Hong Kong Health Care System

Current Situation

This report offers an evaluation of Hong Kong's health care system. In this section, three important strengths and four fundamental weaknesses are highlighted.

Strengths

Hong Kong has a relatively equitable health care system. Every resident has equal access to essential health care. The financial burden of health services is financed in an equitable manner, and health services are reasonably equally distributed by geographical region.

Establishment of the HA brought steady improvement in certain aspects of quality and efficiency of services provided by public hospitals.

The health care system is relatively cost effective. Hong Kong's health care system is relatively cost effective when compared to European countries and when cost effectiveness is defined as achieving a better health outcome given a specified amount of resources. Although private and public spending on health care constitutes less than 6 per cent of GDP, this city has one of the lowest infant mortality rates and the longest life expectancies anywhere.

Weaknesses

Hong Kong's medical service has highly variable quality. Hong Kong lacks effective measure to ensure that patients receive comprehensive, highly quality medical care. The medical profession enjoys a privilege to self-regulate without interference and adequate oversight from external organization. Patients spend long queuing and waiting time even for essential treatments (Cancer patients at public hospitals have to wait for up to 40 days for radiation treatment due to a shortage of radiographers ), but relatively short clinical encounter (less than 5 minutes ). Over prescription behavior exists.

Long-term financial sustainability of current system is highly questionable. Although the existing mainly tax-based system has many desirable features, its longer term sustainability is doubtful especially when Hong Kong faces the problems of an ageing population, a slower rate of growth of the economy, and the proliferation of expensive drugs and equipment, etc.

The projections by Harvard team suggest that public health care expenditures may take up as much as 20-22% of the total government budget by 2016, a significant increase from its current share of 13%.

Hong Kong's health care system is highly compartmentalized with an over-emphasis on hospital based curative care.

Hong Kong lacks a coherent overall policy for financing or organizing health care, which could lead to both ineffectiveness and inefficiency of the delivery of health care.

Areas Requiring Improvements

By summarizing the above weaknesses of Hong Kong's health care system, we conclude the following areas requiring improvements.

Quality of Care needs to be improved for higher patient satisfaction and shorter queuing and waiting time.

System of Care Financing needs rethinking in order to address the ageing problem and cost inflation in the future.

Organizational Structure needs reforming for higher effectiveness and higher efficiency.

These results point to the need to seriously rethink and redevelop an overall coherent health care policy and health care financing/delivery system that will meet the needs of the population of Hong Kong.

Developing Options

This section carefully examined the various proposals for reforming Hong Kong's health cre system. In the following we will first analyze the five proposals by Harvard Team and three proposals we come up with.

Option 1: Maintaining the Status Quo

Description:

One option for Hong Kong is to maintain the status quo. Comparing with other countries, the health care system in Hong Kong has much strength. The existing system is generally equitable, efficient and cost-effective. The almost free-of-charge public hospital services provide few incentives for radical reform, apart from the expectations for continued improvements. Also the political feasibility of the status quo makes this option attractive.

Implications for meeting objectives and for major stakeholders:

The current health care system of HK suffers from several serious weaknesses, and it could get worse in the future if no changes are made. Maintaining the status quo will not meet the future objectives of managing the government budget for health care or targeting funds for those who cannot afford to pay themselves. Also, primary care and prevention services are becoming increasing important these days, and the current system does not address these areas very well. Doing nothing to change the system will forfeit the opportunity to overcome compartmentalization, improve quality and efficiency, meet the future needs of Hong Kong population, and manage overall health expenditure inflation.

Under this option, the government treasury would be directly affected, since the rising demand for health care will necessitate increasing government funds for public health facilities. According to our projections, by 2016 public expenditures on health under the status quo may represent 3.4 to 4.0% of GDP and absorb almost 20% of total public expenditures. It may seem that other major stakeholders will remain unaffected; in the long run, however, the general public could be adversely affected. As the government spending for health care increases, less fund will be available for other important areas such as education or infrastructure. Also, public financing of inpatient services becomes increasingly less well targeted to low income people.

Option 2: Cap the Government Budget for Health Care

Description:

An explicit upper limit on government health care expenditure is set. This option may seem to be effective in managing government's budget. A limited budget will lead to reduced quality of services in public facilities, but many of the poor, elderly and sick