What is the big picture?

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)