The government has put forward a proposal for a voluntary medical insurance scheme for public consultation. The motive is simple: to reduce the future financial burden on the government, for providing public health care services to the aging local population. There is, however, one fundamental question: Why has the government chosen a medical insurance scheme as the only option? A related question rears its head: Why doesn't the government invest in the public health care system (the local Hospital Authority and the Department of Health system) instead?

Regarding the second option, the reason provided and emphasized by the government appears to be questionable. There are many ways to reduce the financial burden. The voluntary medical insurance scheme may not be the most cost-effective one, considering not only the fiscal balance of the government (in the health sector alone) but the overall cost effectiveness of the local population and society. For the most part, the government appears ready to transfer most health costs to the people, but in ways that will benefit the private sector, including private health and financial services industries. The government's plan hands over to these private interests business volume and handsome profits, without regard to the increased burdens on citizen-consumers. When health costs are transferred from the public sector to the private sector, the economies of scale and scope of the public sector are lost. The end result may be that society at large must spend more.

The government has allocated HK$50 billion for subsidizing the voluntary scheme. The money will be used for those who are chronically ill or have pre-existing conditions. This also seems illogical. Why should the government subsidize these people to avail private sector services? What it really means is that the government intends to subsidize private sector institutions. A more cost-effective way to apply the (huge) public funding would be to spend it on the public sector and create synergy and scale economy advantages. In addition, subsidies under the voluntary plan will be used to cover services and charges of insurance companies, and this means diversion of part of the public money from its original purpose - the treatment of patients. Patients will have to pay more than the fees levied by the public sector, putting a heavy burden on them and their families. That could impose an additional impact on the financial wellbeing of these families, and their livelihood and the implications could be far reaching. If there were no voluntary medical insurance scheme and no subsidy of HK$50 billion, the chronically ill and those with pre-existing conditions would approach either the public or private sector for treatment. For those unable to afford private fees, the government should enable the public sector to help them, as medical care is part of the entitlement of being a citizen of Hong Kong. Those who can afford it might go overseas for treatment. Whether they are covered by medical insurance or not should not be a political or policy issue for the government and the general population of Hong Kong. Therefore, what is the need for the scheme and why should the government and society subsidize HK$50 billion for it?

There are just two real reasons behind the government's move to push forward the scheme. One is that the government, probably is under pressure from private medical interest lobbyists and wishes to use the scheme to subsidize and support the private sector at the expense of the public sector. Subsidization is part of the plan. The other part is to reduce the scale of public sector services so that more people in Hong Kong are forced to go to the private sector for more expensive treatment. This two-pronged strategy is an attempt to dismantle the effective and world class public health care system that Hong Kong inherited from the colonial period. The other aspect is that the government (as illustrated by the introduction of the Mandatory Provident Fund Schemes) has been too much inclined to support the local financial services industry. This is underscored by the fact that the government is willing to place important matters concerning the wellbeing of ordinary people into the hands of the profit driven financial services industry - all this without benefit of any internationally recognized regulation or monitoring. Hong Kong is not just a financial center. It is probably the least regulated financial center among all world cities. In the recent debacle over the so-called mini-bonds, the incompetence of the government in terms of financial supervision was obvious. The excessively high administrative fees charged by providers of the Mandatory Provident Fund Schemes and the reluctance of the government to correct the problems further confirms the government's intention to let the matter lie. The Central Government in Beijing has recently reversed its medical reform from its former US-style medical insurance system; the SAR government should take heed.

The author is head of China Business Centre, Hong Kong Polytechnic University.

(HK Edition 10/01/2010 page4)