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Public consensus on need for health care reform
There is an undisputed consensus on the need for health care reform among different sectors of the community, Secretary for Health and Welfare, Dr E K Yeoh, said.
In a report on the outcome of the public consultation on health care reform tabled at the Legislative Council Health Services Panel today (July 17), Dr Yeoh said more than 730 written submissions were received during the consultation exercise which took place between December 2000 and March this year.
The majority of the submissions were from the public, totaling 500. The rest came from health care professionals/groups, legislators, political parties, community organizations, private companies and academics.
In addition, officials from the Health and Welfare Bureau attended 152 briefings sessions or forums with different stakeholder groups. Based on the submissions received, the feedback collected from the District Councils and the briefing sessions, it is noted that the following reform proposals have received wide support from different sectors of the community:
� the revamped role of the Department of Health (DH) as health advocate and strengthening of prevention care;
� development of family medicine and community-based integrated services;
� introduction of Chinese medicine into the public sector;
� continuing medical education for all health care professionals;
� cost containment measures by the Hospital Authority (HA); and
� revamping of fees structure, subject to safety net being made available to the poor and the needy.
"The Department of Health and the Hospital Authority have been asked to work out implementation plans for these proposals so that the public can see for themselves quickly the tangible benefits of the reform," Dr Yeoh said.
Another proposal which relates to the development of family medicine and a better integration of primary and secondary care is the proposed transfer of general out-patient clinics (GOPC) from DH to HA. This was generally supported by the public and political parties but views from health professionals were divided. About half of the health care professionals/groups disagreed with the proposal because they believed that the transfer would not achieve the desired result of a better integration of primary and secondary care for the whole system of health care in Hong Kong. Some also questioned whether HA had the necessary expertise, experience and resources to operate these clinics effectively.
In response, Dr Yeoh explained that HA had started its family medicine training programs for its doctors since 1997/98. In addition, it has set up family medicine-based clinics to assist its specialist out-patient clinics patients. HA, with its hospital setting, also provides the best training ground for family doctors.
"Plans are in hand to conduct a pilot scheme for the transfer of five GOPC to HA in 2001/02, and a total of $75 million has been allocated to undertake the tasks. The pilot scheme should serve as a useful reference for the transfer of the other GOPC in future.
"We will fully consult the staff concerned and ensure that the transfer will not bring about any disruption to the current service," he added.
There are several other proposed reform measures that have received mixed response and generated substantial discussions, i.e. public/private interface, Complaints Office under DH, and the Health Protection Account.
Public/private interface
On public/private sector interface, the community at large supported the notion of a better collaboration between the two sectors to rectify the current imbalance. However, many, including health care professionals, politicians and DC members, doubted the effectiveness of the proposed measures, given the significant price differentials between the two sectors.
The Government now plans to set up two working groups to look into the interface issue in greater depth, Dr Yeoh said. "One working group will involve private hospitals with a view to developing new joint health care services and products with their public counterparts. The second working group will comprise medical practitioners from both the public and private sectors to explore the scope for closer collaboration and cooperation.
"We expect the two working groups to come up with concrete proposals in six months' time after their first meeting."
Complaint Office
Comments on the proposed Complaint Office under DH were largely skeptical of its role, function and power. Some were concerned about the likely duplication of duties and possible confusion caused with the existing complaint mechanisms while others called for an independent authority outside the Government.
Acknowledging the concerns of the public and the professionals, Dr Yeoh said, "The Complaint Office is considered an integral part of a wider patient complaint mechanism and quality assurance system. It is expected to work in tandem with the relevant parties, such as the Medical Council of Hong Kong, the Public Complaints Committee of HA and other regulatory agencies, to handle patient complaints in a transparent, user-friendly and accountable manner.
"We are working closely with the LegCo Subcommittee on Improvements to the Medical Complaints. We are also conducting research on overseas models of redress mechanisms to assist us in considering a mechanism that best suits the needs and circumstances of Hong Kong.
"We shall consult the public again upon our discussion with the LegCo Subcommittee and receipt of the reform recommendations from the Medical Council," Dr Yeoh stressed.
Health Protection Account (HPA)
The proposal that attracted the most discussion was the Health Protection Account (HPA). While in general strong reservation had been expressed on the HPA proposals, it is noted that the concept of medical savings did receive a fair amount of support from District Councils, health care professionals, academics, and even some members of the public. The tracking survey conducted by HWB in May 2001 also revealed that more respondents in fact preferred a compulsory medical savings scheme (44 per cent), as compared to a compulsory social insurance scheme (28 per cent).
The Government has set up a working group comprising insurance industry representatives to identify scope for closer collaboration and to devise new products and policies that would dovetail with the implementation of the HPA.
"We hope that through intensive discussion among the parties concerned, the working group will be able to work out some feasible options so that the general public can have a clearer idea about the potential use and benefit of the HPA when we consult the public again," Dr Yeoh said.
"We are also planning to commission further in-depth studies to examine the feasibility of different structures for and the various operational aspects of the HPA for the purpose of further consulting the public.
"With more details in hand, we would be in a better position to address the public's common concerns, such as the actual rate of contribution, details reimbursement arrangement, restrictions on the use of HPA savings, and the implementation timetable, etc."
Other tasks in progress
Dr Yeoh also reported that the Government had commissioned a consultancy study, headed by a health care economist from the University of California, Berkeley, to assess the impact of fees restructuring on the utilization of public and private health care services. The consultancy study is expected to complete by March 2002.
In addition, the Government is considering appointing a panel of overseas experts to advise HWB on health care reform matters and the related policy issues.
"An expert panel would serve as a useful focal point for sharing of insights and experience among knowledgeable experts. We are identifying suitable candidates and plan to hold the first panel meeting of the overseas experts in the latter half of the year," Dr Yeoh added.
An analysis of the public comments on the proposals in the health care reform consultation document as well as the Government's proposed way forward are available on the Health and Welfare Bureau website: http://www.info.gov.hk/hwb.
Background
On December 12, 2000, the Government published a consultation document setting out its vision, policy objectives, guiding values and principles for reforming Hong Kong's health care system.
Entitled "Lifelong Investment in Health", the consultation document proposed strategic directions for reforms and improvements to the existing system and set out the implementation mechanisms to take forwards the various proposals under three main components:
� Reforms to the health care delivery system
� Improvements to the system of quality assurance
� Options for financing health care service
The Government's vision was to recreate, through the proposed reforms, a health care system which would enhance the quality of life of the population and enable individuals to develop their full human potentials. To achieve this aim, the health care system must be able to protect and promote the health of the community; to provide comprehensive and lifelong holistic care to each individual; to offer accessible, equitable and quality services to each patient, and at the same time to remain cost effective, sustainable and affordable.
It was emphasized in the document that the pursuit for better health, if the pursuit was to be successful and sustainable, had to be a shared responsibility among the individual, the community and the Government.
Some improvement measures proposed in the consultation document may be implemented shortly. But major changes will be staggered over a longer period to allow time for refinement, adaptation and adjustment by relevant stakeholders. The Government undertook to consult the public again on those long-term issues, such as the proposed individual Health Protection Accounts, after it had conducted detailed studies.
END/Tuesday, July 17, 2001
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