Lifelong Investment in Health,
a blueprint for future health care system

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The Government today (December 12) 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 proposes strategic directions for reforms and improvements to the existing system and sets out the implementation mechanisms to take forwards the various proposals.

"Our vision is to recreate, through our proposed reforms, a health care system which will enhance the quality of life of the population and enable individuals to develop their full human potentials," said Dr E K Yeoh, Secretary for Health and Welfare, at a press conference today.

"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.

"We emphasize in the document that the pursuit for better health, if the pursuit is to be successful and sustainable, has to be a shared responsibility among the individual, the community and the Government," Dr Yeoh said.

In the document, the Government has set out its proposals under three main components of Hong Kong's health care system – health care delivery, quality assurance, and the funding and financing for health care services.

Having taken into consideration the recommendations of the Harvard consultants and views submitted by the community last year, Dr Yeoh said the Government had formulated strategic directions for reforms and improvements to these components to ensure that the health care system would be able to meet the needs and aspirations of the future generations.

"Some improvements 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," Dr Yeoh stressed.

"We shall consult the public again on those long term issues, such as the proposed individual Health Protection Accounts, after we have conducted detailed studies."

On health care delivery, Dr Yeoh said the Government aimed to improve the interface of the different components of the public and private primary care and hospital services. Among the major proposals are :

- strengthen preventive care through intersectoral co-operation and enhanced community involvement in health education and promotion;

- improve the effectiveness of primary medical care through the promotion of family medicine practice and development of other primary care models;

- transfer the general out-patient service from the Department of Health to the Hospital Authority to achieve integration of primary and specialists care in the public sector;

- develop an electronic Health Information Infrastructure to link up the public and private health sectors, and also with the welfare and community groups, for sharing of information and to build up an electronic lifelong health record for each individual;

- enhance preventive and promotional efforts on oral health, and encourage the provision of affordable dental care services by NGOs; and

- promote the practice of Chinese medicine in the public sector, starting with outpatient service, extending to public hospitals, with a view to promoting collaboration between western and Chinese medicines.

Alongside the reforms to the health care delivery system, the Government proposes to develop a framework of quality assurance to ensure that a high standard of service is provided to patients consistently.

This can be achieved through a combination of education and training, systems support and regulatory measures. Dr Yeoh said, "We propose that all health care professionals to undertake continuing professional education and development to update their knowledge and skill.

"We will encourage all health care institutions to establish quality assurance mechanisms, such as clinical audit and risk management, to help the professionals identify problems and maintain quality.

It is also proposed to set up a Complaint Office in the Department of Health to investigate patient complaints and to assist the complainants to obtain expert advice. "However, the power to conduct disciplinary proceedings, deliver a verdict and award punishment will continue to rest with the professional regulatory bodies," Dr Yeoh stated.

Turning to health care financing, Dr Yeoh noted that about 94 per cent of the hospital services rendered to the local population were provided by the public sector. Fee income accounts for only about 2.5 per cent of the Hospital Authority's recurrent operating expenses. In 2000/01, the public sector health care recurrent allocation amounts to $30.8 billion, taking up already 14.7 per cent of the total recurrent public expenditure.

He said, "We expect the health cost to continue to grow, due to an increasing and aging population, advances in technology and rising public expectations. If the public health care system becomes unsustainable, the lower income groups, who have to rely on public sector services, will suffer most.

"In order to maintain our strengths of accessibility and affordability, and to improve the system's long term financial sustainability, we propose to adopt a three-pronged approach in handling the issue."

First, on reducing costs and enhancing productivity, the Government will continue to enforce vigorously the cost containment measures in the public sector to slow down the overall increase in costs, and to prioritize public subsidies to areas of most needs.

Secondly, the Government proposes to review how to restructure the public fees structure to reduce inappropriate and misuse of services.

"We shall ensure that the public fees will always be set at a level that is affordable by individual patients and there will always be a safety net to enable the financial vulnerable to continue to have equal access to quality medical care. We do not only assist those low income groups, but also the sandwiched class who runs into financial difficulty because of major or chronic illnesses."

Thirdly, the Government proposes to set up individual Health Protection Accounts to assist patients to pay for their own medical services after retirement. This scheme will have the following key features –

(a) it will be a personal account for the individual and the spouse, with mandatory contribution by the individual of one to two per cent of the earnings from age 40 to 64;

(b) the savings cannot normally be withdrawn until the person reaches 65 and upon withdrawal, the savings can only be used for medical and dental care of the person and the spouse, based on public sector rates, or to purchase medical and dental insurance; and

(c) unspent savings left in the account will be passed on to the surviving family.

Dr Yeoh envisaged that a small group of the population would require, in addition to medical treatment, long term care services. The Harvard consultants recommended to establish a separate personal savings account, "Medisage", to purchase long-term care insurance upon retirement. "We support the proposed scheme in principle, but as long-term care insurance is not well developed in Hong Kong, we would require to conduct more in-depth studies of the subject before recommending how to take the matter further," he added.

The consultation document, released for a three-month public consultation until March 15, 2001, can be accessed via the Health and Welfare Bureau website (http://www.info.gov.hk/hwb). Copies of the consultation document will be available from the District Offices of the Home Affairs Department, public hospitals and clinics, later this week.

Dr Yeoh called on the public and all concerned parties to study the consultation document and put forward their views on the way forward either by mail to the Health Care Reform Unit, Health and Welfare Bureau, 19-20 Floors, Murray Building, Garden Road, Central, Hong Kong; by fax (2840 0467); or via e-mail (hcr@hwb.gcn.gov.hk) on or before March 15, 2001.

End/Tuesday, December 12, 2000

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