Health Care Reform -- the Dichotomy between Government and the Profession

Dr. C H Leong *

Reports both from the media and otherwise ever since the birth of the Health Care Reform Consultation Document has unfortunately been negative, or at least not positive, even from the profession. Why is this the case, when it would have been thought that there are many areas that the profession and Government must think in the same way in principle? In this article, I will venture to present my personal views on the basis of this dichotomy basing on my over 12 years of public service and involvement with the profession, and skirting the mind of the Government.

Dual Health Care System

It appears that both the profession and Government agree that the time honoured dual health care system (private/ public) must continue and improve by breaking whatever barriers that may exist in between.

Regrettably, the interpretation may well be different or so it seems as the Health Care Reform Consultation Document unfolds. The profession believes that public and private sectors must exist in equal footing -- a genuine two legged state with one complementing the other so that the public have a true choice, stimulating health care standards.

Government, on the other hand, favours a dual service channelled under one system controlled by the Government. To the private, it is "you do what the public system does not want", or "you do what the Government ask you to do".

Much has been mentioned of "Sharing Informations". Yet, how many referrals from private practitioners to public service are properly answered, and how many of these referrals are finally channelled back to the referring doctors? As a Hospital Authority (HA) Board Member, I have been pushing this from the word "go". Regrettably, the priorities of Information Technology development of the HA has been on business management, payrolls etc until it was too late. Even today, not all public hospitals and specialist clinics are equipped with the Clinical Management System.

"Common Protocol" is another proposal aim at bettering private and public interface. Quite a few of these have been tried since the early HA days, notably on diabetics and hypertension. Yet, how many Common Protocols are now in existence and functioning on a territory-wide basis? Common protocols could only be successfully developed when the public and private sectors can come to agreement on equal footing and that the Academy of Medicine -- the comptroller of standards -- has to be an active participant. Needless to say, Common Protocols are but "flashy eye openers" if the price barrier between the private and the public remain unresolved.

"Sharing Patient Load" must be the panultimate to boost health care service and standards. Regrettably, Government proposals are being perceived as "whilst the public service cannot swallow all it chews, yet it still refuses to spit it out". The much trumpeted Health Protection Account thus is only to ensure that those aged over 65, with no job income, will still be able to afford the "token" charge of public service and to utilise the public care. In essence, there is no direction towards assuring that those "who can afford" will not overload the public health care sector.

Improved Monitoring of Standards and Quality Assurance - A Better Accountability to the Public

Few in the profession would disagree that such is necessary. Furthermore, there are mounting calls from the public.

For the profession, such an improvement should be from the efforts of the profession themselves. Yet, any noticeable improvement on monitoring standards and disciplinary measures has not been effective. The confidence of the public to our professional disciplinary bodies leaves much to be desired. There have been a lot of calls for revamping these bodies, making them more user-friendly and transparent and be seen advocating to the public.

Regrettably, in many areas, our Medical and Dental Councils are dragging their feet. It is "too little and too late" to call for two more lay members into the Medical Council, when the profession is not willing even to take on board compulsory Continuous Medical Education (CME) as a pre-requirement for renewal of practicing certificate whilst this is specified in law for the Chinese Medicine Practitioners. The impression that our professional councils are there to protect the professions' ego first, and anything else second, cannot be easily shrugged off!

Nor is the Government absolved from blame. The legal support, in particular in arranging prosecutions against the blacksheep, has been embarrassing, to say the least. From time to time, there were reports on penalties imposed by the Medical or Dental Councils being quashed by the Court of Appeal based on legal technicality. To wit, it was only last November that the Court overturned a misconduct ruling, criticising legal advice given to the professional disciplinary body involved as interpreting the law erroneously and quoting inappropriate precedents.

On pressure from the public, Government thus proposes to set up a Complaint Office under the Department of Health. This middle-of-the-road approach may well be a good-will effort, but unfortunately will not gain Government any credit. To the profession, the Government is going too far in meddling with professional affairs. To the public, the Government is not going far enough to have an "independent" body to protect the public. It becomes a lose-lose situation!

Health Care Financing

Again the Government and the profession are standing on the same side in principle. To wit, both would agree that "health care cost should be shared between the user and the public purse" and "Government subsidy should be targetted at those who need it most".

In the profession's mind, the concept to be adopted should be "those who can pay should pay" be it in the private or public sectors. This is to ensure that there will not be any unnecessary heavy load on the public service to upset health care standards.

Regrettably, whilst Government proposes the concept of "target subsidy", it never clarifies who the targets will be, and what happen to those outside the subsidy targets.

As mentioned earlier, the proposed Health Protection Account will in no way decrease, rather it will increase, the utilisation of public sector service.

There is nothing concrete in the Consultation Document to rebalance the imbalance of workload between the private and the public sectors. The fear is, of course, undermining of health care standards. Little wonder that the profession, especially those in the private sector, are lamenting that the "Health Care Reform" does little to alleviate the problem of private medical service.

Government and Profession both with vital roles

Yes, Government do have a responsibility to help the private medical service if it is to ensure that high standards are provided to the public. Yet, the condemning finger should not be directed to the Government alone, for the profession must also play their part. The many dichotomies between the Government and the profession, as mentioned, are not insurmountable, especially when both parties are seeing issues eye to eye in principle.

It is time that the profession stick united, forgo unnecessary internal political bickering and suggest the way forward on agreed principles and come out a winner. It is time too for the profession to forgo trivial self ego and self-vested interest, show the public the depth and width of our vision, the degree of our societal commitment and regain our rightful respect and trust.

The Health Care Reform consultation document, irrespective of its worth, is an opportunity for the profession to move a very much needed reform and for us to mould a health care system of tomorrow!

* Dr. Leong is President of the Hong Kong Academy of Medicine. He was a former Legislative Councillor of the Hong Kong Goverment, representing the Medical Functional Constituency. The views he expressed in this article are nevertheless his personal views and not the views of the Academy.