“The private medical fee is too high .... it should be around HK$100.00 for general consultation so that it is more affordable for the general public.” This was Mr. Tung Chee Hwa’s view on private medical practice in 1996. Actually he made such a remark when I asked him in Ruttonjee Hospital during one of his campaigns for the First Chief Executive of the HKSAR in 1996. At that time, the average medical consultation fee for general practitioners was around HK$150.00. I felt a bit upset at Tung’s remarks but never took it seriously.
Now, I understand. Mr. Tung’s wish is realized half way through his second term as the Chief Executive of the HKSAR Government. Undoubtedly, most of us in general practice are now providing general medical consultations at around HK$100.00 per visit, some even lower.
Actually Health Care Reform started before the Rainbow Report in 1993, Harvard’s Report in 1999 and Dr. E K Yeoh’s Consultation Document on Health Care Reform in 2001. The Health Care reform started since the Hospital Authority was set up in 1990 and was perpetuated when our previous Director of Health issued a reply to us in 1997 stating that it was not illegal for any person, no matter doctor or businessman, to run medical services companies in Hong Kong. On looking back, she might not be the person who made the final decision. That is the main reason behind the bloom of HMOs in Hong Kong. And that is one of the main reasons for our price reduction apart from competition from the Hospital Authority since 1990.
When I talked with Mr. Wu Ting Yuk, the new Chairman of the Hospital Authority, last month, I was amazed by his wisdom on the public health care budget. During the meeting, we agreed that the charges of the public health care services now are not reasonable and realistic; and there should be much room for raising charges while maintaining a safety net for the poor and the needy. Mr. Wu said he would welcome any feasible proposal from us to solve the serious problem of public private imbalance.
Similarly, wisdom is shown by our new Secretary for Health, Welfare and Food in saying that those who oppose any increase in health charges fail to realize that the public health care system in Hong Kong is now in its pre-cancerous state. Any more deficit in the public health budget would be detrimental to the Public Health service. Dr. York Chow is 100% right in saying so.
However, from the two meetings with our Chief Executive in 2003 and 2004, I have the impression that he did not realize this problem at all. He had repeatedly said that the number of medical students intake each year should be raised instead of reduced. According to his understanding, the increase in number of medical students would result in the increase in number of medical experts in Hong Kong and would further help in building up the brand name of Hong Kong as a renounced Medical Centre in the world like New York and
There is not much new in Tung’s policy address this year, especially in the section on the health care. Under the section on health care financing, it said …”Members and the health care sector are concerned about whether our public health care system is financially sustainable in the long term. We are now reforming the advisory framework for health care services to facilitate the tendering of advice on our long-term health care policies and financial viability. We also need to further explore ways to enhance our health care system and improve the interface between the public and private health care sectors. Maintaining quality public health care services involving the allocation of community resources and public well-being is a major issue. We will undertake studies within the next two and a half years to help lay the foundation for the formulation of long term strategies…” Obviously, he has pointed out that there should be 2 and more years for us to discuss on future health care reform, and such reform, if there is any, could not be realized during his “reign”.
However, there are some little actions by our Secretary for Health Welfare and Food recently and they include, inter alia:- (1) Proposed increase service charges to which we agree; (2) establishment of Community Care Networks according to the SARS expert report; and (3) the so called one stop service for patients from the young to the elderly.
Then where should we stand, knowing that our boss is not on our side? Shall we co-operate? Or shall we wait 2 and half years more? Or wait till 20XX?
Dr. Yeung Chiu Fat Henry