President, Hong Kong has all along attached little importance to the development of primary healthcare, and the target beneficiaries of the Government’s general out-patient clinics are chronic patients and the disadvantaged groups. Members of the public who fall ill can only turn to private clinics for elementary medical consultations.
As Members may be aware, primary healthcare is the starting point of healthcare, and is also responsible for the prevention of disease and promotion of public health. If it works well, not only can the general health level of the community be raised, but the demand for specialist out-patient and in-patient services will also drop. It is unfortunate that the Government has never attached any importance to this. A few years ago, I moved the motion “Promoting medical check-up for the whole community” in this Council, hoping to enhance the work of disease prevention, an essential part in primary healthcare. The motion was passed at that time, but no action has been taken by the Government.
As society ages, there is a pressing need to develop primary healthcare and a number of Members have put forward many useful views today. I nonetheless wish to point out that the development of primary healthcare needs substantial resources, and public resources are pretty limited. Injecting additional resources to primary healthcare would reduce the amount of resources earmarked for other healthcare services. After all, healthcare financing is the greatest problem. To find a way out for Hong Kong’s healthcare problems, include promoting the development of primary healthcare, we must start with the resources.
The last-term government has actually put forward a good proposal, and that is, promoting the balanced development of public and private healthcare services and implementing the Voluntary Health Protection Scheme (the VHPS). It is hoped that through the implementation of an improved system and a number of economic incentives, people who are dissatisfied with public healthcare services will switch to private healthcare services, thereby reducing public healthcare expenditure.
In fact, a large number of middle-class people, who have the means, are currently patronizing public hospitals. It is not because they do not want to go to private hospitals, but because the public healthcare system has become so big that the relatively smaller private hospital system has scared them off with its few hospital beds and high charges. Therefore, by expanding the private sector, introducing a proper VHPS and providing economic incentives, the middle class would be very willing to patronize private hospitals. Since the service cost of the public healthcare system is very high, the significant reduction in expenditure in the long run would certainly far outweigh the Government’s spending on economic incentives. The resources saved could therefore be used to improve healthcare services.
Regrettably, it seems that the Government has given up the idea of promoting the development of private healthcare. Of the four sites previously earmarked for the building of private hospitals, only one was granted. Another one has been surrendered to the Government and the remaining two have yet to be finalized. As a result, the plans relating to the medical services industry, one of the six industries where Hong Kong enjoyed clear advantages, may be aborted. It seems that the Government has lost interest in improving the VHPS. It has not only started the VHPS all over again, but has also drastically removed some major parts from the original proposal by abolishing most of the economic incentives and the packaged plans. Worse still, it has proposed to regulate health insurance companies in the private sector. This would inevitably expel those budget health insurance plans from the market. I believe it would be difficult for the new proposal to attract members of the public, and the insurance sector also cast doubt on the effectiveness of the VHPS.
Furthermore, the Government has originally earmarked $50 billion for providing economic incentives under the VHPS, but it now said that only less than 10% would be required for the purpose. I think this is nothing more a deceptive remark to fool itself and others because supposedly that $50 billion should last for 20 years and it is only $2.5 billion for each year. Compared with the $40-odd billion expenditure of the Hospital Authority, this is just a small amount. But compared with the long-term public medical expenditure incurred by the VHPS, this is too little. Meanwhile, the Government has also reduced expenditure by 90% and this showed that the old and new proposal are completely different.
Apparently, it is the intention of the Government to let the public healthcare system remain as powerful as it can, which does not do any good to the community. The public healthcare system has many problems and the biggest one is its emphasis on quantity rather than quality. According to rough estimation, a total of over 16 million people have patronized the public healthcare system every year. No wonder we often see various hospitals packed with patients. Information shows that a general practitioner only has a couple of minutes to diagnose a patient, and some new cases for specialist services have to wait for more than one year while some accident and emergency patients have to wait for more than 10 hours before they can see a doctor.
This is awfully unsatisfactory. Not only patients have to wait for long time, the healthcare personnel also have to suffer undue pressure. Under this circumstance, it is downright difficult for the doctors to carefully follow up each and every case. It is not uncommon for doctors to fail to ascertain the cause of disease or even make wrong diagnosis. Worse still, hospitals are accustomed to prescribe a large amount of drugs or grant long sick leave for patients so that they will not return for follow up so soon and add to the already heavy burden on the healthcare system. In that case, whether or not the patients have been sufficiently treated is a big question.
I support the proposal to strengthen the development of primary healthcare, but if the Government still stresses quantity rather than quality, it will only turn public healthcare into a “white elephant”, which may not necessarily do any good to the public. I think the Government should tackle the problem at root by, inter alia, further promoting the development of twin-track system for public and private healthcare sectors and increasing the incentives for promoting healthcare financing reform. Also, it should refrain from tempering the operation of the commercialized healthcare insurance, otherwise there is no way to provide healthcare services that give equal emphasis to both quality and quantity.
I so submit.