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30 March 2001

Health Care Reform Unit
Health & Welfare Bureau
19th-20^th Floor
Murray Building
Garden Road
Central
Hong Kong

VIA FAX & BY MAIL
(Fax No. 2840-0467)

Dear Sirs,

On behalf of the Hong Kong Democratic Foundation, I am pleased to submit our response to the Government’s health care reform consultation paper, "Lifelong Investment in Health".

Should the Bureau be interested in discussing our views in more detail, my colleagues and I would be happy to make ourselves available.

Yours faithfully,

G W H Cautherley
Vice Chairman

Enclosure

The Hong Kong Democratic Foundation (HKDF) finds a great deal to commend in the Government’s consultation paper on healthcare, "Lifelong Investment in Health." The particular strength of this paper lies in its vision of the healthcare needs of the community and the many initiatives proposed to meet these.

Healthcare Provision Issues
Initiatives such as enhanced focus on preventive care, the electronic Health Information Infrastructure, greater integration of Traditional Chinese Medicine into our healthcare system and the establishment of a health Research Office are all similar to proposals made by the HKDF in its submission in response to the Harvard Report.

We also, enthusiastically welcome the concept of closer collaboration between the public and private sectors on primary care, proposals to increase home-based and/or community center based provision of health services, mandatory continuing professional education and training for all categories of healthcare workers, initiatives to improve the licensing requirements for private hospitals and clinics, improve patient complaint mechanisms and promote greater awareness of the need for oral hygiene and dental care.

Healthcare Funding
Where we find the consultation paper particularly deficient is on the difficult issue of healthcare funding. The paper refutes the Harvard Report’s claims of the need for significant increases in funding for healthcare requirements in the future. However, whereas the Harvard Report sets out the assumptions on which its conclusions regarding future funding needs are based, the current consultation paper provides neither factual rebuttal nor projections of future healthcare funding requirements. It is impossible, therefore, to enter into any informed discussion on the issue and we can only hazard the guess that it is precisely because the Government does not wish to enter into any factual debate on healthcare costs, that such information has not been included in the consultation paper.

The paper does make some very sensible proposals, such as continued efforts to reduce costs and fee structure reform. However, these are only put forward in very broad and general terms, without any achievement objectives in terms of percentage cost reductions to be looked for or percentage of total costs to be reclaimed from new or increased fees.

The health protection accounts proposal is not without merit, though the rationale for this has not been well presented.

HKDF Views
We are attaching a copy of the response we submitted in July 1999 to the Harvard Report for easy reference, as we believe the points made in this continue to remain valid. Also attached is Table 1, consisting of selected comparative healthcare information.

Healthcare Provision Issues

1. We continue to believe that there is a need for the Government to be more aggressive in its environmental policy in the areas of air and water pollution, particularly with regard to the former, as polluted air is a significant contributor to respiratory disease and aggravates cardiac conditions.
2. HKDF would urge the Government to expand its proposal for a health Research Office to be more along the lines of the proposals in the Harvard Report for a fully fledged Institute of Health Policy and Economics and our own previous suggestion of linking this with one of our Universities.
3. HKDF has considerable concerns as to the long-term survival of private hospital care provision, given the almost monopolistic current position of the Hospital Authority (HA). As a result we urge the Government to set a medium term target of achieving an 80% HA 20% private sector hospital care provision. For the longer term we should certainly be looking to a ratio much closer to a 50/50 split between publicly and privately funded hospital care provision.

Healthcare Funding Issues

1. The proposals in the consultation paper regarding continuing cost reduction efforts, fee reform and health protection accounts will undoubtedly contribute usefully to reducing the healthcare cost burden on public finances. However, in the absence of any factual justification in the consultation paper that these measures will provide adequate relief, HKDF remains profoundly sceptical that these initiatives will prove to be sufficient.
2. While HKDF may not support the view that healthcare costs will rise to the levels envisaged by the Harvard Report, we maintain our conviction that within ten to fifteen years much more radical reforms of our healthcare system will be required than those proposed in the consultation paper.
3. Consequentially, HKDF strongly reiterates that within a ten to fifteen year time-frame its proposals in response to the Harvard Report of:
   1. an integrated system of provision of hospital care, encompassing both the existing Hospital authority facilities and the private hospital facilities
   2. funding of healthcare substantially through mandatory health care insurance

   will need to be fully in place if the challenge of sustaining an adequate system of healthcare that does not overburden public finances over the long term can be met. We envisage these measures as being phased in over a period of years, on a step by step basis, starting in the near future.

Table 1: Comparison of Health and Health Systems