Hospital Authority passes health test
Alex He says Hong Kong's health governance system may not be perfect, but problems can be dealt with through fine-tuning and improvements rather than by scrapping the Hospital Authority, as some suggest
In mid-July, a legislator's motion on dissolving the Hospital Authority, the statutory body for managing all public hospitals and institutions, stirred widespread debate on Hong Kong's health policies. Although the motion did not succeed in the Legislative Council, heated discussion still goes on.
A committee set up by the government late last month is due to review the authority's performance, but even this has proved contentious; controversies about its membership have arisen. Hong Kong has a world-class health system financed by taxes with very low patient fees. Is an overhaul of its health governance system really necessary?
Criticism of the Hospital Authority usually takes three forms. First, that the quality of care and patient satisfaction have declined, mainly due to long waiting times; second, the uneven allocation of resources; and third, there are still staffing and infrastructure shortages, while the private sector's potential to provide services has not been fully utilised.
We can’t blame patients for visiting hospitals too often … but the ‘free lunch’ syndrome persists
However, these problems are attributable to a series of systemic glitches that can be corrected, rather than fundamental flaws in the design of the authority.
Long waiting times are quite common in most health systems financed through taxation, and the situation in many other countries is a lot worse than in Hong Kong. In Canada, for instance, a patient has to wait four months, on average, for an MRI scan, while the average time for a knee replacement is almost a year.
We can't blame patients for visiting hospitals too often because they have medical needs, but in most public medical systems, the "free lunch" syndrome persists. This leads to overutilisation. As seen in Taiwan, overuse has led to less efficient allocation of financial resources because some patients may not actually need that much tertiary health care.
In theory, it's possible to prescribe very straightforward policy advice. On the demand side, an increase in out-of-pocket fees would deter overuse of the system and thus reduce waiting times. But this is unrealistic in Hong Kong's current political climate; any such suggestion would meet overwhelming public opposition, a lesson learned from the frustration of past public consultations.
Yes, something could be done on the supply side, by enhancing the capacity of the public system or establishing new hospitals, for instance. Unfortunately, both need a long time to take effect, not to mention the constraints on the training capacity of local medical schools.
