Hong Kong's healthcare system, one of the most heavily subsidized in the world, is at a critical juncture. The government's plan to reduce public healthcare subsidies from 97% to 90% by 2030 marks a significant shift that warrants careful scrutiny. While the Health Bureau presents this move as a necessary realignment, it risks deepening existing disparities and undermining equitable access to care.

The immediate concern with increasing costs is that they may deter patients from seeking timely treatment. Healthcare decisions are rarely made with perfect information, and many patients struggle to differentiate between urgent and non-urgent symptoms. As financial barriers rise, what may seem like an "unnecessary" emergency visit today could lead to complex and costly hospital admissions tomorrow. This is particularly true for elderly patients, who often exhibit vague symptoms—such as confusion or agitation—that can easily be misclassified as non-urgent.

Officials argue that some patients exploit accident and emergency (A&E) departments for minor ailments, which correctly identifies a symptom of the problem but overlooks a crucial underlying issue: the lack of accessible primary healthcare alternatives in Hong Kong. Despite the government's 2022 Primary Care Blueprint promising the establishment of district health centers and improved coordination, progress has been sluggish. Currently, less than 20% of public healthcare spending is allocated to primary care, with over 80% directed toward specialist and hospital services. This creates a funneling effect, pushing patients toward hospitals rather than preventive or primary care options.

Chief Executive John Lee Ka-chiu's recent policy address acknowledged the need to strengthen public healthcare. However, the proposed reforms seem to address symptoms rather than the root causes of systemic issues. Proponents of the subsidy reduction often cite other developed healthcare systems, pointing out that even at 90%, Hong Kong's subsidy remains generous compared to countries like Singapore or Britain. Yet, such comparisons can be misleading. Both Singapore and the UK have robust public insurance frameworks that spread risk and costs across their populations. Singapore’s system, which includes MediSave, MediShield Life, and MediFund, provides a safety net alongside personal responsibility. Meanwhile, the UK's National Health Service (NHS) offers near-universal coverage funded through taxation.

Hong Kong, in contrast, lacks a comprehensive social health insurance system, despite a 1999 report by Harvard experts recommending its creation. The government did launch a voluntary health insurance scheme in 2019, but participation has been disappointing, particularly among middle-aged and elderly residents. Without a solid infrastructure to distribute costs through risk pooling, reducing subsidies merely shifts expenses onto individuals, often without the necessary protections.

Historically, Hong Kong's public healthcare system was designed to ensure that no one is denied care due to financial constraints. However, research indicates that a significant minority of residents struggle to afford necessary medical treatment, leading to worse health outcomes. This suggests that patients with higher healthcare needs are facing increasingly insurmountable financial barriers.

In a public-private healthcare framework, the inequities in access to primary care are glaring. Outpatient services are predominantly provided by private entities, creating obstacles for low-income individuals. A typical Hongkonger who falls ill outside regular office hours finds limited options: general outpatient clinics close by 5 PM, and district health centers often lack the capacity to serve as after-hours alternatives. This leaves A&E departments and a few community pharmacies run by local NGOs as the primary recourse for many patients.

Encouragingly, the government is expanding the medical fee waiver scheme to benefit up to 1.4 million residents. However, implementing this initiative requires careful consideration to avoid overwhelming patients with a complex digital process. It's essential to ensure that those less digitally savvy, such as older adults, have adequate support from medical social workers so they are not left behind in accessing necessary care.

While the government justifies its latest healthcare reforms as a preparation for an ageing population, it is crucial not to overlook the unmet needs of frail older residents. Recent research suggests that successful prevention and treatment of chronic diseases have contributed to increased life expectancy in Hong Kong, yet older residents are increasingly presenting with geriatric syndromes like frailty and cognitive impairment. These conditions often defy specific disease protocols and can be misclassified as non-urgent, complicating the healthcare response.

The path forward for Hong Kong lies not in austerity but in a bold, evidence-based restructuring of its healthcare system that aligns with the needs of its ageing population. Reducing healthcare subsidies without accompanying risk-pooling mechanisms or a substantial investment in primary care threatens to exacerbate existing disparities.

To effectively address these challenges, Hong Kong must prioritize developing a robust primary care system that is accessible and affordable for all residents. This system should facilitate seamless transitions from public to private networks of primary care doctors, ensuring that most residents can find a general practitioner within a short distance from home.

Ultimately, a 21st-century healthcare system must strive for greater equity while adapting to demographic realities. It is essential to create a healthcare environment where visits to the doctor are affordable and where healthcare providers are well-equipped to handle the complex, non-specific health issues prevalent among older patients. Only through such comprehensive reform can Hong Kong hope to build a healthcare system that not only meets the needs of its current population but also stands resilient in the face of future challenges.

By Lewis Koch

The author is a current affairs commentator.

The views do not necessarily reflect those of Orange News.

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