My Health My Choice Healthcare Reform Second Stage Public Consultation Consultation Document Food and Health Bureau Hong Kong Special Administrative Region Government October 2010 KEY TERMS Term Description Health Protection Scheme A standardized and regulated framework for health insurance (HPS) proposed by the Government for the second stage public consultation on healthcare reform. Core requirements and Requirements and specifications standardized under the HPS that specifications under the all health insurance plans to be offered under the HPS are required HPS to meet. Health insurance plans Health insurance plans that meet the core requirements and under the HPS (HPS Plans) specifications under the HPS to be offered by insurers. These include Standard Plans and other health insurance plans that provide top‐up benefits and add‐on components over eand abov the Standard Plans. Standard Health Insurance Standardized health insurance plans that are offered by insurers Plans (Standard Plans) strictly in accordance with the core requirements and specifications under the HPS without any top‐up benefits and add‐on components. Top‐up benefits and Top‐up benefits or add‐on components that insurers may choose to add‐on/additional offer beyond the core requirements and specifications under the components HPS, e.g. higher benefit limits, better service class, broader service coverage such as general out‐patient consultation. Diagnosis‐related groups A method of classifying medical conditions requiring hospital (DRG) admissions or ambulatory procedures by diagnosis and complexity that can be used as a basis for costing or charging for medical services. ABBREVIATIONS CHC Community Health Centre DH Department of Health DHA Domestic Health Accounts DRG Diagnosis‐related groups eHR Electronic health record FHB Food and Health Bureau HA Hospital Authority HMDAC Health and Medical Development Advisory Committee HPS Health Protection Scheme OCI Office of the Commissioner of Insurance PCO Primary Care Office PHI Private health insurance PPP Public‐private partnership WGPC Working Group on Primary Care CONTENT Message from Dr York Y N CHOW, GBS, JP, Secretary for Food and Health ............i Executive Summary.............................................................................................................iii Chapter 1 Healthcare Reform – First Stage Public Consultation ........................1 Chapter 2 Healthcare Reform – Progress To Date ..................................................8 Chapter 3 HealthCare Reform – Second Stage Public Consultation................20 Chapter 4 Voluntary Health Protection Scheme...................................................26 Chapter 5 Supporting Infrastructure for Health Protection Scheme................48 Chapter 6 Way Forward .............................................................................................60 Appendix A Health Protection Scheme and Illustrative Standard Health Insurance Plan ..........................................................................................62 Appendix B Hong Kong’s Current Private Health Insurance Market..................72 Appendix C Hong Kong’s Current Private Healthcare Sector................................86 Appendix D Overseas Experience in Private Health Insurance.............................96 Appendix E Health and Medical Development Advisory Committee ..............103 Appendix F Consultative Group on Voluntary Supplementary Financing Scheme .....................................................................................................106 References ....................................................................................................................108 Message from Dr York Y N CHOW, GBS, JP, Secretary for Food and Health Dear Citizens, An effective and sustainable healthcare system requires close monitoring and steering by the Government. It needs to ensure equitable access and provide safety net for all, through a robust public system supported by public funding. It also needs to provide adequate choices for you, our fellow citizens, through a private sector that is equally professional and transparent to consumers in both quality and service fees. Our current healthcare system in Hong Kong is highly rated internationally, but we need to continue to refine and develop our monitoring and steering mechanisms for the service capacity, market coverage, professional development and financial sustainability of our healthcare system. That is the essence of the healthcare reform we are embarking on. It has been two years since we first launched the healthcare reform and consulted your views on the comprehensive package of reform proposals in 2008. With your support in the first stage public consultation, we have been enhancing public healthcare services and taking forward the service reform proposals making use of the increased budget for health. Since 2007/08, we have increased our budget for health from $30.5 billion to $36.9 billion and invested over $15 billion in healthcare infrastructure and safety net. Making use of the increased resources, we have built a solid foundation for the healthcare reform: (1) Enhance Primary Care: the Primary Care Working Group comprising primary care practitioners from both the public and private sectors has formulated an overall primary care development strategy for Hong Kong which the newly established Primary Care Office will be taking forward. (2) Promote Public-Private Partnership (PPP): a number of pilot projects to deliver healthcare services through PPP are already underway and we set to further expand the scope. We will also facilitate the private sector to expand capacity through encouraging development of private hospitals. (3) Develop Electronic Health Record (eHR) Sharing: the eHR Office together with the IT experts from the Hospital Authority (HA) is working closely with the private sector to implement the eHR Programme to provide a sharing infrastructure bridging the public and private sectors. Message from the Secretary for Food and Health Page i (4) Strengthen Public Healthcare Safety Net: to improve public healthcare services, we have increased the subvention for HA from $28.0 billion to $32.7 billion and will further increase it next year. We have also injected $1 billion into the Samaritan Fund to help those in need. It is time we move on to the next stage of the healthcare reform. We have listened carefully to your views: you value your voluntary choice for public or private healthcare; you treasure the public healthcare system as the equitable safety net; and yet you want more choices and better protection in private healthcare. We believe the Government can play an active role. We have thus formulated proposals for a Health Protection Scheme (HPS), a scheme for standardizing and regulating voluntary private health insurance, that aims to provide you with better choices for lifelong protection. We will also be your lifelong health partner by proposing financial subsidies that invest together with you in your long-term health protection. We will continue to uphold the public healthcare system as the safety net for the whole population. By enabling more people to access private healthcare, the HPS will relieve the pressure on the public healthcare system so that it could better focus its resources on target service areas and population groups, especially low-income families, under-privileged groups and other needy patients. The proposed HPS would thus benefit everyone, both those opting for private healthcare and those taken care of by the public system. It would also complement the service reforms underway and help enhance the long-term sustainability of our healthcare system. I would like to take this opportunity to express my appreciation of the contribution by members of the Health and Medical Advisory Committee and its Working Group on Healthcare Financing, as well as members of the Consultative Group on Voluntary Supplementary Financing Scheme, who have played a pivotal role in the formulation of the proposals for the HPS for consultation. We are committed to joining hands with you in tailoring the HPS to the benefits of all. We look forward to receiving your views and suggestions in this second stage public consultation on the healthcare reform. Dr York Y N CHOW Secretary for Food and Health October 2010 Page ii Message from the Secretary for Food and Health Executive Summary Healthcare Reform We put forward a comprehensive package of proposals to reform the healthcare system in the Healthcare Reform Consultation Document “Your Health, Your Life” in March 2008. These include four healthcare service reform proposals to enhance primary care, promote public-private partnership in healthcare, develop electronic health record sharing, and strengthen public healthcare safety net, and a healthcare financing reform proposal to consider introducing supplementary healthcare financing via six possible supplementary financing options. 2. We conducted the first stage public consultation on healthcare reform in March to June 2008 and published the consultation report in December 2008. Building on the views received, we are improving public healthcare and taking forward the service reforms, making use of the increasing government budget for health. We have also formulated a voluntary Health Protection Scheme (HPS) as the next step in healthcare reform. This document mainly sets out our proposals for the Health Protection Scheme to initiate the second stage public