Speeches
Speech by SFH at the Hospital Authority Convention 2008
Following is the keynote speech by the Secretary for Food and Health, Dr
York Chow, at the opening ceremony of the Hospital Authority Convention 2008
today (May 5):
Healthcare Reform: Of the Professions, By the Professions, For the
Professions
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Vice Minister Wang, Mr Wu, Mr Solomon, honoured guests, dear friends and
colleagues,
This year's theme of the convention is "A New Era of Patient Care". The aim
is to propound health system changes which embrace innovation, improvements
and modernisation at multiple levels and which will meet patients'
expectations. This is most timely.
Expectations of the Community
-----------------------------
We initiated consultation in the community two months ago. It aims at
bringing about structural reform to the healthcare system, for one prime
objective - to bring about better healthcare to Hong Kong people. We need to
do so to meet the expectations of the community. For a world-class city like
Hong Kong which values freedom, harmony and benevolence, the community
expects the healthcare system to -
* enable everyone to have access to appropriate healthcare services;
* take care of the low-income and underprivileged; and
* provide more and better choices of personalised healthcare.
Here present today are the dedicated healthcare professionals who are the
pillars of our healthcare system. The healthcare reform is thus as much for
you all as for the community. Together, we all have our part to play in
building tomorrow's healthcare system that will have greater capacity,
provide better quality care, cater more to individuals' needs and make our
people healthier.
Problems of Our Existing System
-------------------------------
But let me first step back a little and recount the problems facing us. The
Hospital Authority has been delivering good quality care for our people. Our
favourable health indices owe much to the hard work of our public doctors,
nurses and other healthcare workers. However, there are severe bottlenecks
in public services and the problem will only get worse as the population
ages.
We are also facing demand for greater choice of services - as living
standards are raised, many members of the public are expecting more
personalised healthcare like choice of doctors, better privacy in wards, and
more readily available services, even if these would mean paying more. But a
public system by definition provides the same service for all: patients do
not have a choice of doctors in public hospitals, public healthcare is
allocated by queuing and triage, and general ward and long queues are the
norm.
The demand for choice of services can be seen from the money the community
spent. The government spent some $38 billion a year on public healthcare.
The community spent some $30 billion a year on private healthcare, over $8
billion of which is through private health insurance taken out either by
individuals or by employers. One-third of our population has some form of
medical insurance coverage for private services.
However, choice for private hospital services is limited by lack of
transparency of fees, and current private insurance does not necessarily
provide adequate coverage to meet the uncertain bills. Even middle-class
patients, when faced with the choice of going to public or private
hospitals, often choose public hospitals despite the long queues and the
lack of choices. The result is that the community chooses the private sector
for less than 8% of their in-patient services.
Meanwhile, the nature of the business of voluntary health insurance makes it
inevitable for insurance companies to seek out healthy individuals and avoid
claims pay-outs. This has the effect of excluding higher risk individuals
especially the old and the sick, and putting pressure on healthcare
providers to keep down their costs and lower their standards.
Objectives of the Healthcare Reform
-----------------------------------
The problems faced by our healthcare system cannot be solved by simply
putting in more money - we need structural reform to the system that can
meet the challenges of an ageing population and medical inflation and at the
same time meet the expectations of the community, especially our
middle-class, for more choice of better services. I believe the reform
should also meet the aspirations of our healthcare professionals for a
better working environment, greater career opportunities, and greater job
satisfaction in serving the needs of the community.
The Healthcare Reform seeks to embark upon a whole package of
inter-connected measures to bring about this structural reform -
(1) To strengthen primary and preventive healthcare and establish a family
doctor system through developing primary care standards for different
age/gender groups, registering doctors who provide family doctor services,
and subsidising patients with vouchers for preventive care through their
family doctors. A working group under the Health and Medical Development
Advisory Committee will start work on this front after the first stage
consultation, and will engage the medical and healthcare professions.
(2) To focus the public sector on its four priority areas: (a) acute and
emergency; (b) low-income and under-privileged groups; (c) high cost,
advanced technology and multi-disciplinary treatment; and (d) training of
healthcare professionals. In doing so, we will need to strengthen the public
healthcare system as the community's safety net. We need to provide the
public, including middle-income families, with the peace of mind that they
don't need to worry when they fall ill. We also need to rationalise public
hospital fees.
(3) To deliver more secondary care apart from the four priority areas
through the money-follow-patient concept. This is done through different
forms of public-private partnership, including purchase of private services
and development of PPP hospitals. HA is now rolling out the cataract surgery
pilot scheme and the primary care partnership pilot project in Tin Shui Wai.
