Medical ReformMedical ReformCourse Code : POLS7050Course Code : POLS7050Course Name : Public AdministrationCourse Name : Public AdministrationSemesterSemester : Autumn 2009: Autumn 2009

Prepared by:Prepared by:Rex Chan & Veronica LauRex Chan & Veronica Lau

Why we need a Medical Why we need a Medical Reform?Reform?

Problems has been Problems has been inducedinduced

• Foreseeable non-sustainable healthcare system

• Long waiting time for public medical services

• Limited alternative choice for medical services

• Insufficient safety net

Problem 1: Foreseeable non-Problem 1: Foreseeable non-sustainable healthcare systemsustainable healthcare systemEvidence 1

“HONG KONG'S DOMESTIC HEALTH SPENDING”

Source from Hong Kong Medical Journal

Problem 2: Long waiting time Problem 2: Long waiting time for public medical servicesfor public medical services

Evidence 2Waiting time for first appointment for patients triaged into the "routine" category at Ambulatory Care Centre, TMH

Problem 3: Limited alternative Problem 3: Limited alternative choice for medical services choice for medical services

• Examples- Chinese medical services

Evidence: only 12 clinic offering such services, but none of them was established in hospital

- natural medical treatment

Problem 4: Insufficient safety Problem 4: Insufficient safety net net

• cannot afford the fee in private hospitals• rely on public services• growth in service demand deteriorate service

quality• patients will not be secured

Factors inducing the problemsFactors inducing the problems

1. Rapidly ageing population2. Increasing occurrence of lifestyle-related

diseases3. Rising medical costs brought about by

advances in medical technology and expectations for improved quality of care

4. Insufficient emphasis on primary care5. Over-reliance on hospital services6. Significant public-private imbalance7. limited continuity and integration of care

Existing policy to deal Existing policy to deal with the problemswith the problems

Increase Funding!!!

!

Advantages of increasing Advantages of increasing medical fundingmedical funding

• Cope with with the rising medical costs

• Enhance the medical education for professionals

• Promote general medical knowledge among the public

• subsidy the hospitals for better equipment

Disadvantages of Disadvantages of increasing medical fundingincreasing medical funding

• Does not solve the existing problems comprehensively

• Not sustainable• Limited by simple taxation and low

medical charges• over-reliance on public hospital

services will be worsen

SolutionSolution

Six Supplementary Six Supplementary Financing ProposalsFinancing Proposals

Supplementary Financing Supplementary Financing ProposalsProposals

1. Social Health Insurance (SHI)2. Increasing the user fees--Out-of-pocket

payments3. Medical Savings Accounts (MSA)4. Voluntary Private Health Insurance (VHI)5. Mandatory Private Health Insurance (MHI)6. Personal Healthcare Reserve (PHR)

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

Selecting the best solutionSelecting the best solution

1. Out-of-pocket payments (user fees)

- a simple, direct and efficient means to provide additional resources

- Encourage using the public healthcare services more judiciously

- more self-responsibility for people’ s own health- help in coping with increasing healthcare needs

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

Selecting the best solutionSelecting the best solution

2. Voluntary Private Health Insurance (VHI)

- offer the voluntary choice to choose their own insurance products

- like insurance exclude pre-existing conditions- not guarantee renewal of policies- not provide any assurance on future premium- Not highly likely be an effective solution

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

Selecting the best solutionSelecting the best solution

3. Personal Healthcare Reserve (PHR)

- Deposit part of income into a personal account- For mandatory regulated medical insurance- For savings to invest & meet healthcare expenses,

e.g. insurance premium- However, a two-tier service structure

- Unlikely be an effective solution

Under PHR First-class healthcare services

Not under PHR Second-class healthcare services

Selecting the best solutionSelecting the best solution

Out-of-pocket(user fee) will have the most widespread effect on meeting the increasing

needs of healthcare

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

BenefitsBenefits

1. a simple, direct and efficient means2. create healthy competition between

the public and private sectors to solve the public-private imbalance

3. encourage using the public healthcare services more judiciously

4. be more self-responsibility for people’ s own health

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

BenefitsBenefits

5. ensure the medical services would not be overused

As a result, fair for the users to

take up more responsibility for their own healthcare expenses

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

CostsCosts1. lead to rising medical costs in private

market2. pose great burden to the elderly, patients

with chronic illness, low-income families and other underprivileged groups

3. no risk-pooling effect, burden fall on the people who fell ill

4. could not afford the heavy medical fee e.g. poor elderly, chronic patients and low-income families

Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)

ImplementationImplementation

• Food and Health Bureau (FHB) the Panel on Health Services of the legislative Council(Lego) Committee

Public Government

Professional• Create a fair atmosphere for different levels to

express their opinions• set on a personal or family-based limit on

medical expenses to moderate the effect of fee increase

ImplementationImplementation

• The Secretary for Food and Health Dr. York Chow Yat-ngok

Political StrategyPolitical Strategy• Mr. Lee Cheuk Yan concerns user fee

pose great burden• representative of public are not allow

to get equal treatment• because unequal proportion• a phenomenon : all the decisions

might be made by Government department, but not the public

• E.g. high range rising medical costs in private healthcare market

Political StrategyPolitical Strategy

Solution• different working scopes equal

proportion• representative of underprivileged can

participate in the decision-making process • set control on a personal or family-based

limit on medical expenses to moderate the effect of fee increase

• create an advisory board to review the decisions made by the committee

Assessing the impactAssessing the impact

Q & A