The Position Paper of
the Hong Kong Ac ademy of Medicine
in conjunction w ith all the 15 Academy Colleges
tow ards the Health Care Reform Consultation Document
PRE AMBLE
The Hong Kong Academy of Medicine is of the opinion that a
total health care reform is in dire need to face the challenges of the
next decade and to meet the aspirations of the society. On these
bases, we support the principles and directions in the Consultation
Document, viz the need to revamp the health care delivery structure;
the need to improve the quality assurance system and thus to
increase the accountability of the health care providers; and the
need to revisit the public health care financing options.
The Academy is the highest standard setting and vetting body
established by statute for the dental and medical professions. Our
response and proposals to health care reform will thus be based
mainly on standard maintenance and improvement.
W hilst we are somewhat disappointed that very little details are
offered in the Consultatio n Document to effect a meaningful
consultation, we are conscious of our obligation as health care
providers not only to criticize what are not workable, not only to
support areas that are sound albeit in principle; but to make
constructive proposals to add “meat” to the “skeleton ”.
We look forward to the Health and Welfare Bureau to take on
board our deliberation and our suggestions in the implementation of
any health care reform.
HOW DID WE CONSULT?
At a very early stage of the launching of the Consultation
Document, the Council of the Academy with the kind help of officials
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from the Health and Welfare Bureau deliberated on the Document
and produced an initial position paper.
That paper forms the basis of a wide consultation to the different
Academy Colleges and Academy Fellows. This position paper was
also circulated to various medical bodies. The paper was also put on
the Academy’s website.
Up to 15 March 2001, the Academy has received feedbacks from
6 Academy Colleges and 15 individuals (mainl y Fellows). A forum
for Fellows was also held on 7 March.
Their responses have formed part of this paper and are attached
in full in the compendium.
THE DELIBERATION
THE HE ALTH CARE DELIVERY SYSTEM
Primary Health Care
We have no reservation in s upporting the promotion of primary
health care and the direction to train more primary health care
Family Physicians. To this end, we propose that the hospital based
part of training for the trainees in the Hospital Authority (HA) should
be more comprehensive including sessions in radiology and
radiation oncology. Furthermore, funding of Family Physician
training outside the hospitals should come from the Government.
W hilst training and improvement in primary health care is to be
recommended, the Academy is of the opinion that training of other
specialties should not be ignored. Similarly, adequate funding must
be forthcoming from Government to ensure that training can be
based on College -approved units in private institutions .
There is a lack of emphas is on Preventive Medicine in the
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Consultation Document. The Academy believes that promotion of
health is the key to the promulgation of a healthy society and a
means to minimize hospital admission. Each health care
professional should assume the role to pr ovide advice on preventive
medicine, whether they be in the public or private sector.
Role of the Academy
Every trainee on admission to a training programme of any
specialty should have a mapped -out course. In this aspect, the
Academy is of the opinio n that it has a responsibility and role in
working with the HA, Department of Health and other organizations
involved in training in matching trainees to the different training
units.
Similarly, we urge the Government to work with the Academy to
determine the manpower needs for different specialties and to
establish a policy of the need for “Generalist -Specialists” versus
“Super-Specialists ” in the future.
General Out Patient Clinics
The principle of the HA taking over the General Out Patient
Departments (GOPDs) as a means to minimize “fragmentation” of
health care services should be considered.
The Academy believes that the GOPDs under the HA should
mainly act as training centres for Family Physicians. Also, primary
medical care should best be pr ovided in the private setting as it is
affordable to most and would thus cut down our public health care
budget. Needless to say, at the same time, a simple system must be
in place, eg coupon system, to ensure that the poor and needy
would not be deprived of care.
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Traditional Chinese Medicine
Some Colleges are of the opinion that as Traditional Chinese
Medicine (TCM) is set to form part of the health care system, any
pilot project of including it in the public health care service should
be in the realm of primary health care. Many in the Academy share
the same view.
We stress that such endeavour should be undertaken by
Government only on a new budget as further stretching of the
already over-stretched public health care budget is a recipe for
lowering standards.
Dental Care
We are disappointed that no new views are expressed in the
Consultation Document in relation to oral health.
The Academy is of the view that Government must reassess the
public sector ’s role in oral care (both preventive a nd curative). We
feel that public oral service should be provided for groups with
special needs, not only to offer them care, but also to be an avenue
for training of specialists in the field of dentistry.
