"Your Health, Your Life" - Healthcare Reform Consultation Document
30 May 2008
Food and Health Bureau
19/F Murray Building
Central, Hong Kong
"Your Health, Your Life" - Healthcare Reform Consultation Document
We are writing in response to the above consultation document and are enclosing our submission together with a copy of a public opinion survey on Selected Healthcare Policy Issues carried out by the Lingnan University in January 2008 and a paper published in May 2007 by the Healthcare Policy Forum on "Containing costs, enhancing quality and improving access - A proposal for reforming Hong Kong's healthcare system".
We hope you will find the enclosed useful in formulating the healthcare policy.
Alan Lung Ka-lun
HONG KONG DEMOCRATIC FOUNDATION RESPONSE
"YOUR HEALTH YOUR LIFE" HEALTHCARE REFORM CONSULTATION
As the consultation document outlines in Chapter 1, there is a compelling case for the need for reform of the healthcare delivery system in Hong Kong. The Foundation would particularly emphasize the absence of an organized primary care network and related to this, the compartmentalization of service delivery between different levels of care. Other defects the Foundation would also like to highlight are the supplier domination nature of our system and the lack of regulation of the private sector.
The key objective of the reform of our healthcare delivery system should be:
to contain the long-term growth in the cost of healthcare provision,
to enhance the quality of healthcare provided and
to ensure efficient access to healthcare on the basis of need and irrespective of means.
In the light of these objectives, the Foundation supports the general thrust of the recommendations in Chapter 2 of the consultation to implement a more structured system of primary care services that will also facilitate a smoother interface between primary care and hospital care and private care and public care.
Furthermore, the Foundation also supports the contention that there is a need to provide funding support to the less well off in our society to enable them to have access to the primary care system, since this will need to be largely provided by the private sector. The Foundation is also in agreement with the objectives of the proposals in Chapter 2 to strengthen public health functions.
Public-Private Partnership and "Money follows Patient"
Also compatible with the objectives of healthcare reform, as set out in our second paragraph above, is the role of public-private partnership in healthcare. However, this should not be on the basis of public funds subsidizing the cost of provision of private healthcare, but on the basis of purchasing/funding patient access to private care at a cost that is compatible with or lower than the cost of provision from the public sector.
We believe this should be part of a "money follows" patient concept that should also be implemented within the public healthcare system. In regard to this we note that in a public opinion survey carried out by the Lingnan University Public Governance Programme in the latter part of 2007, that 82% of the 1,000 + respondents agreed that patients should be allowed to choose the hospital of their preference.
Electronic Health Record Sharing
The Foundation strongly endorses the proposal in Chapter 4 to develop electronic health record sharing and again we note that in the Lingnan University Public Governance Programme public opinion survey the introduction of this was supported by 82% of the respondents.
Public Healthcare Safety Net
With regard to the issue of strengthening the public healthcare safety net, the Foundation believes that the provision of public healthcare services should not be looked upon as a safety net, but rather viewed in the perspective of the United Nations Research Institute for Social Development's contention that "health systems are set up to serve population health and the provision of all according to need."
Healthcare should be viewed as part of a community's over all social policy, an investment in the well-being and productivity of the community. As such, since healthcare benefits the community as a whole, it should be a key priority for allocation of public money.
Additional Operation Reforms
In addition to the operational reforms proposed in the consultation document, the Foundation would like to endorse two further reforms proposed by the Healthcare Policy Forum in its paper "Containing Costs, Enhancing Quality and Improving Access - A Proposal for Reforming Hong Kong's Healthcare System" published in May 2007.
These proposals were instituting a new healthcare organizational structure and establishing a research institute for clinical excellence. We would strongly urge the Bureau to look at both these initiatives and would hope to see proposals along these lines included in the next consultation document the Bureau issues.
A New Healthcare Organizational Structure
The key, in fact the imperative, to effective implementation of reforms is the strength of the organizational structure within which the reforms are carried out. The Foundation agrees that there is substantive merit in the Healthcare Policy Forum's proposal for a new two-tier organizational structure, with the upper tier responsible for, among other things, macro-level planning, advising the Food and Health Bureau on issues relating to healthcare, allocating public funding to providers, setting and monitoring standards and the lower tier, in effect an extended Hospital Authority, responsible for managing all public health service provision and public health programmes.
Establishing a Research Institute for Clinical Excellence
The Foundation believes such an Institute could have a considerable positive impact, in the longer-term, on the cost effective delivery of healthcare services. This is similar to a proposal made in the 1999 Harvard Report and we envisage such an Institute could reflect functions similar to those of the UK's National Institute for Clinical Excellence.
Healthcare Provision Funding
The consultation document puts forward six options for supplementary funding for Hong Kong's healthcare system in Chapters 8-13. As expressed by many others commenting on the consultation document, the Foundation finds these options are supported with inadequate details. In our view, the information provided is not sufficient to enable an informed choice to be made among the options proposed. Furthermore, from the information provided, it seems quite clear that all of these options, to a greater or lesser extent depending on the individual option, will distribute a disproportionate burden of the supplementary funding onto the middle class, which we believe to be both unjust and possibly socially divisive.
We also believe that it is inappropriate for the Government to come to a unilateral conclusion, in Chapter 7, that the existing financing model is unsustainable. We believe that in the interests of fairness the public view should be sought on this and it should have been included as a seventh option. We would urge the Bureau to seek public opinion on this by including it as an option in its next consultation document.
The Way Forward
The Foundation believes it will be relatively easy for the Government to secure broad public approval for its operational reforms as evidenced. The public opinion survey the Healthcare Policy Forum commissioned to be carried out by Lingnan University Public Governance Programme last September, which covered over 1,000 respondents. This survey showed that 83% of the respondents supported increased government spending on healthcare provision, 82% supported the introduction of a territory-wide system of electronic health records, 82% agreed patients should be allowed to choose to be treated in their hospital of preference and 76% supported the enhanced primary care proposal.
However, the issue of supplementary funding is already proving to be contentious, particularly among the middle class.
In view of this, the Foundation would most strongly urge the Government to proceed with its operational reforms first, both in view of the strong public support for these and particularly in view of the moderating effect the proposed operational reforms will have on the future growth in healthcare costs. The Government should defer the issue of supplementary funding to allow additional time for the community to come to a consensus view on how funding of the healthcare system should be handled for the long-term. With our robust economy and the HK$50 billion set aside by the Financial Secretary for assisting healthcare reform, there are ample financial resources to fund the implementation of the operational reforms without resorting to supplementary funding in the next few years, at least.
Reproduction of this paper is permitted with proper attribution to the Hong Kong Democratic Foundation