|In the 11 years since the establishment of the Hospital Authority, the public health care
budget increased from 6 billion to 30 billion. Ninety percent of the 30 billion went to the
In times of plenty, it might be even in the interest of the
Hospital Authority to strengthen the expectation of its patients and
potential patients. Thus, patients were no longer known as patients,
they were instead called customers. Customers, as in other
businesses, were treated in a manner to attract their patronage and
increase in their consumption. The ever-increasing expectation of
the customers, and their strong demand for service, has given the
Hospital Authority the political support for its expansion. The
rewards to the Authority are more public money, more senior posts,
and the domination of health care in Hong Kong.
The sad fact of life is that times of plenty won't last forever,
and there is a limit on how much public money can be used to fuel
the expectation and demand of the customers (or to be more exact,
When public funded health care has been so good for such a long
time, there is no way the Government can turn away the customers of
the public hospitals, and it would be almost impossible to ask them
to pay more. The only course of action the Government can take is to
demand the Hospital Authority to produce more for less. When the
front line staff were already labouring under various enhancement of
efficiency programmes and long working hours, the Hospital Authority
introduced a new pay scale for doctors in the year 2000, despite the
strongest ever protest. The new pay scale means a pay cut, despite
increased workload and responsibility. The public doctors were
angry, they were at the same time depressed. I'm sure they still are
angry and depressed. They are depressed because apart from the
Hospital Authority, no other realistic employer is available. With
the domination of health care by the Hospital Authority entering the
private market becomes no longer an option.
When heavily subsidized service becomes the norm, private medical
practitioners who have been earning an honest living by providing
cost efficient and personalized service to their patients are often
regarded as too expensive nowadays. I'm sure that if the unit cost
of the service of the Hospital Authority is available for
comparison, private service will be found equally, if not more cost
When heavily subsidized public service is so readily available,
for example, free-of-charge 24 hours access to the public hospitals
through the accident and emergency departments; there is very little
incentive for Hong Kong people to take out insurance for the service
of the private hospitals.
Private doctors fear a declining livelihood and they are as
depressed as their public sector colleagues. They are depressed
because there seems to be no way that they can stop the decline.
Doctors also suffered a dramatic decline in their respectability.
When receiving low cost high quality health care becomes a right,
doctors become servants responsible for upholding this right. The
care and the devotion of doctors could be taken for granted, because
it is the right of patients to receive their service. Failing to
cure a disease could sometimes be regarded as an infringement of a
personal right. Culprits causing medical incidents must therefore be
To quite a few people, not only to receive low cost, high quality
health care is a right, this right must be further protected by a
low cost and expedient medical complaint and redress mechanism. It
is widely believed by doctors that substantial amounts of public
money have been used to settle medical complaints out of court,
sometimes regardless of the merit of the complaints. The public
system seems to be the only place where the right of the patients
can be upheld.
The people have been demanding for the ideal, without trying at
the same time to behave more like ideal citizens. Ranking health
care policy makers and Hospital Authority officials have been doing
nothing to change this unhealthy mindset; instead they are doing
everything to reinforce it. They talk too often about strengthening
quality assurance in health care, but they have been silent on the
fact that quality does come at a price.
|Hospital Authority officials talk too often about strengthening quality assurance in
health care, but they have been silent on the fact that quality does come at a price.
Doctors feel betrayed by their leaders. Many at the top of the
hierarchy of the profession have become administrators and policy
makers. They have been in the leadership for long enough to be held
responsible for the state of the profession. Doctors demanded change
in the leadership. If doctors can vote for all the medically related
key positions, I'm sure that we'll see quite a few new faces.
Unfortunately, the highest medically related position doctors can
vote in or out of office is their representative in the legislature.
I can still feel the very high expectation of doctors when they cast
their votes in the Legislative Council election. 60 percent of the
registered voters, or 5000 of them cast their votes. That was the
highest ever turnout in an election of the functional constituency.
Doctors hoped for a leader that could lead the profession out of the
quandary, but I doubted how many of them could really understand
that the power of a Hong Kong legislator is rather limited. The real
power is in the hands of the executive-led Government of the Hong
It was against this background that I got elected. The election
was not an easy one; there were 4 candidates. The main reason why
there were so many candidates was, I believe, because there was no
straightforward solution for the problems of the medical profession,
and there was no straightforward solution for the problems of our
health care system. As doctors, we know that if there are many
different treatments for a disease, there is no satisfactory
treatment for that particular disease.
I got elected, as my electorate told me, because I have been bold
enough to get to the core of the problem, even though I was unable
to offer an immediate solution for the problem. One of my slogans
for the election was "Health care reform starts with the reform
of the mindset of our policy makers". I've been true to my
belief and have been trying to reform the mindset of the policy
makers, in particular, health care policy makers since my election.
