Medical Reform Medical Reform Course Code : POLS7050 Course Code : POLS7050 Course Name : Public Administration Course Name : Public Administration Semester Semester : Autumn 2009 : Autumn 2009 Prepared by: Prepared by: Rex Chan & Veronica Lau Rex Chan & Veronica Lau
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Medical ReformMedical ReformCourse Code : POLS7050Course Code : POLS7050Course Name : Public AdministrationCourse Name : Public AdministrationSemesterSemester : Autumn 2009: Autumn 2009
Problem 2: Long waiting time Problem 2: Long waiting time for public medical servicesfor public medical services
Evidence 2Waiting time for first appointment for patients triaged into the "routine" category at Ambulatory Care Centre, TMH
Problem 3: Limited alternative Problem 3: Limited alternative choice for medical services choice for medical services
• Examples- Chinese medical services
Evidence: only 12 clinic offering such services, but none of them was established in hospital
- natural medical treatment
Problem 4: Insufficient safety Problem 4: Insufficient safety net net
• cannot afford the fee in private hospitals• rely on public services• growth in service demand deteriorate service
quality• patients will not be secured
Factors inducing the problemsFactors inducing the problems
1. Rapidly ageing population2. Increasing occurrence of lifestyle-related
diseases3. Rising medical costs brought about by
advances in medical technology and expectations for improved quality of care
4. Insufficient emphasis on primary care5. Over-reliance on hospital services6. Significant public-private imbalance7. limited continuity and integration of care
Existing policy to deal Existing policy to deal with the problemswith the problems
Increase Funding!!!
!
Advantages of increasing Advantages of increasing medical fundingmedical funding
• Cope with with the rising medical costs
• Enhance the medical education for professionals
• Promote general medical knowledge among the public
• subsidy the hospitals for better equipment
Disadvantages of Disadvantages of increasing medical fundingincreasing medical funding
• Does not solve the existing problems comprehensively
• Not sustainable• Limited by simple taxation and low
medical charges• over-reliance on public hospital
services will be worsen
SolutionSolution
Six Supplementary Six Supplementary Financing ProposalsFinancing Proposals
1. Social Health Insurance (SHI)2. Increasing the user fees--Out-of-pocket
payments3. Medical Savings Accounts (MSA)4. Voluntary Private Health Insurance (VHI)5. Mandatory Private Health Insurance (MHI)6. Personal Healthcare Reserve (PHR)
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
Selecting the best solutionSelecting the best solution
1. Out-of-pocket payments (user fees)
- a simple, direct and efficient means to provide additional resources
- Encourage using the public healthcare services more judiciously
- more self-responsibility for people’ s own health- help in coping with increasing healthcare needs
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
Selecting the best solutionSelecting the best solution
2. Voluntary Private Health Insurance (VHI)
- offer the voluntary choice to choose their own insurance products
- like insurance exclude pre-existing conditions- not guarantee renewal of policies- not provide any assurance on future premium- Not highly likely be an effective solution
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
Selecting the best solutionSelecting the best solution
3. Personal Healthcare Reserve (PHR)
- Deposit part of income into a personal account- For mandatory regulated medical insurance- For savings to invest & meet healthcare expenses,
e.g. insurance premium- However, a two-tier service structure
- Unlikely be an effective solution
Under PHR First-class healthcare services
Not under PHR Second-class healthcare services
Selecting the best solutionSelecting the best solution
Out-of-pocket(user fee) will have the most widespread effect on meeting the increasing
needs of healthcare
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
BenefitsBenefits
1. a simple, direct and efficient means2. create healthy competition between
the public and private sectors to solve the public-private imbalance
3. encourage using the public healthcare services more judiciously
4. be more self-responsibility for people’ s own health
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
BenefitsBenefits
5. ensure the medical services would not be overused
As a result, fair for the users to
take up more responsibility for their own healthcare expenses
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
CostsCosts1. lead to rising medical costs in private
market2. pose great burden to the elderly, patients
with chronic illness, low-income families and other underprivileged groups
3. no risk-pooling effect, burden fall on the people who fell ill
4. could not afford the heavy medical fee e.g. poor elderly, chronic patients and low-income families
Reference : http://www.beStrong.gov.hkReport on First Stage, Public Consultation on Healthcare Reform, published by the Food and Health Bureau(December 2008)
ImplementationImplementation
• Food and Health Bureau (FHB) the Panel on Health Services of the legislative Council(Lego) Committee
Public Government
Professional• Create a fair atmosphere for different levels to
express their opinions• set on a personal or family-based limit on
medical expenses to moderate the effect of fee increase
ImplementationImplementation
• The Secretary for Food and Health Dr. York Chow Yat-ngok
Political StrategyPolitical Strategy• Mr. Lee Cheuk Yan concerns user fee
pose great burden• representative of public are not allow
to get equal treatment• because unequal proportion• a phenomenon : all the decisions
might be made by Government department, but not the public
• E.g. high range rising medical costs in private healthcare market
Political StrategyPolitical Strategy
Solution• different working scopes equal
proportion• representative of underprivileged can
participate in the decision-making process • set control on a personal or family-based
limit on medical expenses to moderate the effect of fee increase
• create an advisory board to review the decisions made by the committee