Motion on “Promoting Healthcare Reform” (2019.06.06)

MR CHAN KIN-POR (in Cantonese): President, Hong Kong has recently launched the Voluntary Health Insurance Scheme (“VHIS”). Many middle-class people are interested in the scheme and there has been much discussion about it in the community. The response to it has been better than I have expected. VHIS can help the people and this is certainly nice. But then this situation also reflects the disappointment of the people with the public healthcare system as all those who can afford want to switch to the private healthcare system.

Hong Kong’s medical technologies have always been on a par with global levels. However, out public healthcare service quality has been under criticism for problems such as prolonged service waiting time and brief consultation time. I believe that there are two basic reasons for these shortcomings. First, too many patients but insufficient healthcare personnel. The public healthcare system is inadequate in both resources and manpower, directly resulting in excessively long waiting time for patients. Healthcare personnel are exhausted with heavy workload, and naturally the quality of healing is affected negatively. People from the medical sector have pointed out that in Hong Kong, the time spent by doctors on each patient is probably less than one third of that in the United States. The quality of healing will certainly be affected, as we can imagine.

Second, given a lack of primary healthcare service in Hong Kong, treatment will only be arranged when people have become seriously ill. The result, just as described in the motion today, is that the people can hardly receive treatment at an early stage of illness, creating more pressure on and more demand for specialist healthcare, and thus prolonging the already lengthy waiting time for specialist services.

The problem of tight resources is resolvable. In recent years, the Financial Secretary Mr Paul CHAN has allocated a substantial amount of resources to help improve the current situation, including setting aside $300 billion for preparing the second 10-year hospital development plan, $10 billion for a public healthcare stabilization fund, and $5 billion for upgrading and acquiring medical equipment. Although the measures concerned cannot resolve all the problems, we can see that the Government is willing to allocate funding to healthcare and provide more resources to tackle the problems, which is an important step.

But the shortage of healthcare manpower is actually the biggest problem now. The controversy surrounding the recruitment of overseas doctors has persisted for an extended period. I just want to stress that in 1 000 population, there are 2.4 doctors in Singapore, 6 in Germany, 3.4 in the United States, and only 1.9 in Hong Kong. If we want to catch up with the level in Singapore, there actually is a shortfall of 3 400 doctors. It is impossible for us to find so many doctors within a short period and recruiting overseas doctors is thus the only solution available.

Under the Singaporean model, all the top medical schools in the world are included in an approved list. All graduates from these medical schools on the list will become eligible for private practice once they have finished practising under supervision in a public hospital in Singapore for a period of time. This system has been in operation in Singapore for more than a decade and no major problem has ever occurred. Recently, the number of local doctors in Singapore has risen and they can even delete some medical schools from the list to tighten the restrictions. I hope that the medical sector can consider these solutions seriously or even put forward improved proposals for the community to debate. Otherwise, the problems will certainly not be resolved, the people will continue to suffer and even the doctors cannot be spared from the hardship.

The motion today also mentions the issue of public-private healthcare partnership. Hong Kong began to study healthcare financing in 2005 and came up with a large-scale medical insurance scheme. I also participated in the study at that time. Under the proposal back then, the Government would inject $50 billion to provide young people with subsidies in purchasing insurance, set up a high risk pool to help chronically ill patients purchase insurance, and regulate medical charges with diagnosis-related groups (“DRG”)-based packaged pricing. As it was expected that many would join, the Government would provide subsidies and insurance premiums would be set at an even more attractive level, a lot of patients would be diverted to private hospitals, which would relieve the pressure from the public ones.

Very unfortunately, the Government has eventually withdrawn the proposed $50 billion subsidy for unknown reasons, depriving the scheme of the benefits of insurance subsidies and a high risk pool. The now implemented VHIS has merely enhanced and regulated medical insurance schemes, leaving another highly important area, medical charges, utterly untouched. While tax incentives offered by the Government to VHIS participants are well received, VHIS is not as attractive as the original plan and probably cannot achieve large-scale effect of a diversion from public to private hospitals. We have also lost an opportunity for medical reform. But these are all bygones and we should continue to look forward. As proposed in Prof Joseph LEE’s amendment, we should continue to promote medical insurance schemes, urge the Government to increase economic incentives, encourage people to join the schemes and try our best to divert those who can afford to private healthcare system.

Separately, as VHIS has met with overwhelming responses, it is necessary for Hong Kong to build more private hospitals expeditiously in order to meet future needs. When the Government initially put forth the healthcare funding option, it was accompanied by a private healthcare support arrangement under which private healthcare industry would be developed and DRG-based packaged pricing would be launched. Regrettably, the development of private healthcare industry has been less than satisfactory. So far, only one new private hospital has been completed while a large-scale hospital is still under construction, which simply cannot meet future needs.

To make VHIS a success which brings genuine benefits to the people, there should be more private hospitals providing sufficient inpatient beds. DRG-based packaged pricing should also be implemented to enhance market transparency and prevent the persistent escalation of medical inflation. At present, medical inflation is higher than general inflation. If medical inflation continues to rise out of control, it will directly lead to a persistent surge in premium levels, generating serious implications for medical insurance schemes. Currently, VHIS has met with positive responses and is expected to be participated by a growing number of people in the future. By then, people are covered by medical insurance but their needs cannot be met as hospital inpatient beds are insufficient. This will probably result in long queues for services once again and medical charges will definitely shoot up. Therefore, we must now work on the support arrangement and continue to promote private healthcare industry and consider the introduction of DRG-based packaged pricing again.

I so submit.

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