SCMP Friday, November 24, 2000

Health-care plan shunned


Health officials have all but discarded the controversial Harvard report's recommendations on how to pay for public medical care.
Instead, they are set to announce for consultation a system based on that of Singapore, in combination with other options.
The Harvard report, commissioned by the Government and released in April last year, called for two compulsory "risk-sharing" medical insurance schemes, under which all employees and employers would have to contribute a combined total of three per cent of wages.
This would mean hospital bills for middle-income earners would increase by more than 10 times. The schemes would not cover the full cost of hospital stays, while the health plan for the elderly might cover only 30 months of treatment.
Changes are needed in the way public health-care is financed because the present system, which relies on taxes to subsidise cheap services, is unsustainable. The Harvard report estimated that, without reform, public health-care expenditure would swallow 20 to 23 per cent of the total government budget within 18 years. It accounts for 14 per cent now and costs about $30 billion each year.
But it is understood the recommendations of the $7 million report by 15 academics have not been adopted. The proposals had been modified "according to
local values and community aspirations", a government source said last night, adding the Government was now confident of a positive public response to the Green Paper, which would be published next month outlining the options.
The source said a medical savings scheme similar to Singapore's with "some variations" was likely to be set out. Singapore's health-care financing system consists of three parts: Medisave - compulsory personal savings which cover primary care; Medishield - compulsory savings that cover acute care in hospitals; and Medifund - voluntary savings for catastrophic or long-term medical needs, for example chronic illnesses or a heart bypass operation.
A Medisave account would be more easily accepted than the Harvard recommendations because it worked like personal savings, the source said.
Secretary for Health and Welfare Yeoh Eng-kiong and his top aides have recently begun testing the water to see how the government plan will be received.
"Those being put in the Green Paper are just the options. We are open to public consultations on the final choice and the way forward," the source said. He denied the Harvard report was being discarded entirely.
"The Harvard report made a correct diagnosis of the health-care scene," he said.
A forum organised by Dr Yeoh and the Hospital Authority on Wednesday saw about 100 people listen to World Health Organisation consultant Dr Kai Hong Phua, who is associate professor in health policy and management at the National University of Singapore.
"Dr Phua defended the Singapore system and discussed it in depth. It seemed to me at least this suggested it is the system that Hong Kong is going to take. It's more like a testing of the water to find out what the opinion of the profession is like," said one of those invited, Dr Choi Kin, a council member of the Hong Kong Medical Association and the president of the Practising Estate Doctors' Association.
Dr Phua said on Wednesday that Hong Kong "should not put all its eggs in one basket", in reference to the funding choices. "My own personal preference is that there are many ways of skinning the cat and so you should not close your options. You should really have a diversified approach - whatever works and is acceptable to your population," he said.
Dr Phua said the elements were taxation redistribution, a voluntary insurance scheme, and savings which would make sure that "each generation should save for itself". He said the Harvard report's "prescription was not appropriate. The diagnosis was incomplete".
Legislator Dr Lo Wing-lok, who also attended Wednesday's forum, said the Government should be mindful of the "political realities" with proposals that would ask "people to dig deep into their pockets when Hong Kong was just coming out of the Asian financial crisis".
There will be three months' consultation on the Green Paper. Implementation will be in phases, with some changes done quickly, but major reforms carried out over a 10-year period.