On 19th July 2005, the long awaited Discussion Paper on the Future Service Delivery Model for our Health Care System – “Building a Healthy Tomorrow” - was finally released by the Health, Welfare and Food Bureau (HWFB). As usual, it attracted a lot of criticism from the community except the Government Officials and the tycoons. The most important question of “Who is to foot the Bill?” in the final report is the centre of discussion in the past 2 weeks. Without the support from the community especially the middle class, would such proposal by the Bureau be in vain as before?
Your Council was invited to have a sharing session on the Paper with members of the Health and Medical Development Advisory Committee on 22nd July 2005. The following was presented to Dr. York Chow during the meeting.
We applaud the Government for her attempt in devising a courageous blueprint for the future health care in Hong Kong. As the public health care system is unsustainable with the public Budget constraint, the proposal is indeed one with drastic changes.
It is suggested in the Paper that Public hospitals should concentrate on acute and emergency care; low-income and underprivileged groups; illnesses that entail high costs, advanced technology and multidisciplinary professional teamwork and training of health-care professionals. We agree on such Positioning of the Public Sector for a meaningful utilization of the Government limited resources. However, we point out that this is the minimum that the Government should insist on without provoking millions of people marching in the streets again.
We disagree on the Government’s attempt to dictate the role of the Private Sector. The Government should not dictate the Private Sector to provide AFFORDABLE medical service to people of average income level. Similar to other trades, the role played by the Private Sector should best be left to the free market force. If the Government insist on Positioning of the Private Sector, this would be unfair to our medical profession as there is no such positioning of the private sector of other professionals by the Government before.
We disagree on the tone of the Paper somehow depreciating the private sector of the medical profession. There are certain paragraphs in the paper misleading the public to believe that the private sector is not up to standard and to ask for a tighter control of the private sector, as reported recently in a lot of media.
We all know that there is certainly variation of standards among the doctors in all levels and sectors, but such standard is the minimum required and governed by the Medical Council of Hong Kong. After all, we have the best Health Care Indices in Hong Kong. Would you think that such good health care result is the work of the Public Sector in Hong Kong alone? I told Dr. York Chow that in the past 4 years, there is an average of 10 to 12 disciplinary inquiries by the Medical Council of Hong Kong each year. Among the 10 to 11 convicted cases each year, 2 would be on drug label, 2 on dangerous drug records, 2 on fake documents, others on practice promotion etc and only 0 to 1 case would be on doctor’s standard each year. And among all these convictions due to substandard practice, most of them are specialists who have to undergo CME. After all, there are a lot of experienced public colleagues joining the Private sector lately. Would they be substandard too? Therefore, I personally asked Dr. York Chow in the sharing session to delete all such unfair remarks to the private sector in the Bureau’s final paper at the end of this year.
I was astonished at the comment from representative of the Practising Estate Doctors’ Association in the meeting. He was concerned with the term Family doctor being used too loosely by the Government to cover general practitioners, Family Physicians, any other specialists. According to his presentation, it would take around 26 years for the training of enough Specialists in Family Medicine in Hong Kong who are the only doctors qualified to be Family doctors. According to him, even doctors who have looked after up to two or three generations of patients cannot be qualified as Family doctors. As such, there would be less than a dozen of so called qualified“Family doctors” among the 300 odd Public Estate Doctors.
We do support the promotion of Family doctor concept by the Government. Preventive and primary health care is more cost effective and should form the key to any health strategy. A family doctor system like that in the United Kingdom and Canada helps to ensure continuous care. To make these happen in Hong Kong, private doctors including general practitioners and specialists besides Specialists in Family Medicine must be brought into the system. So the real question is how to build a better-integrated system. A tax-funded system cannot achieve integration unless Hong Kong follows United Kingdom in building up a National Health Service for private doctors, as it did in 1948.
Without the same commitment as that of the Government of United Kingdom, to open 24 hour clinics or group practices by the private sector should be up to the free market and should not be dictated by the Government unless she is willing to shoulder the cost. We disagree on the setting up of requirements and standards of practice to the private sector by the Government to target for a benchmark for primary medical care in Hong Kong. Nor are we happy to accept unilateral imposed requirements on our private colleagues by the Government in her agenda of Purchasing primary medical care service from the private sector. The Government should not, by so doing, attempt to create a bigger health care kingdom of her own. In fact, the Government should listen to our opinions in the matter of contracting out medical service on equal grounds. She should instead concentrate on her commitments to the public with her limited budget. In the interests of the health of the community, the Government should seriously consider the regulation of illegal drug sales and the regulation of contract medicine, as in the case of HMOs. Otherwise, the Primary Doctor concept could not function to maximize its benefit in the continuous care of the community.
Nevertheless, we agree that Primary Health care doctors should be engaged more in health promotion and disease prevention; the Residential Care Home for the Elderly to employ more doctors; the Government to expand the service of the Community Nursing Service to the private sector and to revise the public health service fees to decrease the public private fee differentiation.
As a responsible profession, I urge you to study the Paper of “Building a Healthy Tomorrow”* and give us comments in the enclosed survey circular no. 0608 so that we can send them to the HWFB before the end of October this year. For your information, Dr. York Chow, Secretary for Health, Welfare and Food has promised to come to our Princess Margaret Hospital Sunday Afternoon Symposium on 16th October 2005 to answer all our queries. Please try your best to attend.
Dr. Yeung Chiu Fat Henry
*The discussion paper of “Building a Healthy Tomorrow” can be downloaded from the website : http://www.hwfb/hmdac/.