are also proud of our medical practitioners and other healthcare professionals who have devoted themselves to protecting us against disease.
The professionalism and selfless dedication of our doctors and nurses during difficult times has inspired us all. Hong Kong remembers deeply the heroes of SARS and all those who came to the rescue in our darkest hour some five years ago.
However, there are areas of concern for our healthcare system. These include a serious imbalance between the public and private market share, and bottlenecks building up in many areas of the system. Primary care services may not be fully comprehensive. Most serious of all, our ageing population and the rapid advancement of medical technology threaten the financial sustainability of the healthcare system.
These problems are complex and inter-related. Addressing the issues, while maintaining the strengths of our current system poses a huge challenge. In Hong Kong, we cannot simply prescribe a solution that the Government deems best. We believe in explaining the problems, discussing possible solutions and studying the implications with the entire community.
A patient in Hong Kong won¡¦t accept any treatment without understanding what the illness is, what the options are and their implications. Likewise, the public will not accept a change to the healthcare financing system without fully understanding the extent of the problem, the various options and implications.
Hong Kong is not alone in facing problems associated with an ageing population and rising costs related to medical technology advancement. Different economies have responded differently.
Each arrangement represents a different set of societal values and preferences. Each community has to decide for itself what are its values and principles in health protection before identifying the most appropriate financing arrangement.
Many of you are familiar with the Australian system, where universal access to the publicly-funded health care system, Medicare, is financed through general taxation. At the same time, the government strongly encourages private insurance as a means to reduce demand on public hospitals and ease cost pressures on the public health care system.
Private insurance gives those who can afford it a greater choice of providers, access to more timely care and flexibility over the timing of care. The Australian Government tightly regulates private insurance and provides incentives for young and healthy people to take out insurance.
The underlying principle is that the public health care system should provide everyone with equitable access to the same level and standard of health care based on needs. At the same time, those who can afford it should be facilitated to have more options. This helps to shorten queues at public hospitals and benefits those who have to rely on the public health system.
Other economies place much stronger emphasis on equal access. In Canada and Britain, for example, the basic guiding principle of health care policy is universal and equitable access. This is provided on the basis of need, through triage and queuing, regardless of the ability to pay. It is predominantly publicly funded through taxes and provided free-of-charge or at very low fees.
The private health care sector in these countries is comparatively much smaller. The case is similar in economies that have developed social health insurance as a financing means, such as Austria and Belgium in Europe and Japan and Korea in Asia. In these economies, equitable access to health care is financed by mandatory contributions from the workforce.
At the opposite end of the spectrum is the United States, where access to health care depends on the ability to pay. Only low-income families and the needy are provided with a minimal set of services funded mainly by the government. Under this kind of system, self-responsibility for health care is emphasised. People are accustomed to taking care of their own medical needs through insurance or savings.
In the United States, accessibility and adequacy of healthcare for low-income families, the needy and the elderly ranks among the hottest issues in the health care policy debate and the on-going election campaign.
Hong Kong currently stands between the Australian system and the British system. The Government has been providing universally accessible health care to the whole population. General Government revenue is funding 95 per cent of its public health system; the remaining 5 per cent comes from fees charged to patients. Poor families on social security do not pay at all. Our public health system takes care of 90 per cent of in-patients and 30 per cent of general out-patients. It has worked remarkably well for Hong Kong in the past. There is also a general consensus that our public purse should continue to shoulder the health care needs of the low-income and vulnerable groups. Also, that it should provide acute and emergency care for all, and treat those who are struck by illnesses that require complex and very expensive treatment.
To achieve this, we have pledged to increase public health care spending from 15 per cent of the entire budget of the government to 17 per cent of the entire budget within five years. I am confident we can achieve this goal, while at the same time, maintain our low tax regime and principle of small government.
Although we had a healthy budget surplus in the last financial year, Government income is subject to economic cycles. There will come a time before long when government funding alone can no longer sustain our healthcare system, without raising taxes substantially. If we do not introduce changes to the financing arrangements for health care, we will find it difficult to offer high quality services to all in the future.
The combination of our ageing population and low fertility rate results in a shrinking local workforce which has to shoulder the rapidly rising healthcare costs associated with old age and new medical technology. We are duty bound to care for our elderly citizens, but this means that future generations will feel the pinch.
So we need to consider now, what form of supplementary health care financing can be put in place to meet the future demands. Here we need to take into account societal values and principles.
Does Hong Kong want further wealth redistribution beyond taxation? If so, a mandatory social health insurance scheme could be introduced.
On the other hand, we already have a public system providing a safety net for all, so should those who can afford it be contributing more and also enjoy more choices through a mandatory regulated insurance system?
Should people look after their own healthcare needs more? If so we should raise the current public health care fees, while reinforcing the safety net for the needy.
These are some of the questions we need to answer at an early stage of the reform process.
Within my term of office running to 2012, we will press ahead with reforms to the healthcare services. We will also forge a consensus on health care financing to ensure its sustainability.
This is no empty talk. The government has already pledged HK$50 billion, or roughly US$6.4 billion, from our fiscal reserves to help implement the reform. How to put this money to best use has yet to be decided.
Another important area is strengthening the private medical sector. It is our policy to encourage and facilitate the development of private hospitals in Hong Kong. I have asked the Secretary for Food and Health to work with the Secretary for Development to explore suitable policies to achieve this. This includes making available land for such development.
The first stage of our public consultation on healthcare reform ends on June 13th, so we still have a month to go. We will then narrow down the options and elaborate on the options that remain on the table for a second stage consultation to be held next year.
I urge the surgeons of Hong Kong to take an active part in the consultation process. We need your counsel. You are major stakeholders. We treasure every bit of your views. I also encourage our guests from overseas to share with us the pros and cons of other healthcare financing systems.
As we study the way other cities are coping, other cities are watching us as we embark on this crucial exercise.
Ladies and gentlemen, it is a rare opportunity to have so many leading lights from the surgical world under one roof. Not only do we have medical luminaries from Australia, New Zealand and Hong Kong, we also have distinguished speakers from North America, Europe, Asia, the Pacific and the Mainland of China.
The theme of this Congress is ¡§Achievement through Collaboration¡¨. I am confident that through your shared experience and knowledge we can all look forward to even greater achievements in the surgical profession, and enlightenment in global public health.
It remains for me to wish our overseas guests an enjoyable stay in Hong Kong. I know you have a busy schedule, but I hope you will be able to find time to look around our city. I can guarantee you will not be disappointed.
Ends/Monday, May 12, 2008
Issued at HKT 18:03
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