Progressive and broad-ranging reform of Hong Kong's health care system is required if the public is to be offered greater choice and better services in the future. It needs to include much-reduced reliance on public funding and increased private sector involvement (including further private insurance).

Back in December 2000, the Hong Kong SAR Government published a consultation document setting out its own vision, policy objectives, guiding values and principles for reforming Hong Kong's health care system. Entitled "Lifelong Investment in Health," the consultation document proposed some major strategic changes including reforms to the health care delivery system, improvements in the quality of care and service, and future financing options.

After a three-month public consultation period, the overall findings were reported to the Legislative Council's Health Services Panel in June 2001. Health care delivery and quality assurance improvements can justifiably be left in the hands of the health care professionals, but the system's overall structure, its financing and the role of the public and private sectors in it should have wider input.

The ultimate goals in this improvement must be to (a) offer greater patient choice and (b) reduce the reliance on public sector financing, encouraging those who can afford to pay to contribute more. Achieving these requires a focus on three issues -- (a) a review of hospital and other charges (especially the discrepancy between the public and private sectors), (b) the further development of private sector provision of services and (c) the introduction of a system of private insurance to cover costs and (d) the promotion of each citizen's responsibility for his own health needs.

The Chamber believes that these issues should be urgently addressed, especially given the pressures on the dominant provider of services, the public health sector, and the broader concerns about levels of public spending and continuing Budget deficits. The Budget problem is particularly pressing. This fiscal year (2002-03), for example, an estimated $32.45 billion will be spent on the provision of health services, or 14.8 per cent of total recurrent spending, making it the second largest spending item after education. Moreover, annual spending continues to increase and has increased more than three-fold over the past 10 years.

As the Secretary for Health and Welfare, Dr E K Yeoh, has recognised any new system can only be viable if there is shared responsibility between the government and the individual, with those who can afford it contributing to maintaining their own good health.

At the same time, those less fortunate should still be able to rely on a (publicly subsidised) system that provides a quality health service at a cost the community can afford.

Hong Kong currently has a public health care system that is mostly reliant on tax revenues (with some 98 per cent of health care services being funded in this way) and has the advantage of simplicity and reasonable efficiency. But this almost exclusive funding directly from the public purse is unique in today's world and there are alternatives. Singapore, for example, relies on a compulsory medical insurance scheme for individuals, while the United States is predominantly market-oriented and Taiwan is social insurance based.

There is little doubt that Hong Kong's present system is accessible, affordable and equitable, but in the medium-to-longer term continued total reliance on government funding from our low tax revenues is simply not viable. First, as has been pointed out above, are the pressures on the Government Budget and the continued rise in public health care costs to the point where they now account for 14.8 per cent of recurrent government spending (in fiscal year 2002-03).

Second, is the continued ageing of the population (reinforced in the latest government population estimates government through to 2031), that will result in a rising prevalence of diseases associated with age and thus increased health care needs. Third, technological advances in the health care field are likely to continue to increase the demand for, and cost of, health care.

The time has come in Hong Kong to promote individual responsibility for health care through insurance schemes for those who can afford them and the development of the private sector as an alternative to public care across the community. As part of this process, health care charges need to be rationalised and made more realistic (especially between the public and private sectors), while efforts to contain costs to keep basic health care services affordable must be ongoing.