If these prove effective, we will expand these schemes to other worthwhile
areas and further explore other possible PPP models. In future, public and
private will be effectively one sector, a sector for better care and more
choices for our people.
(4) To change the behaviour of both patients and healthcare providers to
focus more on health and wellness promotion instead of just curing
illnesses. Apart from establishing service models and providing incentives
for behavioural change, we need to provide the platform for healthcare
professionals to work in collaboration rather than in isolation. The
electronic health record system will provide the infrastructure, but we also
need healthcare professionals to work together.
The Roles of the Healthcare Professions
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Can we all live up to these challenges? I would like to share with my
professional colleagues here today my vision of how we can all contribute to
the reform, and what's in the reform for every one of us. First of all, the
growing and ageing community needs a better healthcare system with greater
capacity, in which the public and private healthcare providers collaborate
to provide the community with the care it needs. Healthcare professionals of
all disciplines will play an ever more important role in this system. The
system will afford them the opportunity to develop their professional skills
and potential, and at the same time to provide the best care to their
patients.
People of different aspirations will find their place in an expanded sector.
For those who are dedicated to serving the public especially the
underprivileged, the public system will continue to provide a stable career
and development opportunities. For those who are more entrepreneurial, the
expanded healthcare market and the rationalised public-private relationship
will provide them with business opportunities in delivering value-for-money
services to those who want more and better choices. For those who don't want
to choose one over the other, the future system will provide them with
opportunities to serve between both ends of the spectrum. Let me look at it
more closely from the perspective of individual professions.
Doctors
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For doctors who will be at the forefront of these reforms, irrespective of
whether they are working in the public or private sector, I would urge them
to seize the opportunities provided by the expansion of the healthcare
market. The much expanded and vibrant private market is likely to provide
more business to those who equip themselves better by pursuing excellence in
clinical skills and providing more patient-oriented care. Although the
Medical Council has recently relaxed rules for advertisements, I don't
believe good doctors need any. Word of mouth is always more effective for
the medical profession, and word of mouth stems from clinical skills and
patient care.
More innovative ways of delivering care by doctors apart from the
traditional clinic setting would probably need to be developed to suit an
evolving society and ever changing needs of patients. In the future
healthcare system where primary and preventive care is given much greater
emphasis, community-based healthcare solutions are expected. Out-reach
services, customised services for institutions such as elderly homes,
family-based services, out-of-hours consultation and advisory services,
health and wellness promotion programmes, patient self-monitoring programmes,
are but a few examples of what may be possible in filling the gaps in
demand.
I would also remind my fellow colleagues that healthcare is no longer
something where a doctor alone can provide the best results. In fact, the
worldwide trend is that healthcare is increasingly delivered through doctors
in group practice, networking with allied health professionals including
pharmacists at the community level, and providing collaborated and
integrated care for patients in a seamless manner. In a patient-oriented
healthcare system, no healthcare professionals, not least doctors, can
afford to practise in isolation without risking patients' well-being. The
electronic health record system will provide private doctors as well as
other healthcare professionals with the tools for providing better
integrated services.
Hospitals
---------
Notwithstanding the emphasis on primary care, hospitals remain an important
point of care, and even more so when they have to concentrate on the more
complex and difficult cases that could not be handled at the primary care
level. To strengthen public confidence in the hospital system, we will
develop an accreditation system for hospitals, both public and private,
involving the medical professions and the private hospitals. Both should
meet the same standards of care and provide the same assurance to the
community on quality, irrespective of their different service offerings.
The integration of primary care with hospitals, as well as the interface
between public and private hospital care, is pivotal to the reform of the
healthcare system. We are working on how to bridge the electronic health
record system between the Hospital Authority and private hospitals. Our aim
is a patient-oriented system where "record-follows-patient", with the
patient at the centre of the system design, according the privacy and
security protection that would inspire public confidence.
With greater public-private-partnership opportunities, and greater demand
from the public for the whole range of healthcare services, it is essential
that private hospitals also develop capacity and capability for a broader
range of clinical services apart from their traditional and recent focus
such as obstetrics. We are working with the Development Bureau to explore
suitable policies to facilitate the development of private hospitals,
including the availability of suitable land for development.
We would also need to work with private hospitals and the insurance industry
to promote better care for patients, while at the same time avoid
unnecessary medical procedures. Recent data suggest that the premium of
voluntary private health insurance rose much faster than the income growth
of our middle class. This is clearly unsustainable and sooner rather than
later the premium hike of voluntary insurance is likely to undermine
people's incentive to stay insured and to use private healthcare services.
