Hong Kong has never placed importance on the development of primary healthcare. The service targets of the government’s general out-patient clinics are mainly chronic patients and the disadvantaged. Normal citizens can only go to private clinics for a preliminary diagnosis. As we all know, primary healthcare is the first step to medical care; it can, at the same time, take on the responsibility of preventing diseases and promoting public health. If this job is done well, not only can it improve general health of the whole community; it can also decrease the demand for the government’s specialist out-patient and inpatient services. Unfortunately, the government has never focused on this matter. A few years ago, I raised the motion of “promoting medical check-up for the whole community” at the Legislative Council. The purpose of my motion is to keep people well and prevent diseases from occurring, and primary healthcare is one of the key points. The motion was passed, but the government has not implemented my recommendations.
Hong Kong is facing an ageing population, meaning the development of primary healthcare is extremely urgent. Today, many legislators have made many useful suggestions, but I want to point out that the development of primary healthcare needs enormous resources. Public resources are limited; if we put more resources into developing primary healthcare, the resource allocation of other medical services would definitely be affected. Therefore, the biggest problem we have always been facing is healthcare financing. To solve Hong Kong’s public health problems, which will involve the promotion of primary healthcare development, we should first tackle our limited resources.
The last government has actually made a very good suggestion – to promote the dual-track healthcare system encompassing the public and the private sectors by introducing the voluntary Health Protection Scheme (HPS). By providing a comprehensive system and financial incentives, the HPS aims to attract citizens who are dissatisfied with the public healthcare services to use the private healthcare services. Thus, the public expenditure on healthcare can be minimised. As a matter of fact, many middle class citizens seek medical assistance at public hospitals. It is not because they do not want to go to private hospitals, but that the public healthcare system is dominant. The private healthcare system is small, beds are limited and fees are expensive – all these have scared away the middle class. Therefore, in addition to a proper voluntary HPS and the financial incentives, if the private healthcare system can be expanded, the middle class will definitely be willing to use the services of private hospitals. The cost of providing public healthcare services is actually very expensive, so the dual-track system will help cut public healthcare costs to a large extent in the long run. The cost savings will surely exceed the financial incentives the government has given. The resources saved can be used to improve the quality of healthcare services.
Regrettably, the government seems to have already given up on the development of the private medical sector. Originally, there were four pieces of land reserved for building private hospitals, but only one was granted. One has already been announced that it will be returned to the government; there are still no plans for the other two pieces of land. The medical and healthcare sector has been identified as one of the six priority industries, but the related development plans may also be terminated. At the same time, the government seems uninterested in promoting the HPS. Not only do they reinvent the wheel for HPS, the government also erased the essences of the original plan and many of the financial incentives. Under the revised HPS, the government has also given up on developing packaged charging of the HPS, and even suggested to regulate the private health insurance market. This would make low-priced health insurance plans disappear from the market. I believe that it is difficult to attract citizens to join the new HPS; the insurance industry is also sceptical about its effectiveness.
Moreover, the government had originally reserved HK$50 billion to provide financial incentives for the HPS. But now they say only 10% of the fund is needed to develop the plan. In my opinion, the government is just deceiving themselves and others. This $50 billion was suggested to be used throughout 20 years – $2.5 billion per year. In comparison with $40 billion, the annual spending of the Hospital Authority, this is a very small amount. The expenditure which the public healthcare sector can save because of the HPS will be much greater than this amount. Under the revised HPS, the government has cut down 90% of the expenditure. This shows the astronomical contrast between the old plan and the new plan.
Evidently, the government wants to maintain the dominance of the public healthcare system. This does not benefit the society at all. The public healthcare system already has many problems. The biggest issue is that it is too focused on the quantity rather than the quality. According to rough estimates, each year, 16 million people obtain their medical care within the public health care system in Hong Kong. No wonder public hospitals are always overcrowded. Statistics show that a public hospital’s general practitioner only has a few minutes to see one patient. Patients applying for specialist outpatient service have to wait for over a year. Some emergency department patients have to wait for over ten hours to see a doctor.
The reality is not looking optimistic. Not only do patients have to wait while being in pain, there is also immense pressure on medical staff. Under these circumstances, doctors cannot provide comprehensive follow up on every patient. They perhaps cannot find the cause of the illness, or even give the wrong diagnosis. These mistakes occur very often. Moreover, the public hospitals have gotten into the habit of prescribing lots of medication to patients and giving them long sick leaves. It seems that the hospitals wants to prolong the time of the next check-up so as to reduce the burdens on the healthcare system. Under these circumstances, it is doubtful whether the patients are being given sufficient treatment.
I am a strong advocate for primary healthcare development. But if the government continues to focus on quantity rather than quality in developing primary healthcare, it will only make the public healthcare system become a “white elephant”; thus causing a negative impact on our citizens. In my opinion, the government needs to start from the root. This includes promoting the dual-track system for public and private healthcare sectors, and adding more incentives for the healthcare financial reforms. The government must not interfere with the operation of the medical insurance industry; otherwise it cannot provide healthcare services which have both quantity and quality to citizens.
