Initial Position Paper of the Council of
the Hong Kong Ac ademy of Medicine
on Health Care Reform
Background
The last health care policy paper was published in 1974. During
this quarter of a century, much has changed in the development of
medical sciences, the demographic pattern of the population, the
increase in demand of patients, and the political and socio -economic
aspects of the society. A new policy direction is, therefore, wanting to
meet the health care aspirations of this developed metropolis.
In 1999, Government engaged an expert team from Harvard to
study Hong Kong’s health care system. A report was launched. W hilst
many of the facts and suggestions are questionable, 2 salient points
emerged:
The quality of Hong Kong doctors are highly va ried.

The Hong Kong health care
mechanism, is unsustainable.
system,
with
its
current
funding
It is on this report and after extensive consultation that
Government produced this “Lifelong Investment in Health –
Consultation Document on Health Care Refo rm” on possible way
forward.
The Consultation Document
The document covers 3 main areas of possible reforms: 


on the Health Care Delivery System
on the System of Quality Assurance
on Financing Health Care Service
Regrettably, the document is very m uch on concepts. It is a skeleton
with little flesh. W hether this is intentional to attract suggestions for
details is for Government to answer, suffice it to say that it is an
important document that we must respond, as it will point the way
forward for health care into the 21 s t Century.
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Furthermore, we must respond positively with constructive
criticisms, suggestions and better alternatives; for “killing” this
document will set back any health care reengineering for at least five
years.
How should the Academy respond ?
As the highest standard -setting medical professional body
established by statute, it is our duty to respond and to respond early so
as to guide and stimulate the profession and the public to navigate
through the document diligently.
After in-depth discussion, the Council of the Hong Kong Academy
of Medicine has agreed on the following position. This paper is an
initial position paper to collect the views of its Fellows and members of
the medical profession with a view of formulating a more collective view
of the profession in general. This paper hopefully will help the public to
understand the profession’s views on the document in particular the
quest for an even better standard of medical practice.
Basing on these, we have come to the following position: -
PROPOSED REFORM ON HE ALTH CARE DELIVERY SYSTEM
(I) General
Areas w e Agree in Principle

Strengthening Primary Health Care

Empowering the Department of Health to propose and promote
health targets

Re-organising Primary Medic al Care through providing in the
public sector family medicine practice, and improvement of such
practice in the private sector.

Developing a Community Based Integrated Health Care Service
Model, and adopting a multi -disciplinary and multi -sectoral
approach.

HA taking over the running of General Out -Patient Clinics
We agree this in principle that it w ill provide a seamless
health care. Yet, it must not be allowed to stifle the w orkload
of the private sector. This scheme ought to be reviewed after
having gained some initial w orking experience.
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Areas w e need More Details

The funding basis of training programmes in the future.
Areas w e Propose

A policy on the funding to improve standard of the whole
spectrum of medical care and not just of Primary Medi cal Care.

Utilisation and placement of trainees in the private sector for
training purpose, and the availability of funds.

A defined role for the Academy and its Colleges in coordinating
training and matching training with service provision in the HA.

Better coordination between the Academy and the Government,
HA and the universities so as to strike a proper balance in the
training of “general specialists” and “supra -specialists”, as well as
to address the possible problem of inadequate clinical cases for
training purpose versus too many trainees in some specialities.
(II) Traditional Chinese Medicine (TCM)
We w ould disagree that mone y for public TCM service in future
should come from existing budget for public sector as this w ill
further cut dow n mone y for an already over -stretched service,
thus denigrating standards.
(III) Private and Public Interface
W e agree that this is vital. Yet, a better interface can only be
achieved if Government is willing to come forward with the role of
heavily subs idised public health care – for what and for whom?
(IV) Dental Care
W e are disappointed in the complete lack of new initiative in the
Consultation Document. W ith little facilities for provision of
specialist training in the public sector, standard will not improve.
W e propose that Government should consider providing dental care
for more selected population at least for training purpose.
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PROPOSED REFORM ON QUALITY ASSURANCE
(I) Requirement of Compulsory Continuing Medical Education
(CME)
W e agree whole -heartedly but would like to see the Medical and
Dental Councils move to compulsory CME for registration of medical
and dental practitioners once the CME programmes are well
organised.
(II) Setting up of a Complaint Office
W e agree in principle in so far as this Office acts to investigate
areas relating to patient care, assist complainant and mediate
between complainant and complainee.
Yet, it must not duplicate the functions of the relevant
professional councils, and professional autonomy must not be
denigrated. In short, the ultimate enquiry and disciplinar y
pow ers must lie in the relevant professional councils.
(III) The role of the Academy, as a statutory body in Quality
Assurance in medical standard and practice, must be recognised
and assured.
Areas w e Propose

Assure the Medical and Dental Councils to be user -friendly.

Improve transparency of the Medical and Dental Councils by
adding more “lay members”.

As a statutory body to vet medical standards, the Academy
should have more in put in the Medical and Dental Councils by
increasing the number of Academy representatives in these
councils.

The Academy to be empowered to coordinate CME programmes
also for non-specialists.

Government must w ork w ith the profession to improve
relation betw een patients and service providers to prevent
emergence of “over -demanding patients” and consequential
“defensive medical practice”.
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PROPOSED REFORM ON FINANCING OPTIONS
Funding of health care service is closely related to “standards”.
Areas w e Agree in Principle

The principle of Target Subsidy
Areas w e need More Details

W ho and W hat are the “Targets”?

W hat happen to those conditions or patients falling outside the
“Targets – excluding from public medical service? / Full cost
payment in public institutions?

Health Protection Accounts (HPA)

W ill the insurance industry offer policies for people of 65 and
above? If so, will the premium be affordable by most?

The HP A, as described, w ill only provide reimbursement at
public charge rate, ie curre ntl y $68 per bed per day. How
can it ease the grossl y imbalance in service demand
betw een the public and private sectors?
Areas w e Propose

Government should define the role of heavily subsidised Public
Health Care.

Those outside the “ambit” will be ma de to realise that they have
to pay for medical service, be it in private or public institutions.

Government should have concrete measures to encourage the
public to take up private medical insurance, or do their own
savings, or others.

Any workable fina ncing option must re -balance the current gross
imbalance in service demand between the public and private
sectors.
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