【明報專訊】THE GOVERNMENT has unveiled its healthcare financing reform plan. There are voices in favour of it as well as against it. While it should persevere with the reform, the government must heed the doubts expressed. We must be clear about two facts. First, our healthcare system is fraught with problems. Public hospitals are overloaded. The situation will worsen as the population ages. Second, the private health insurance (PHI) system is full of loopholes now. Policyholders have difficulty making claims. Their interests are by no means effectively protected. This problem is serious. The government's scheme is not perfect. However, if it is in place, middle-class citizens will have wider PHI choice, and more public healthcare resources will be available for looking after elderly and infirm patients. It represents a step in the right direction.
Public hospitals, whose services are inexpensive and very much in demand, now have a 90% market share. The system has long been overstretched. Not prepared to join the long queue, many have taken out PHI. They turn to private hospitals for healthcare services. However, there are many problems with PHI. According to the consultation document the government has just issued, the PHI market, which has been rapidly growing for years, is actually in a very sorry state.
*Individual PHI plans' profit margins are far higher than groups'. A factor in this is that individual policyholders' claim ratio is lower. During 2005 to 2009, the group claim ratio (the ratio of the amount of claims to that of premiums) was 81%, while the individual ratio was only 57%.
*In 2004-05, inpatients paid out of their own pockets 28.7% of the total expenditure on private inpatient care. The ratio soared to 41.6% in 2006-07 (three years later).
More and more people have taken out PHI. Medical costs have soared, but PHI claims have not gone up proportionately. One reason why the claim ratio is low is that some policyholders have refrained from making claims after their discharge for fear that they would be required to pay sky-high premiums. Another is that inpatients often find their policies do not cover the services they have received only upon their discharge.
The government's healthcare financing reform plan is an important step in the right direction. The government will step up regulation. It will have insurers offer standard PHI plans, require private hospitals to increase their price transparency and take regulatory measures pertaining to insurers' and private hospitals' costs and profits. The introduction of such measures is worth looking forward to.
Hong Kong private health insurers must be aware that the days are numbered when they may keep raising premiums and refusing to meet claims. Private hospitals must be aware that, Hong Kong people being enlightened and very jealous of their rights, the days are numbered when patients would allow themselves to be fleeced. If they obstruct the reform, Hong Kong's healthcare system may collapse. In that event, the public, private hospitals and insurers will all suffer, and the government will have to intervene in the situation vigorously.