Stakeholders hope badly needed reforms to sustain the city's increasingly expensive public healthcare system will come in this week's inaugural Policy Address by Chief Executive (CE) Leung Chun-ying.

Only days before the address was to be delivered on Jan 16, a report by the Ombudsman underscored some of the chronic problems in the system. The report dealt with reasons that may prevent critically ill patients from being moved with dispatch to the nearest emergency facility. The reasons were purely procedural and bound up in the notion that public hospitals each had a catchment area ... and that patients within a given catchment area must go to that hospital, even if another hospital was closer.

The Hospital Authority explained that the catchment procedure was a matter of how resources are allocated and went on to argue the distance from an emergency unit, or the time it takes to get there, should not be held as the only important factors when dispatching patients.

Be that as it may, uneven allocation of resources and factionalism are considered chronic, critical problems afflicting the Hospital Authority. Leung promised in his electoral manifesto that management of the city's public hospitals would be carefully evaluated.

Tsang Kin-ping, chairman of the Alliance for Patients' Mutual Help Organizations, wants the government to review the 20-year-old Hospital Authority Ordinance to evaluate whether the organization should remain a public entity.

The alliance made other demands to the government in December. It wants a review of the regulation of private hospitals. It is calling for the provision of a public dental service. He said expectations for the new CE are high, since the CE came out so strongly in favor of affirmative changes in the healthcare sector.

Kenneth Fu Kam-fung, president of Hong Kong Public Doctor's Association, agrees that recruitment of part-time, private practitioners has alleviated physicians' workload in the past few months, but that was as far as it went toward addressing a chronic problem.

"Residents of remote areas, like Tuen Mun, deal with an aging population and low-income households. The patients are getting lower quality public healthcare," Fu said. "There are inconsistencies. The safety net isn't very safe."

Factionalism remains an obstacle in the fair allocation of resources, argues Fu. He contends top managers with the authority must reallocate resources to clean up a culture that is hurting patients in the long run.

On the other hand, the authority told Fu that the burden falls on the government, not the Hospital Authority per se, to provide greater incentives such as job promotion and compensation to doctors. Thus, Fu said he hopes for good news in the Policy Address.

One other approach to sharing the burden of the public healthcare system was to divert some patients to the private sector.

Chow Pak-chin, vice-president of the Hong Kong Medical Association, had been an advisor to the CE during last year's election.

Given that half of the city's practitioners are serving 90 percent of the patients who are dependent on the public system, Chow said he hopes the Policy Address will provide clues to closer public-private partnership.

One prime example, Chow, an ophthalmologist, cited was the Cataract Surgeries Programme that effectively cut short the waiting list for cataract surgery in public hospitals after 2008.

Later this year, a working group will put forward recommendations on the city's health protection scheme, including components of the insurance plans and financial incentives to facilitate implementation of the scheme. The CE had promised to offer tax allowances to residents who bought healthcare insurance.

Chow said while the proposed allowance will reduce government revenues, the public reserve will benefit in the long run as more people will look for cures from the private sector.

He also named another "less obvious" benefit. "When people pay for something, they tend to hold more responsibility to their own health," said Chow. "When people take less sick leave, the productivity added to society will eventually exceed the loss in tax revenues."

The CE had already delivered his promise to raise the credit of healthcare vouchers for the elderly to HK$1,000 a year. He had also proposed to expand the voucher scheme to cover chronic patients.

The concept has the backing of former deputy health chief, Gabriel Matthew Leung, who suggested last weekend that the voucher scheme should cover other needy residents to reinforce primary healthcare through partnership with the private sector.

kahon@chinadailyhk.com

(HK Edition 01/15/2013 page1)