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About HKCFP > President’s Message

March 2018

Back in December 2017, I attended a consultation session on the financial budget review chaired by the Financial Secretary Paul Chan Mo-po. I was really keen to find out what the new budget was. Last week, under a huge fiscal surplus, Mr. Chan announced expenditure on public healthcare services will be increased by 13.3% to HK$71.2 billion in 2018-19, i.e. HK$9,600 per resident. An additional recurrent funding of HK$6 billion will be allocated to Hospital Authority and an extra HK$200 million will be funded to enhance the healthcare professional training.

Here comes the question: “How much money will be spent on primary healthcare?” I am sure Mr. Paul Chan has no answer!


I am a nostalgic person and recently Prof. Lam Tai Pong has filled my appetite by lending me his copy of “Health for All, The Way Ahead, Report of the Working Party on Primary Health Care” published in December 1990. The Working Party was chaired by the highly respectable Prof. Rosie TT Young and two of our ex-Presidents, Dr. Peter CY Lee and Dr. Natalis CL Yuen were involved. It was no secret that the person who drafted this report was a young Administrative Officer called Carrie Lam! I will highlight a few main points mentioned in this report and I have to award the title “Best Fortune Teller” to Mrs. Carrie Lam.

 

The definition of Primary Health Care back in 1990: Primary Health Care is essential health care made universally accessible to individuals and families in the community at a cost that the community and country can afford. It forms an integral part both of the country’s health system of which it is the nucleus and of the overall social and economic development of the community. However, Hong Kong always shifts the nucleus from primary healthcare to the more expensive hospital care. It is unnoticeable when there is a budget surplus. What happens when there is a budget deficit? This unsustainable system will collapse!

The second point mentioned was the considerable variation in the quality of service and standards of care in the private sector of primary medical care. There was a shortage of qualified and well trained primary care doctors or family physicians. This is still applied in 2018. Unless the standards of practice in the private sector were improved, it would not be wise to consider transferring the 15% public sector provision to the private sector. What happens today is the public sector is swallowing up to 30% of the primary care consultations and its share of cake is getting bigger and bigger year after year.

The third point was training doctors in Family Medicine. The report has rightly pointed out Family Physicians are long-term investment. Governments in other parts of the world are funding training in Family Medicine because they realize Family Physicians deliver the most cost-effective care to the patients and is more relevant when countries are facing rapidly rising costs of financing health services. Hong Kong is experiencing rising health cost but the Hospital Authority as the sole training provider is allocating less than 10% of medical graduates to train in Family Medicine. Maybe Dr. Leung Pak Yin is wiser than Mrs. Carrie Lam and does exactly the opposite. Our dear Dr. Donald Li always has the “Purchaser Provider Split” delivery model in mind. One of the main aims of PPS is to create competition between providers which lead to improvements in service delivery, greater efficiency and better quality of training to our future generation. In Hong Kong, Hospital Authority is both the purchaser and provider of postgraduate medical training. What a monopoly!

Finally, it comes to the structure for the delivery of Health Services. The Authority should have two separate divisions, i.e. a Hospital division and a Primary Health Care division, to take account of the different approaches and orientation required in managing hospital and primary health care services and to ensure parallel and balanced development of both primary and secondary/ tertiary care. Now we only have a “supra” Hospital Authority! The best sentence from this report: “Planning for a Primary Health Care Authority should proceed with concurrent improvement to our primary health care services which is long overdue.” Carrie Lam you are a smart cookie with a crystal ball.

Dr. Angus MW CHAN

President



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