After years of “benign neglect” by the Government, the appointment of our new Chief Executive of the HKSAR Government may shed new light into our future health care reform.
According to the Chief Executive of the Hospital Authority, we are using the least amount of resources to provide health care standard of high caliber. However, the current financial deficit in the Hospital Authority is not sustainable and would indeed worsen in time without decisive action. In other words, our brittle health care system is a time bomb to the HKSAR Government.
That is the reason why when I attended a meeting between members of the Election Committee of the Medical Sub-sector and Mr. Donald Tsang (The Chief Executive to be in the material time) on 16th June 2005, Mr. Tsang said that he realized the urgency of our health problem and stressed that the two issues of Severe Public Private Imbalance of Health Care Services and Health Care Financing have to be tackled immediately when he was formally appointed the Chief Executive.
I told him in the meeting that HKDU would support and treasure the presiding dual system of Private and Public Medical Services in Hong Kong. However, the morale of private doctors is dangerously low nowadays because of the low patient attendance rate due to the Severe Public Private Imbalance of Health Care Services. Furthermore, I told him that apart from competition from Chinese Medicine Practitioners, private doctors are facing the competition from a lot of fake “clinics” which are actually dispensaries illegally selling drugs to patients for treatment purposes. I stressed that the Government should tighten the control of such illegal drug sales so as to protect the interests of the citizens. I think Mr. Tsang understood our worry since he was a formal sales representative of drug firm.
I also told him about the problem of contract medicine in Hong Kong nowadays. I told him that contract medicine has been established for a number of years in Hong Kong. From recent statistics, such industry is providing medical service to over one million of the Hong Kong population. Our experience is that administrators of such contract medicine, irrespective of whether they are medical doctors or not, are making a great profit at the expense of private doctors and also the portion of money supposed to spend for optimal health care of those participants. Such giant investors in contract medicine are planning to control the private health care market in such a way that is both detrimental to the income of private doctors and also to the health of the community at large. On Mr. Tsang requested for a solution, I quoted the attempt by the Australian government to control HMOs through the Medical Practice Act of Australia (Please refer to P. 4 of the HKDU December 2004 Bulletin) for his consideration. Mr. Tsang remarked that he would look into the matter.
We all understand the importance of primary health care. We all know that primary health care includes curative care and a wide spectrum of activities aiming at health promotion, disease prevention, health maintenance and rehabilitation of patients and their families. Moreover, primary care doctors should also act as “gatekeeper” of the hospital system. It should seek to minimize pressure on the more expensive and technologically more specialized medical services. In most cases, patients should only gain access to hospital care upon referral by a primary care doctor.
Ideally, the interaction between primary care and secondary care should be a two-way flow. When a primary care doctor diagnoses or suspects an ailment in a patient’s conditions which requires specialist or hospital care, he / she will refer the patient for consultation and / or treatment in specialist clinics or hospitals. After the necessary treatment has been given and the patient’s conditions stabilized, the secondary care doctor should refer the patient back to the primary care doctor for continuity of care.
However, such mechanism is not working and is not supported by the government or the public for years and the present Problems of our Health Care System include:
We fully understand that any genuine health care reform to contain cost should now be based on the future successful development of family doctor concept. A strong family doctor concept would surely solve the above-mentioned problems. Under such a concept, there would be continuity of medical care for patients, improving interface between different levels of care and enhancing collaboration between the private and public sectors.
The measures that the Government should take would include (a) effective measures to promote the family doctor concept; (b) educate the public on the importance of continuity of care; (c) put in place incentives to encourage adherence to a family doctor such as tax concession for health care expenditure and (d) establish a system of easy transfer of patient record between different levels of care.
To improve the interface between primary care and secondary care, public specialist outpatient departments should make a conscious effort to download patients to be taken care of by primary care practitioners where appropriate, and that primary care practitioners should minimize inappropriate and unnecessary referrals to the secondary level. In the long term, a territory-wide information system should be developed for entering, storage and retrieval of patients’ medical records by carers in both the private and public sectors.
The Government should consider promoting primary care by “buying” service from and by making referrals to private primary care practitioner. While on preventive care, it is important for we, primary care doctors, to include a large component of prevention in care, actively look out for health problems, and spare more efforts on primary prevention, assessments and correction of health risks. We are contemplating on Exercise Prescription for patients starting next year in the hope that by promoting such, patients become more aware of their personal health while at the same time those suffering from chronic illnesses like hypertension, diabetes mellitus and obesity would benefit in the long run.
The role played by primary care doctors would be much more important in the future, are you well prepared for that?
Dr. Yeung Chiu Fat Henry