Nurses
------
Obviously we need more nurses for the future healthcare system, both to
cater for the expansion of services and the rising demand for elderly
healthcare due to an ageing population. Apart from being partners to doctors
in delivering healthcare for patients, we will see more nurse-led services
as the mode of delivery and mix of services evolve. For instance, the
greater emphasis on primary care also means nurses will have a bigger role
to play in providing community-based healthcare services.
In future, specialisation of nursing skills is the trend. The variety of
services required for different healthcare scenarios ranging from
specialised care in hospital ICU and in-patient wards, to outreaching care
at the community level for the elderly, calls for nurses with specialised
skill sets, and should cater for nurses of different career aspirations. It
will be essential that nurses seize the opportunity for change and put
themselves firmly in a position to assume their greater role in the future
healthcare system.
Allied Health Professionals
---------------------------
Like nurses, the expanding healthcare system will require more allied health
professionals. The greater emphasis on primary care will also demand a
greater role for the allied health professionals. In particular, as I have
mentioned, we envisage the enhanced primary care system to be one in which
health professionals provide patient-oriented care in a collaborative manner
within a co-ordinated network. Every allied health professional in the
private sector will be part of this network.
We note the aspirations of some allied health professions for statutory
recognition of their professional status. To encourage the allied health
professions to further develop their expertise under the principle of
professional autonomy, and to further enhance our primary care and
rehabilitation services to tie in with the healthcare reform, we plan to
review the structure, composition and operation of the Supplementary Medical
Professions Council within the next term of the Legislative Council.
Chinese Medicine Practitioners
------------------------------
Chinese medicine practitioners are an important player in our primary
healthcare system. The elderly healthcare voucher pilot scheme that we
intend to launch early next year has recognised their role. The Government
has been putting tremendous efforts in providing a framework to support the
further development of the profession. We have already committed to
establish a public Chinese medicine clinic in each district for training and
for facilitating the development of "evidence-based" Chinese medicine.
Looking forward, we will further promote the collaboration of Chinese and
Western medicine. We will look at how research in Chinese medicine can be
facilitated to further build up the scientific basis to support the
deployment of Chinese medicine in our public healthcare system. In this
regard, we will develop in the long-run ways of providing in-patient
services based on Chinese medicine. Much work still needs to be done. But
the Government is committed to leveraging our unique strength in promoting
collaboration between these two long-established medical professions in the
community for the better care of patients.
Dentists and Other Healthcare Professionals
--------------------------------------------
Dental and oral health services are an important part of primary healthcare.
We have, as a first step, included dental and oral health services in the
scope of our elderly healthcare voucher scheme. This is in addition to
government-provided oral health services for primary school students and the
emergency services provided to the public in general. In future, we will
consider how we can further strengthen the role of dental services in our
primary healthcare reform.
There are other healthcare professionals and workers who are contributing to
the health and healthcare of our community. I am unable to go into each and
every one of them today. But let me state the obvious that a bigger and
stronger healthcare system will have a place for each and every healthcare
professional and worker who is dedicated to provide the best care for
patients.
Conclusion
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Let me conclude by emphasising that the healthcare reform is everything
about how we bring about structural changes to the healthcare system to make
it sustainable - sustainable in meeting our future challenges arising from
an ageing population and escalating medical costs, and sustainable in
meeting our community's expectations for continuous improvements in the
quality of healthcare.
However, there are two issues essential to sustainable reform. One is
sustainability of resources. How to ensure that the community can afford the
healthcare system they are expecting, when the resources for the system are
likely to be constrained under the present financing arrangements, and how
to ensure a stable financing system despite the regular fluctuating economic
cycle that affects Hong Kong?
The question of healthcare financing is thus raised in the hope of
addressing this issue upfront, rather than deferring it to the future and
making it an obstacle to the reform. The preference for any financing option
or arrangements is very much a question of societal values that we would
like to hear from the community. But the need to address the issue of
financing in order to support the reform is one issue that the community
needs to recognise.
The second critical issue is the unity and reform mindset of our healthcare
professionals and workers. We must not forget the difficult times we had in
the past seven or eight years, when we faced pay reduction, constraints on
services, and poor occupancy of private hospitals. Our proposed primary care
and service market reform will ensure better access and quality of care for
our citizens, and a sustainable financing system will let the service
continue to develop according to our community's need and the international
service trend and standards.
We, including all of you working in the present system today, will all have
an important role to play in the healthcare reform. We are committed to
making the reform as much a reform for you as for the community. To do so,
we need your support. Not just to endorse the reform, but also as a strong
stakeholder of the system, to drive and lead the various actions of the
reform, and to explain them to the public.
Finally, let me join others in wishing the convention success. Thank you.
Ends/Monday, May 5, 2008
Issued at HKT 13:25
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