Ageing Hong Kong needs a more accountable public healthcare system

Since the establishment of the Hospital Authority more than three decades ago, Hong Kong residents have, rightfully, enjoyed health services that are among the most affordable globally. Health outcomes – including life expectancy and mortality rates for acute illnesses – rank among the best in the world, often outpacing those in many developed nations. The Hospital Authority was founded on the principle that no one should be denied adequate medical treatment through lack of means, a noble mission that must be upheld. Rising healthcare costs and a budget deficit, however, are threatening this assertion. If we had not witnessed these challenges, the cost of hospital visits would not need to be revised today Healthcare expenditure has been spiralling upwards globally over the past 20 years, underscoring the need for reform. In the United States, for instance, this led to then-president Barack Obama’s Affordable Care Act in 2010, which aimed to expand health coverage while reducing waste and inefficiencies in health services. By pushing for a capitation payment system – with fixed fees for the entire coverage agreed upon in advance – instead of volume-based payments, the law forced healthcare providers to produce the best possible health outcomes without unnecessary expenditure, allowing successful institutions to retain excess funds. In Hong Kong, government funding constitutes over 90 per cent of the Hospital Authority’s income, placing an untenable burden on taxpayers. For eight years, the authority shied away from adjusting hospital fees due to a lack of political will. While the Hospital Authority is not required to meet economic targets, this reluctance was unacceptable given that efficiency goals have languished at every level of the organisation. As health expenditures surge, it is irresponsible to ignore the ticking time bomb. And subventions – grants from the government – should not be seen as unlimited. Patients will always ask for more health services, yet they are shielded from the costs. For too long, overlooking the elephant in the room to prevent political fallout seems to have been the solution. The Health Bureau stepping up to reform the fee schedule of public hospitals is commendable, not least because directing resources towards patients crippled by catastrophic illness is the essence of hospitals ab initio. In late March, the Hospital Authority announced a series of necessary fee increases, requiring patients to pay more out of their own pockets. In concrete terms, most visits will cost an additional HK$100-200 (US$13-26) from next year. If people only sought hospital care for catastrophic illnesses as needed, their annual healthcare expenses as a percentage of total spending would remain stable. Under the new fee structure, visits to accident and emergency (A&E) departments for critical and emergency cases – such as for strokes and heart attacks – will be free, down from a charge of HK$180. The current long A&E waiting times are often a reflection of the number of patients who should be accessing care instead at community outpatient clinics. Emergency physicians, ambulances and emergency clinics are costly. When A&E departments end up treating more non-urgent patients than those with genuine emergencies, it drains resources away from those facing life-threatening situations and is a critical misuse of healthcare resources. Some patients accurately express frustration with the lack of healthcare options at night, while others may be uncertain about whether their symptoms signify a trivial issue or serious health threat. The situation demands immediate action from the Primary Healthcare Commission to strengthen the community health system and promote health literacy. The implementation of the Primary Healthcare Blueprint is long overdue. The integration of community pharmacies into the system and the transformation of health-seeking behaviours are essential steps that must be executed decisively. In introducing district health centres, Hong Kong should learn from successful hub-and-spoke healthcare models, such as in New Zealand. The value of district health centres remains uncertain, particularly due to the low use rates at some facilities. Administrators must ensure district health centres focus on chronic illness management, fostering relationships with patients rather than merely following a “recruit, screen and refer” mentality. Henceforth, both public hospitals and district health centres must allocate resources based on health outcomes. This requires stronger governance of health finance and a strategic approach to using taxpayer funds. The objective of district health centres should unequivocally be to enhance patient care and health outcomes in the community. It is time for action and accountability in our healthcare system. Additionally, disbursements must consider the ranking of these metrics alongside other crucial health outcomes. It is vital that we engage experts to determine which specific outcomes are most effective in driving healthy behaviour. As Hong Kong’s population ages, an increase in health expenditure is expected. We must rigorously evaluate the efficiency of our resource allocation based on population health outcomes to meet the needs of the community effectively.

Ageing Hong Kong needs a more accountable public healthcare system

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}While revising the public hospital fee structure was a much-needed move, more can be done to improve efficiency and resource allocation

While revising the public hospital fee structure was a much-needed move, more can be done to improve efficiency and resource allocation