The existing two-pillar healthcare system in Hong Kong should be changed to a three-pillar structure that allows patients more choices of better services, a civilian policy think-tank said yesterday.

The Bauhinia Foundation Research Centre, one of the territory's most prominent think-tanks, also suggested individual medical savings accounts to help the elderly in their post-retirement life from the age of 65.

An overhaul of the current public healthcare system is necessary, said the Centre's chairman Norman Chan, because people over-rely on remedy and neglect prevention. As a result, there emerges an imbalance between the public and private healthcare systems because public services are heavily subsidized - up to 95 percent of the cost.

In addition, the aging population, aspirations for new treatments and medicines, and low tax make it very difficult for public finance to sustain the burden in the long run.

Quoting government figures, Chan said public healthcare spending amounted to $39.1 billion in 2001/02, equivalent to 3.1 percent of GDP and 14.5 percent of government expenditure respectively. If the pattern remains unchanged, the ratio to GDP and government expenditure will increase to 4.3 percent and 21.5 percent respectively in 2020 and 5.3 percent and 26.5 percent respectively in 2030.

"If only healthcare accounts for more than one quarter of government expenditure, what will happen to education, welfare, security?" he said.

It has been proposed that the public and private healthcare systems will remain, with the first pillar (public healthcare safety net) continuing to be heavily subsidized, while the users pay for the third pillar (private healthcare) services. But there comes a middle pillar of enhanced services including extended primary care services, long-term care and privately purchased medical items and medicines, with the patients receiving up to 50 percent of the cost of services on average. To facilitate good interaction between the three pillars, portable electronic medical records have been recommended.

On the idea of medical savings accounts, Chan said this would encourage people to save money in return for better healthcare services in their later years. The amount of contribution shall be 3 percent - 5 percent, he suggested, because a lower ratio will not yield much money yet 5 percent - will be a burden on the people.

All people have been encouraged to open medical savings accounts and those at work are required to contribute, and the account holder can buy healthcare services for their family members too. Employers are welcome to contribute for their staff but it is not a mandatory requirement. People under 65 can take money out of the account if necessary.

"Given these are savings accounts, people under 65 should not use the money if not for serious illness when the balance is say, below HK$30,000," he said.

As for the money received, he suggested the money be invested in low-risk portfolios to yield a stable return. On the administration side, it has been suggested that Mandatory Provident Fund Schemes Authority be used to collect the contributions, but a separate organization shall be set up to approve and release payments.

(China Daily June 7, 2007)