Hong Kong can pride itself on its cradle-to-grave medical system that allows every citizen to have easy access to health care. Faced with a rising aging population with a longer life span as well as a shortage of medical and nursing staff, it is inevitable that our public health system is under increasing strain to maintain high standards of care. With the city's population of the elderly projected to grow to 28 percent by 2039 from the present 12.8 percent, the situation will get worse. It is only a matter of time before the bomb explodes. A series of medical blunders or mishaps over the past few years explains the worsening quality of public health care. When a crisis like SARS hits the city again, the consequence could be unmanageable.

People here like to visit public hospitals whenever they are stricken with fatigue or illness, no matter how long they have to wait in queues.

The insured do not know whether their conditions are covered by their policies. Nor do they know how much they can claim for the costly private healthcare. Cunning insurers can always find ways and set certain terms to deny them their claims or reduce the amount of claims. And for those better off, illness is not only bad for their health, but also for their wealth, for treatment at a private medical hospital can be stunningly expensive.

It is in this backdrop that the government is keen to launch a voluntary medical insurance scheme as a solution to the ills that afflict the public system. Drawing on HK$50 billion for a span of 25 years as incentives for Hong Kong people to sign up for private health insurance, the authorities hope to relieve pressure on the overstretched public system and improve its overall healthcare quality. The proposed incentives include a 30 percent discount for young citizens, premium subsidies for the elderly and high-risk patients. But the premiums for the latter category are going to double the amount a healthy person pays.

The scheme is doubtless well-intended. But I am afraid the government seems to have underestimated the potential risks involved in subsidizing the insurance sector or private healthcare groups. It is needy patients who deserve such assistance. It is also doubtful whether the scheme can garner enough public response to get off the ground.

When it comes to the use of a staggering sum of HK$50 billion, the public expects that it will truly reflect the government's values and its governing philosophy: to benefit the underprivileged and the needy, not the better-off.

However, those who suffer from chronic diseases will only be able to claim full compensation in the fourth year after they enrol for the scheme. In the first year, they are not entitled to reimbursement of the bills for treatment of pre-existing diseases. Ironically, many chronic patients are not quite certain to survive the four-year restriction period. Most of them are poor and unable to pay insurance premiums. With whatever little money they have, these people will rather buy medicines than pay premiums.

The standard plan will only provide basic coverage for packaged services at private hospitals, such as minor surgical procedures and accommodation in third-class wards but excluding clinical visits. Those who look for coverage for more expensive care or treatment have to dig deeper into their pockets. What makes the scheme all the more unattractive is the devil in the detail. It was reported that the premiums do not include the commission for insurers, which may charge as high as 50 percent of the premiums. The government still needs to work out a reasonable and acceptable amount with the insurance sector. But will insurers succumb to the government's demand? I would say the odds are against us. Ordinary people who under the scheme pay the same amounts as market prices for a policy that only covers basic medical care would ask, "why bother?"

Even the Hong Kong Medical Association is opposed to the idea. In its view, the proposal could be unfair to the middle class. However, there can also be a counter-argument as to why the middle-class, who can afford private healthcare, should be subsidized in the first place.

The chief problem is the lack of regulations on insurance premiums, coverages as well as private healthcare fees which can spiral to a staggering and unreasonable level. Medical insurance plans usually impose certain conditions for some illness claims and policy holders will have to pay much higher premiums for critical illness. The popular perception is that it is difficult to make claims unless you are nearing death.

On the other hand, private hospitals can also take advantage by further marking up their fees. At the end of the day, the HK$50 billion may end up becoming subsidies for profit-oriented private hospitals and insurers. And if that really happens, the scheme will then defeat its chief purpose of helping the needy and society at large.

It's time for deep introspection. The government must rethink and redevise a plan to make the best utilization of the HK$50-billion fund with a view to improving our public health system and promoting primary medical care.

The author is a current affairs commentator.

(HK Edition 09/30/2010 page11)