Transcript of Dr Donald K.T.

Lis Speech
I think, being in the medical profession myself, I would like to take up the issue of the
critical success factor of successful reform by honest self-criticism, and I would like
to present some of my opinions on some possible flaws in the present health care
system in Hong Kong, of which the beauty is it can be quite easily corrected, in my
mind.
The major point, of course, is, I think, primary care deelopment and family medicine
has been neglected in the past and the emphasis has been on a hospital-based system
thus far. I think it is recognised, uniersally, that health care systems that do not
recognise the importance of a sound base of well-trained primary care doctors, are
unfortunately doomed to e!perience failure. "nd in countries where the health care
system is primary care orientated, there are lower costs of care, better leels of health,
less use of medication and a high satisfaction rating for health care serices proided.
In my iew the key to a successful health care system depends on good control at
entry leel and also good directions after that. #rimary care doctors or family
physicians hae often been described as gatekeepers. $ut it%s not just keeping people
out, it%s also giing the proper instructions. If you turn somebody away, you hae to
tell him or her where to go. "nd also, if you let them in, you hae to also tell them
where they should be going. "nd this is why primary care doctors are so important.
$ut then the practice of primary care also needs a ery good monitoring system, just
like quality assurance of all medical doctors in general. That%s why the deelopment
of family medicine will ensure quality primary care. &amily physicians listen and
understand patients, treat them as persons and proide comprehensie continuous and
whole person care to them and their families. 'mphasis is on the deelopment of
good doctor-patient relations, continuity of care, preention, education and
counseling, to help patients manage their health problems.
It is a pity that although resources hae been mobilised in the past to find deficiencies
in the health care system in Hong Kong, the recommendations are not being complied
(with) and there has definitely been a lack of production of primary care doctors * in
the training of primary care doctors, family physicians * and also in allowing
practising primary care doctors who want to receie remedial training or additional
training to become family physicians.
+f course, one of the problems is, I think, in uneen allocation of resources. "t
present the disparity of the allocation of the health care budget and the
disproportionally large budget for pharmaceutical drugs aailable to hospitals,
enhances this hospital-dominated health care system.
I think the public%s e!pectation is quite important and I think one of the ways forward
is really good education of the public and what they should e!pect from seeing a
doctor. ,ight now, een at the primary care leel, what the patient e!pects may not be
what is best for them. -ost patients would e!pect a whole bag of pharmaceutical
drugs as a form of treatment and they are reluctant to spend time, for e!ample, to
receie health education on preention, and also receie the proper counseling which
is, a lot of the time, a lot better than supplying numerous drugs for them. I think
.
public education should begin at primary school leel, so those primary school
children should know what to e!pect when they see a doctor.
,ight now, officially, goernment outpatient clinics proide a proportion of primary
care and priate doctors seem to be proiding the majority of primary care. $ut the
case is not true and there is actually unfair competition because although the Hospital
"uthority is supposed to be proiding hospital-based care, it is actually also taking
care of a lot of the portion of these patients, mainly because of the allocation of the
budget for pharmaceutical drugs. This problem must be addressed. "nd I think the
presence of family doctors in hospitals will be a solution to this. "gain, we are
talking about the channeling of patients. This time, not just in, but out to the
appropriate bodies. &or e!ample, priate practitioners, nowadays, who hae
recommended patients to go to goernment hospitals, these patients, a lot of times, opt
to remain in the hospital care system and they refuse to come back into the priate
system, mainly because they get a lot of subsidy for pharmaceutical drugs and also
long term drug supplies. This must be addressed.
I would like to just talk about quality assurance, in general. " lot has been said about
this and it goes to much more than just continuing medical education. ,ight now,
specialists or hospital-based doctors probably hae a pretty good system of quality
assurance, and also, the specialists are under the scrutiny of the Hong Kong "cademy
of -edicine. $ut then, what about primary care proiders in general/ 0nfortunately,
there was ery little training of family medicine or proper training of how to delier
primary care, in the past, so I think it is time that we look at those practising doctors
in primary care, to look at their standards.
It is not just knowledge but also consultation skills, and also doctor attitudes, because
this will promote the proper doctor-patient relations. This will educate the patient on
how he or she should seek medical attention. 1o we feel that since there are 2,333
practising primary care doctors in Hong Kong, a ery efficient way is to do a medical
audit on the standards of these primary care doctors. &or those who fail to meet the
standards, then they can always go back for some remedial training. This is probably
quite a cost-effectie e!ercise.
$ut quality assurance, as I said, goes beyond knowledge. The premises of the practice
is important, and also the attitude of the doctor, how he sees the patient, and all these I
think should be taken into consideration. There are also other factors concerned, and
that is incenties for quality care. I think, although this is not strictly something that
applies to the doctors, it is something that we should address.
&or e!ample, commercial insurance schemes that offer ery unrealistic coerage, may
be actually incenties for poor quality care. "lthough a doctor could be ery well
trained in family medicine or in any other specialty, but because of unrealistic
remuneration or lack of incenties to proide care, then there is no way the kind of
quality that we want will be deliered. I think it is time, for e!ample, that the
goernment may consider setting up the proper authority to regulate insurance
schemes.
I probably want to cut it short because I know we are short of time and I look forward
to more questions, but I think, basically, a primary care led health care system is what
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I think would be one of the possible solutions in our health care reform. Thank you.
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