Replies to LegCo questions

LCQ5: Healthcare reform

Following is a question by the Hon Frederick Fung and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (June 20):

Question:

The Government published the discussion paper called "Building a Healthy Tomorrow" in July 2005 for public consultation on the future service model for healthcare. The Government subsequently indicated that it would conduct public consultation on healthcare financing in the first quarter of 2006. But the consultation was repeatedly postponed, and no specific date for the consultation has been fixed so far. In this connection, will the Government inform this Council:

(a) of the latest progress in drafting the consultation document and the difficulties encountered, the reasons for repeatedly postponing the publication of the consultation document, and the expected time to start the consultation;

(b) whether the healthcare financing options in the consultation document will include mandatory contributions, health insurance, improvements on the basis of maintaining the status quo, and a mix of these modes; if so, of the details, and the criteria adopted by the Government for choosing the healthcare financing options; whether the criteria will include the results of large-scale opinion surveys; and

(c) given that the Government provided a number of estimated figures in the above-mentioned discussion paper, such as the projection that the proportion of public healthcare expenditure in tax revenue would increase from the then 22% to more than half by 2033, without setting out the assumptions and data on which such figures were based, whether it will make improvements in this respect when it conducts the new round of consultation, so that the public can have a clear grasp of the actual situation?

Reply:

Madam President,

Healthcare reform is an important long-term project. Our reform objectives are clear: to ensure a sustainable healthcare system, provide quality services and enhance the health of our population. With these objectives in mind, the Health and Medical Development Advisory Committee (HMDAC) released a consultation document entitled "Building a Healthy Tomorrow" in 2005, setting out a number of broad directions for our future healthcare service delivery model, which have received general support from the public and healthcare sector.

In the past year or so, we have worked towards formulating concrete proposals on our healthcare reform based on these broad directions and developing appropriate healthcare financing arrangements. I must point out that healthcare financing is only part of the healthcare reform, and the service delivery model and financing arrangements must be complementary. We have thus considered the two issues in conjunction, and conducted not only studies on the financing arrangements but also the overall planning for our healthcare services. We hope to come up with a comprehensive proposal on service delivery and financing arrangements, in order to provide the public with a clear and complete blueprint for our future healthcare system.

As it is stated in "Building a Healthy Tomorrow", we hope to build consensus in the community on the reform through a progressive approach. More importantly, the discussions on this issue so far have shown that healthcare financing arrangements are not purely a financial issue, but an issue concerning the overall societal values of the community. We need to forge a consensus in the community on some basic issues in order to successfully take forward healthcare reform. From the consultations and discussions held in the past, the following general consensus of the community can be deduced:

(1) After years of discussions, the public have generally acknowledged that ageing population and advances in medical technology would result in an increasing demand and growing expenditure for healthcare services. To ensure sustainability of our healthcare system, its service delivery model and financing arrangements would have to be reformed, or else we could no longer maintain quality healthcare services.

(2) The public have generally accepted the existing public healthcare policy, i.e. to enable the public to have equitable access to affordable healthcare services, and to provide low-income families and vulnerable groups (including the disadvantaged elderly and the chronically ill) with a safety net, in order to ensure that no one would be denied adequate medical treatment for lack of means.

(3) Our existing tax-financed public healthcare services should continue to play a leading role focusing on the provision of priority services. The Government should also continue to make greater commitment in healthcare services, with a view to strengthening the safety net, improving existing service and investing in public health.

(4) Inevitably the community may have different views on our healthcare system. However, it is still the general expectation of the public that the system can promote social equality and take care of the vulnerable groups. Most people agree that, apart from additional commitment by the Government, it would be incumbent upon those who can afford to assume a greater share of the responsibility, so that more resources in the healthcare system would be available for the care of the needy.

(5) At the same time, we also have to improve our healthcare services and enhance their service quality, such that the public can choose more, better, more efficient, more cost effective and more transparent services, as and when they invest more in their own health.

(6) In reforming our healthcare services, we need to redress the existing imbalance between public and private sectors, strengthen collaboration and exchange of talents between both sectors, and facilitate healthy competition in service quality and professional standards. Our aim is an efficient public healthcare system and sustainable private healthcare market.

