Reducing healthcare subsidies without significantly increasing funding for primary care could exacerbate health inequalities.

Hong Kong’s proposal to decrease public healthcare subsidies from 97 percent is under consideration.
90 percent by 2030
marks a considerable change in one of the globe’s most subsidized systems. Although the Health Bureau presents this as an essential adjustment, the reform requires thorough scrutiny due to its extensive repercussions on healthcare equality and accessibility.

The primary worry at hand is that
the increased costs
may discourage patients from pursuing prompt medical care. Healthcare choices often lack complete data — patients might find it challenging to differentiate between symptoms that demand urgent consideration and those that can be addressed later.

By imposing financial obstacles, we run the risk of converting current “non-essential” emergency room visits into more complicated and expensive hospitalizations down the line. This issue is especially pertinent for older individuals; their ailments such as urinary tract infections frequently manifest through signs like disorientation or restlessness—symptoms that can be mistakenly categorized as not urgent.

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Officials
argue
that some patients
exploit
Accidents and emergencies (A&E) departments are being used for treatments that should ideally be managed elsewhere, addressing only the symptoms rather than tackling the root cause. The real issue highlighted here is the scarcity of readily available primary care options in Hong Kong.

Despite the government’s
2022 Primary Care Blueprint
Promising improvements for district health centers and enhanced coordination have advanced very slowly. According to the plan, under 20 percent of public healthcare funds were allocated to primary care, whereas more than 80 percent went toward specialized and hospital services, leading to a setup where many patients end up being channeled into hospitals.

CEO John Lee Ka-chiu’s speech from last year
acknowledged
The necessity to reinforce public healthcare exists, yet the reforms seem to tackle symptoms instead of addressing root issues.

Supporters of decreasing subsidies argue that even with a 90% subsidy rate, Hong Kong still offers more generous support than many other advanced healthcare systems such as those found in Singapore or Britain. However, this comparison may fail to account for significant disparities in underlying healthcare infrastructures.

The public insurance structures of both Singapore and the United Kingdom effectively distribute risks and expenses among the general populace. In Singapore, MediSave, MediShield Life, and MediFund form a comprehensive support system that complements individual accountability. Meanwhile, the United Kingdom’s National Health Service ensures extensive coverage for almost all citizens via tax funding.

Despite being commissioned, Hong Kong does not have such a social health insurance system.
report
In 1999, Harvard experts recommended it, prompting the government to launch the project.
voluntary health insurance scheme
In 2019, however, engagement remained low, notably amongst those who were middle-aged and older. Without an extensive framework for spreading out financial burdens through shared risk management, cutting down on subsidies merely transfers these costs onto individuals lacking corresponding safeguards.

Hong Kong’s public healthcare system was designed to “deny no one” regardless of financial constraints. Yet research has shown that a minority cannot afford the necessary medical care, and experience worse health outcomes than the general population. This suggests patients with higher healthcare needs face greater financial barriers to treatment.

Although Hong Kong has a mixed public-private healthcare system, access to routine primary care is uneven, disproportionately benefiting those with greater financial means. This inequality occurs due to the significant dependence on private providers for outpatient services, which introduces barriers related to costs.

Consequently, according to the 2022 blueprint, only 30 percent of overall health expenditures in Hong Kong go towards primary care, whereas the worldwide average for 88 nations stands at 54 percent.

A person from Hong Kong facing illness during off-duty hours has limited choices: general outpatient clinics usually shut down before 5 pm, and district health centers do not have the capability to act as a viable nighttime option. This leaves mostly just a handful of community pharmacies operated by local non-governmental organizations (NGOs) along with emergency rooms as potential solutions.

It is heartening that the government is
expanding
The medical fee waiver program aims to assist as many as 1.4 million individuals in Hong Kong. However, when putting this into practice, it’s essential to make sure that patients who require assistance aren’t burdened by a complicated online procedure. It is important to have enough medical social workers available to aid those with limited technological skills so that nobody gets overlooked.

Although Hong Kong’s authorities defend the recent healthcare reforms as being essential for preparing for an
ageing population
It is crucial not to overlook the unfulfilled needs of vulnerable elderly residents. Research indicates that advancements in preventing and treating chronic conditions may have significantly contributed to longer lifespans for Hong Kong citizens, with instances of diseases like lung cancer decreasing among seniors.

Rather than specific ailments, elderly residents of Hong Kong are more frequently exhibiting “geriatric syndromes,” including weakness or diminished mental capacity, which do not align neatly with standard treatment guidelines for particular diseases. According to our yet-to-be-published findings, we have observed a rise in cases labeled under categories like “symptoms, signs, and abnormal clinical or laboratory finding NOS/ NEC” — such as sudden disorientation or overall decline — over recent years. As these individuals typically show vague symptomatology, they tend to be categorized as needing either less immediate care (“semi-urgent”) or routine attention (“non-urgent”).

In the case of Hong Kong, the approach shouldn’t be one of cutbacks; instead, it must involve an ambitious overhaul grounded in factual analysis, tailored to serve its growing elderly demographic. Cutting back on healthcare support without implementing pooling strategies or significantly boosting investments in basic health services could exacerbate inequalities. Therefore, Hong Kong ought to concentrate on building a sturdy foundation for primary care that ensures everyone has access to cost-effective medical assistance.

Over time, the administration needs to improve its approaches to guide patients away from public systems towards private networks of primary care physicians. Many residents of Hong Kong can conveniently locate a general practitioner near their homes within a quarter-hour. There is an emerging necessity to create a healthcare framework that keeps medical consultations cost-effective while guaranteeing practitioners have the skills needed to address intricate and nonspecific health concerns prevalent among elderly individuals. An updated healthcare model must aim at higher fairness levels while aligning with population changes.

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The article initially appeared on the South China Morning Post (www.scmp.com), which serves as the premier source for news coverage of China and Asia.

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