The existing two-pillar healthcare system in Hong Kong should be
changed to a three-pillar structure that allows patients more
choices of better services, a civilian policy think-tank said
yesterday.
The Bauhinia Foundation Research Centre, one of the territory's
most prominent think-tanks, also suggested individual medical
savings accounts to help the elderly in their post-retirement life
from the age of 65.
An overhaul of the current public healthcare system is
necessary, said the Centre's chairman Norman Chan, because people
over-rely on remedy and neglect prevention. As a result, there
emerges an imbalance between the public and private healthcare
systems because public services are heavily subsidized - up to 95
percent of the cost.
In addition, the aging population, aspirations for new
treatments and medicines, and low tax make it very difficult for
public finance to sustain the burden in the long run.
Quoting government figures, Chan said public healthcare spending
amounted to $39.1 billion in 2001/02, equivalent to 3.1 percent of
GDP and 14.5 percent of government expenditure respectively. If the
pattern remains unchanged, the ratio to GDP and government
expenditure will increase to 4.3 percent and 21.5 percent
respectively in 2020 and 5.3 percent and 26.5 percent respectively
in 2030.
"If only healthcare accounts for more than one quarter of
government expenditure, what will happen to education, welfare,
security?" he said.
It has been proposed that the public and private healthcare
systems will remain, with the first pillar (public healthcare
safety net) continuing to be heavily subsidized, while the users
pay for the third pillar (private healthcare) services. But there
comes a middle pillar of enhanced services including extended
primary care services, long-term care and privately purchased
medical items and medicines, with the patients receiving up to 50
percent of the cost of services on average. To facilitate good
interaction between the three pillars, portable electronic medical
records have been recommended.
On the idea of medical savings accounts, Chan said this would
encourage people to save money in return for better healthcare
services in their later years. The amount of contribution shall be
3 percent - 5 percent, he suggested, because a lower ratio will not
yield much money yet 5 percent - will be a burden on the
people.
All people have been encouraged to open medical savings accounts
and those at work are required to contribute, and the account
holder can buy healthcare services for their family members too.
Employers are welcome to contribute for their staff but it is not a
mandatory requirement. People under 65 can take money out of the
account if necessary.
"Given these are savings accounts, people under 65 should not
use the money if not for serious illness when the balance is say,
below HK$30,000," he said.
As for the money received, he suggested the money be invested in
low-risk portfolios to yield a stable return. On the administration
side, it has been suggested that Mandatory Provident Fund Schemes
Authority be used to collect the contributions, but a separate
organization shall be set up to approve and release payments.
(China Daily June 7, 2007)