I've been providing aggressive, yet professional check-and-balance
to the all-powerful executive-led Government, in the very
specialized policy area of health care. I did this with the
long-term interest of Hong Kong in my mind. I believe that the
people of Hong Kong are intelligent enough to be confronted with the
truth in health care. If Hong Kong genuinely wants health care
reform, those who have been perpetuating the populists' illusion of
a utopia in health care must stop doing so at once.
I might be guilty as a legislator for being too specialized in
one area, but if my observations in health care can be applied to
other policy areas, the mindset of quite a few people, both within
and without the Government is in need of a reform.
Unlike countries that have gained independence from the colonial
powers, none of the Government officials and none of our politicians
have the experience of fighting to free Hong Kong from her former
colonial master. They don't even have the experience of negotiating
for the future of Hong Kong with the former colonial master on
behalf of the people of Hong Kong. When China and Britain negotiated
for the future of Hong Kong, our politicians sat helplessly on the
sidelines. Neither China, nor Britain allowed the participation of
the people of Hong Kong in the negotiation. The three-legged stool,
with Hong Kong one of the legs, was unacceptable. When Chris Patten
staged the fight with China, quite a few politicians jumped onto his
bandwagon and formed the delusion that they have fought for the
freedom and democracy of Hong Kong. When everything was decided
between China and Britain, including agreeing to disagree, I doubted
whether there was anything to fight for. Did our politicians even
really put their own life and freedom at risk fighting for the
freedom of Hong Kong? What political price have they paid?
Most Hong Kong politicians have received no such training and
acquired no such credentials as the people to rule Hong Kong. They
were on the sidelines before the hand over, and they remained on the
sidelines after the hand over. Quite a few of them developed the
mindset of a leashed guard dog. They bark aloud at anything
suspicious, but they never have the opportunity to deliver a real
The guard dogs undoubtedly will demand the ideal, especially when
they are not required to deliver the ideal they are demanding.
Freedom, democracy, equal opportunity, transparent and accountable
government, more welfare, less tax, and low cost high quality
comprehensive health care, just to name a few.
What these guard dogs do not know is how to put all these ideals
together and make Hong Kong work. The same observation can be
applied to the executive-led Government. The senior officers of the
colonial civil service were largely retained and were propelled to
ruling positions in their respective policy areas, but are these
people who have been working all their life as implementors of the
policies of the colonial government, ready to become policy makers
themselves? For the few outside the colonial civil service, who were
chosen for ruling positions, do they have the political maturity
required of their jobs?
I would illustrate the interaction between politicians and
government officials, and the effects of such interaction, by using
examples from the policy area of food safety. Food safety is one of
my favourite policy areas.
|Politicians demand the Government guarantee the absolute safety of food, so that
people can continue with their risky eating habits.
It is sad to see politicians making demands for the government to
attain the impossible. It is even sadder to see government conceding
to such demands without bringing out the truth. Politicians demanded
that the government prevent another outbreak of bird flu by
introducing even more stringent control on the live poultry
industry, and at the same time keep the industry alive. The
Government conceded. The truth is that the stringent control
introduced will most likely kill the industry, but even these
measures cannot guarantee that another outbreak of bird flu will not
occur. Public money is being spent on a lost cause and delaying a
rational discussion on the future of the proprietors and employees
of the industry.
Politicians demand the Government guarantee the absolute safety
of food, so that people can continue with their risky eating habits.
It's already known that deadly bird flu is transmitted to man
through close contact with chickens, but the taste of chickens that
can be selected live from a cage was glorified recently in the
Legislative Council. The government has been blamed for the recent
outbreak in cholera, for not carry out enough enforcement action in
restaurants selling raw seafood, when the most effective means to
prevent cholera is to stop eating raw seafood. The government has
been accused of trying to conceal from the public that a beef
carcass was tested positive for E. Coli O-157. The test was done as
a risk control measure of the slaughtering process in 4 out of every
5,000 beef carcasses. It was not done to guarantee the absolute
safety of beef; absolute safety can only be guaranteed by cooking
Such accusations made by politicians were stupefying. The
apologetic responses of the Government on these accusations were
beyond my comprehension. The circus of accusations and apologies,
may, however, serve some useful purposes. It may make the Government
even bigger, by making the people more dependent on the Government.
It may also help to perpetuate the delusion of the politicians that
they have been doing something useful.
It is not fair to put all the blame for the present quandary of
Hong Kong on government officials and politicians. We should, after
all, be grateful for a peaceful transition. Hong Kong people ruling
Hong Kong will take a bit of time to mature. Perhaps maturity will
come earlier, if beginning today the people of Hong Kong can stop
mourning about the departure of our former colonial master, and
begin to accept not only Hong Kong, but also China as our home.
Perhaps the people of Hong Kong, like most Chinese do, are willing
to give their utmost to their home, without asking what they can get
The above does not necessarily
represent the views of the Foundation.