IMPROVEMENTS TO QUALITY ASSURANCE
Continuing Medical Education and Quality Assurance
The Academy is in full support of the need for Continuing
Medical Education (CME). We urge the Government to ensure that
CME be a criteria for renewal of practicing certificates of all medical
and dental practitione rs. In this aspect, the Academy will urge the
two professions to declare on their own the need for mandatory CME
instead of waiting for the public to force it upon us.
The Academy has come round one good cycle of CME for
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specialists. We will take stock o f our experience and channel the
future CME programmes towards Continuous Professional
Development (CPD) and to assure the public that assessment by the
Academy is the yardstick of high standard.
The Academy is of the opinion that we owe it to the rest o f the
medical and dental profession to organize CME for them. On this
basis, the Academy will set up a special committee to look into and
to design with the different Colleges special CME programmes and
other programmes for non -Fellows and that we will pro vide the
mechanism for recording their attendance and participation.
It is felt that many non -Fellows are desirous of advanced
learning. Hitherto, such opportunities are wanting. The Academy
takes it as our duty to arrange remedial training programmes
through the different Colleges for those with such ambitions, so as
to assure that they could, given time, be awarded Fellowship of
different Colleges and, if criteria are met, to be Fellows of the
Academy.
Structured quality assurance for health care is c oming and is
here to stay. The Academy, as a standard setting body, must take an
active role in working out the details with the professions and advise
Government the way to bring it forward. Meanwhile, the Academy is
in dialogue with institutions specialized in quality assurance to see
how quality assurance can be introduced into the different medical
and dental disciplines.
Medical Registration Ordinance
and Dentists Registration Ordinance
The Academy notes that loopholes exist in these two
Ordinances that could make a mockery out of the Academy as a
standard setting and vetting body for specialists. To this end, we
urge the Government to expedite any necessary amendments to
these two principal ordinances so that the system to attain high
standards cannot be abused.
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It is regrettable that as a standard setting and vetting body, the
Academy has a minimal representation in the Medical Council and
none in the Dental Council. The policy must be quickly determined,
and the corresponding provisions amende d without delay.
Monitoring S ystem
The Academy believes that a good monitoring system is
essential not only to assure the public of our high standards, but
also to ensure that the dental and medical professionals exhibit
their accountability. W hateve r monitoring system however must
never be, nor seen to be, eroding into professional autonomy.
We are of the opinion that the Medical and Dental Councils must
be the core monitoring and disciplinary bodies of the corresponding
professions. Yet, there are obvious areas for improvement notably
the lack of investigatory power.
The proposal to set up a Complaint Office under the Department
of Health could be considered. The membership and the role of this
body must be properly defined. It would be counter productive if the
whole body consists of members from the Department of Health only.
Instead, it should have a wide sectorial representation including
that of the lay public. Similarly, this body should only take on the
function of a mediator and a primary investigator. Any issues
concerning professional misconduct must be referred back to the
relevant professional disciplinary bodies.
OPTIONS FOR HEALTH CARE FINANCING
Standards are very much associated with availability of funds.
The current situation of public health care where a limited budget is
providing for an unlimited need and demand has resulted in a
markedly overloaded public sector and very “lean” private sector.
The end result, understandably, will lead to progressive erosion of
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standards in both sectors. W hatever funding options Government
proposed must re -balance this imbalance to assure that standards
could not only be maintained but improved.
The concept of “target subsidy” is an acceptable one. In no way
should those devoid of means be facing second -rate health care,
nor should public medical service provide only second rate medical
care. Yet, there must be a device to ensure that those who “can pay
should pay” so that those who cannot pay will not have to suffer the
forever lengthening queues in the public sector.
The Academy is of the opinion that the Health Protection
Account may not be adequate to provide the necessary incentive or
funding to effect a public/private rebalance. We would like to see
more detailed figures of such and await Government to come out
with “new products ” in terms of insurance / savings after discussion
with the insurance industry.
We fully endorse the principle of “the cost of health care to be a
shared responsibility between the users and the public purse ” as
highlighted in the Chief Executive ’s first Policy Address. We urge
the Government to abide by and pursue on this principle in any
funding options in the future.
CONCLUSION
The Academy would like earnestly to see a reform. The principle
and directions set out in the Consultation Document should be
supported. We hope Government will seriously study each
suggestion in detail, come out with workable options and indepth
figures for the profession and the public to give their final input.
The Academy has discussed the Document in a positive way. We
have highlighted areas where, in our mind, fallacies exist. We have
made harsh criticisms. At the same time, we have proposed
constructive suggestions for the way forward.
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