Christian Service News
Issue 61 (October 2008)
All Proposals on Medical Reform
should be Evidence-based
It is true that Hong Kong is facing the challenge of population ageing. However, when it comes to policy formulation, not only the quantity but the quality of the “aged” population has to be considered as well. Put it another way, the elder people in 2033 will be very different from the elder people in 2008. According to the 2006 By-census, those in their 40s and 50s possessed very high education attainment level. For example, for those 40-44 years old, 22.6% of them have attained post-secondary education level; while for those 65 years or older the proportion was only 6.2%. Also, for those 40-44 years old, 5.9% of them were professionals and 14.5% were managers or administrators.
This trend of improving population quality can also be observed if we consider only the older population. While in 1996, 15% of the older population was managers or administrators, the proportion increased to 19.5% in 2006. However, the proportion for the whole population has in fact decreased from 12.1% in 1996 to 10.8% in 2006. This contradictory trend has obviously cast a doubt on the assumption that older people in 25 years time will actually be a burden to the society of Hong Kong.
If only the elderly dependency ratio (i.e. the proportion of the number of those 65 years or above to every 1,000 working population) were taken into account without consideration on the quality of the older population at the same time, public policy thus formulated would likely be subject to bias or incorrect interpretation.
On the other hand, if the total dependency ratio (i.e. including children and older people) were taken into account in the formula, the social burden would in fact, contrary to general impression, decrease from 401 in 1996 to 353 in 2006.
Another factor that should be taken into consideration is the changing background and attitude of the “future senior” population.
As these would-be seniors are more likely to be middle-class than before, they would have a greater concern for their own health. The blooming market on physical checkups in recent years is an obvious reflection of this change.
Also, the attitude towards medical insurance of these future seniors is noticeably much more favourable than older people nowadays.
These two “cultural changes” are perhaps the result of the trend of the increasing middle-class in Hong Kong that prefers to pay more for better service, and a consequence of the fact that these would-be seniors are simply not eligible for means-tested government subsidies.
From the above discussion, it follows that the six government proposals on medical financing should be subject to more stringent analysis and discussion.
And no matter which option is finally taken, the most important thing is to ensure those in need will not be excluded from proper medical service, and that the quality of medical service must be improved rather than just focus on the financing issue.
Moreover, healthcare reform should also emphasize on primary healthcare rather than hospital care, because it is more fundamental and is the best precaution to subsequent costly medical treatments.