Healthcare is not only a descriptive term of concept but also an action of direct relevance on the lives of all homo sapiens, sans race, religion or political border. The question – Whose health? Who cares? - is profoundly complex. It inseparably mixes economic forces with cultural traditions; and brings to conflict between individual freedom and collective societal decisions. Most countries are going through their perpetual healthcare “reform” for the past many years. Re-thinking in search for a solution is very much on the mind of the citizens of Hong Kong. Here we examine the direction and the future of healthcare in Hong Kong.

Several important factors assert influence on any decision making. These include the phenomenal speed in the technological advances in Medicine. What can be done now or in the near future are the materials of science fiction stories. Yet the cost-effectiveness, the ethical tolerance of many treatments, devices and procedures are still to be determined. There has been an explosion of information with a magnitude exceeding the handling capacity of the human mind. The expectations from the public on the medical profession continue to mount insatiably. Doctor-patient relationship has also metamorphosed from a paternalistic and authoritarian mode to a complex partnership mode with much of the “informed choices” presented, discussed and understood in different ways. Finally, the practice of Medicine has almost fragmented to a “practice by committees” with multiple specialties, sub-specialties and sub-subspecialties involved in the care of a single patient creating conflicts in priority setting and incurring escalating cost. There is a total lack of a central unifying clear and caring voice to comfort the patient and build that sense of confidence and trust —which is the all important in patient care.

There are several models as to how to fund a healthcare service. For the equalitarian, healthcare provided by the State is tantamount to an entitlement. In contrast, the libertarian regards that to be a self-reliant responsibility. The utilitarian shares resources with other competing priorities; and the pragmatist does what is doable along the path of least resistance.

Family Medicine must rise to the call, step up to the plate and play the role of the hero in Hong Kong’s healthcare reform. We must educate both the public and the medical profession, and bring our disparate and fragmented way of providing care to focus. Family Medicine must position itself to be the foundation of healthcare delivery and healthcare reform in Hong Kong. It must foster a better doctor-patient relationship with the sick; and doctor-doctor relationship within the medical profession. To do so, the College is in a unique position to educate and to generate primary data on healthcare needs and outcomes. The College is also well situated to co-ordinate with academic institutions, government and non-government institutions. This would result in original scientific information from which will mould our own healthcare policy. This would be, in this diverse and metastable milieu, a guiding light for our social transformation. With that vision in mind, the direction and future of healthcare in Hong Kong is positive and bright.

*This paper was presented at the 23rd Dr Sun Yat Sen Oration on 3 June, 2012