In sum, I have three criteria for assessing the effectiveness of the healthcare reform that we are taking forward:

(1) For the public, we should maintain equitable, affordable and sustainable healthcare services. At the same time, we strive to enhance service quality and cost-effectiveness, provide the public with choices of more and better quality services, and raise health consciousness of the public on personal health and preventive care.

(2) For healthcare professionals, their professional quality and standard should be enhanced continuously in tandem with international development, and their professional conduct maintained. At the same time, there should be room for more competition and collaboration between the public and private sectors, in order to facilitate vibrant development of the healthcare service market, and providing a stable working environment for healthcare workers.

(3) For the overall healthcare system, the health of the population should be more efficiently and cost-effectively improved. Through emphasis on primary health care especially preventive care, reduce healthcare services demand and expenditure in the long run and ensure institutional and financial sustainability of our healthcare system, in order to achieve our long-term goal of a healthier community.

I would like to stress that no matter what reform or financing proposals are put forward, the Government's commitments in healthcare services will only be increased and not reduced. As pledged by the Chief Executive in his election platform, the share of expenditure on public health care in the total public expenditure will be increased from 15% to 17% in five years. However, given the premise of a low-tax regime and small government, it will not be possible for the Government to allocate unlimited resources to healthcare services. In view of changes in our demographic structure and rising healthcare costs due to technological advancement, in addition to the Government increasing its commitment, it will be necessary for the public to assume a larger share of the responsibility for their own health if an effective healthcare safety net is to be maintained.

My replies to each part of the question are as follows:

(a) As mentioned above, healthcare financing is only part of the healthcare reform and the two should be complementary. For this reason, apart from healthcare financing, we have also been formulating proposals for improving our healthcare services, including enhancing primary healthcare services, promoting public-private partnership and facilitating electronic patient record sharing. We have also looked into the long-term subsidisation policy of public healthcare services, with a view to further improving the safety net to better help those in need. The study of healthcare financing also involves many complex issues, including the projection of the healthcare expenditure of our society in the long run, the feasibility of various healthcare financing options and their implications for the healthcare system. Our work is near completion now, and we plan to release a consultation document on the reform of healthcare service and financing arrangements for public consultation in the latter half of this year.

(b) In studying the financing arrangements, we have drawn reference from the experiences of other places overseas, which have adopted various financing models such as social health insurance, private health insurance and individual medical savings scheme. In identifying the appropriate financing arrangements for Hong Kong, we will take into account the societal values of the community as a whole and the unique circumstances of our healthcare system, and examine if any of the various financing options or any mixed model would be suitable to Hong Kong. As mentioned above, our recommendations will be made based on the consensus in the community. The consultation we are planning to hold later this year is to canvass public views on the healthcare reform including the financing arrangements, and we hope to forge a consensus to take forward the reform. The HMDAC will set out the proposed financing options in detail in the consultation paper to be released then.

For primary health care, as we have elaborated in "Building a Healthy Tomorrow", effective primary medical care services can not only improve the health of the population, but also reduce pressure on the hospital system and lower the demand for medical services in the long run. Hence, it is in our vision that the primary healthcare system should be able to provide the public with comprehensive and affordable family and community health care services, with emphasis on health promotion and preventive care, and providing appropriate care for people of different age groups and different health status. Therefore, the reform of primary health care will be a focus of our proposals for improvement to healthcare services. We will put forth recommendations on how to enhance primary health care, promote the concept of family doctors, and encourage the public to take preventive care, with a view to ensuring that the community has access to better primary health care.

(c) As regards the projection of healthcare expenditure, local academics have already made some projections of Hong Kong's healthcare expenditure in the past, based on the projection methodology and experience of overseas countries. Their conclusion was that, given changes in demographic structure and raising medical costs due to technological advancement, if the current healthcare system remains unchanged, Hong Kong's public health expenditure will increase from 3.1% of the Gross Domestic Product (GDP) in 2001/02 to 5.3% of the GDP in 2030. We have made a more detailed projection of the healthcare expenditure in the course of our study on healthcare financing. We will give an account of our projection methodology and findings when we release the consultation document later this year.


Ends/Wednesday, June 20, 2007
Issued at HKT 14:22

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