I have difficulty interpreting
the Healthcare section of the Policy Address 2013 delivered by the Chief
Executive of Hong Kong. I cannot get the
big picture.
The Policy Address is for the
general public. While most of them are laymen
to healthcare policies, all of them are users of healthcare services. The aim of the Policy Address is to tell the
users what they will expect from the new government. There is in fact no right or wrong healthcare
policy. There is even no absolute good
or bad healthcare policy. There is by no
means a government can create and implement a perfect healthcare policy. Afterall we all know that such policy does not
exist. There are always some stakeholders
getting more than others, some getting less than what they expected, and some
being neglected or even discriminated upon. The government is entitled to identify
problems and to set its own priorities. But
at least the government needs to tell us what its vision is, why it thinks so,
and how it is going to achieve it. I do
not see these in the Policy Address.
The Policy Address states only
one guiding principle. The provision of
quality and affordable healthcare services has been a proud achievement. However, there exists a problem, which is the
rise in medical costs due to different reasons. The government needs to “tackle the root of
the problem”. So apparently it seems
clear that the government identifies a problem
and is going to tackle it in this year or in the coming five years. However, it does not elaborate what the root
of the problem is. Obviously the problem
is the rise in costs. But what is the
root of the problem?
Without identifying the root of
the problem, we can still try to tackle a problem of rise in cost. Theoretically, it is simple. You can either cut the cost, or you can put in
more money. Of course you can do both,
but there is always an inclination to either way.
Reading the Policy Address, injecting more money is in solid terms: “The Government allocated additional funding
of about $2.5 billion to the HA last year, raising its annual recurrent subvention to $40.4
billion. We will continue to set aside resources to
strengthen our public healthcare system and enhance its service quality.”
Before
we search for items to cut costs, I suggest looking into items that go the
other way, that is, items that further raise the cost. By cost I mean cost borne by the government but
not cost paid directly from an individual citizen for medical expenses. These policies, once implemented, will be
unlikely to be “uninstalled” and will contribute to the rise in cost to the
government. The number of beds under HA
hospitals will be raised. New hospitals
and clinics will be built. Existing
hospitals will be expanded. The Drug Formulary
will be expanded. The waiting lists of
specialist out-patient clinics will be optimized. Waiting time for semi-urgent and non-urgent
cases will be shortened by, again, injecting more resources. The role of Chinese medicine and Chinese
medicine practitioners in the public healthcare system will be expanded. Chinese medicine in-patient services will be
introduced. (One point to note is that
it is quite uncommon for Policy Address to specifically aim at “enhancing the status of Chinese medicine practitioners”.)
While injecting money is
relatively simple (theoretically, not practically), cutting cost is the
talented part. Let’s have a look at what
the government has offered. It is hinted
that the private healthcare sector is a solution. However, there is no commitment. Public private partnership is mentioned. Despite the cannot-be-considered-favorable
comments from the Audit Commission on the few previous public private
partnership pilot projects, the HA is just going to “study the feasibility
of further service outsourcing”. The
section on private healthcare sector is then dominated by the eye-catching
title of “Regulation of Private Hospitals”.
This is in-line with the
all-too-often-heard comment that people prefer HA to the private healthcare sector
mainly because of the relative lack of regulation. The huge price differential of having a
laparoscopic cholecystectomy with $50,000 in private versus $300 in HA is never
a major factor except to the users. Traditionally,
regulation is never considered a kind of facilitation. The Health Protection Scheme can be a mean to
encourage patients going for the private sector and cut the cost of the
government. However, it is still in the
going-to-be-consultation stage. Whether
it is helpful or not depends on the scale and details of the scheme.
The balance between the public
and private sectors is the only strategy in cutting the cost. Other proven and useful methods are not
considered. Preventive medicine and
primary care have been practiced with success in many developed countries in
cutting the cost of healthcare and in promoting the health of their citizens. Preventive medicine and primary care were once
the high-lighted healthcare policies in Hong Kong. They have remained in the talking level, but then
disappear completely in this Policy Address.
I scratch my head and think about
what the root of the problem is. I am
thinking about drawing the conclusion that the government is going to tackle
the problem of rise in cost by just injecting more money into the HA. Then it comes the epilogue of the Policy
Address. I hear from the news that apart
from what have been mentioned, there will be other policies. They will be in the mode of 成熟一項推一項. I do not know how to translate it, as I am not
sure what it means. Is it referring to
the maturity of a policy from consultation and discussion? Or is it referring to the right timing? Or in fact the beauty is the ambiguity in
meaning and the freedom from scrutiny?
So, the conclusion is that no
conclusion is needed. Let’s forget about
the Policy Address in the meantime.
(Source: HKMA News February 2013)
