In spite of the less-than-optimistic economic outlook, the Hong Kong Special Administrative Region government decided last month to expand the use of elderly healthcare vouchers to seven additional hospitals and dental clinics in major mainland cities in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA).
What can be said with certainty is that the proposal will alleviate the pressure on public hospital services and shorten the waiting time for specialist services in Hong Kong. We will examine other advantages of the program in the following discussion. Meanwhile, optimists should not be habituated against thinking deeply about the financial risks and concerns raised by some financial analysts and medical practitioners in the city.
When selecting GBA medical institutions for the program, the government considers eight key factors: physical location, service quality, experience in management and operation, service scope, capacity, fee standards, knowledge of the operation of the Elderly Healthcare Voucher Scheme (EHVS), and availability of advantageous services.
First, in addition to providing ever-greater convenience for the beneficiaries of the EHVS to gain access to seven additional hospitals and dental clinics in mainland cities, the Elderly Health Care Voucher Greater Bay Area Pilot Scheme (the Pilot Scheme) is expected to enable the government to cut waiting time for specialist and dental services in local public hospitals. It is estimated that about 500,000 Hong Kong residents are now residing in the mainland side of the GBA, and about 90,000 of them are users of the EHVS. Those EHVS users who are living in the northern parts of the New Territories may also cross the border to enjoy medical services at more competitive prices there than those in Hong Kong. With an aging population and more patients suffering from chronic diseases, Hong Kong’s public hospitals are overburdened, and the waiting time for specialist services has continued to lengthen. Our doctor-to-population ratio remains below that of other Asian economies such as Taiwan, South Korea and Singapore. The Pilot Scheme will get public hospitals back on a stronger footing for the delivery of medical services to patients in the city.
Second, senior Hong Kong residents now living in mainland cities in the GBA are reluctant to impose additional burden on family members by requiring them to arrange cross-border medical consultations for them. Exercising self-reliance to get medical services in nearby hospitals and clinics can foster a stronger sense of dignity among senior people.
Third, the current program includes only the two service points of the University of Hong Kong-Shenzhen Hospital, thus many other residents in the mainland side of the GBA have found it inconvenient when using the vouchers. Viewed through the lens of fairness, the current program is quite unfair and does nothing for the credibility of the HKSAR government.
Fourth, the new pilot program will generate more favorable momentum toward deeper economic integration between Hong Kong and the mainland side of the GBA. Finally, more and more mainland residents in the GBA and other regions may cast an admiring glance at the generous healthcare program offered by the HKSAR government. The generosity, together with other institutional strengths of the city, will inject new vitality into the Quality Migrant Admission Scheme. After getting permanent residency status in Hong Kong, mainland talent may consider sponsoring their parents to migrate to the city.
Taking a holistic view, economic capital is the only kind of capital. Economic capital includes all tangible and intangible assets that can easily be recorded in monetary terms. Other types of capital are: ultimate capital (health), cultural capital (knowledge and skills that may not be easily translated into immediate material rewards), social capital (personal charm, physical attractiveness, a supportive web of relationships either inherited or acquired by social networking skills), and institutional capital. The last type of capital includes a stable and secure political environment, a fair legal system, the availability of promising economic and educational opportunities, a low crime rate, a good welfare system, good and effective governance, and high physical quality of life. If you are a citizen of a developed country endowed with the above-mentioned institutional capital, you are automatically entitled to that kind of institutional capital.
With vast institutional capital, developed countries are in a better position to win the hearts and minds of prospective immigrants from developing countries. From the perspective of an immigrant, he or she can enjoy the fruits of efforts made by the previous and existing citizens of the adopted country without first making the effort. We believe that the Pilot Scheme will make the city more attractive by increasing its institutional capital.
On the negative side, financial analysts are afraid that the additional medical expenditures will make it more difficult for the HKSAR government to climb out of a structural financial deficit. It is estimated that more than 15,700 EHVS users have used the vouchers at the HKU-Shenzhen Hospital, spending a combined HK$51.8 billion ($6.62 billion). Therefore, we should balance the benefits of the program with its associated financial risks. Moreover, there are concerns about the quality of medical services provided by the newcomers under the program. According to a survey, about 72 percent of respondents in Hong Kong are confident of the medical institutions of the city (Mu Yaping et al, Studies on the Legal Issues in the Regional Economic Integration: Take Guangdong-Hong Kong-Macao Bay Area As An Example (HK: Chung Wa Book, 2020)). A related concern is that the GBA mainland cities and Hong Kong are operating two sets of different healthcare systems; Hong Kong’s medical regulatory bodies have no jurisdiction over the medical institutions covered by the program in the mainland side of the GBA in any alleged negligence claims. The local medical and dental professions are also unable to provide remedial treatments for returned Hong Kong patients needing medical follow-ups after visits to medical institutions in the mainland under the program.
Finally, Dental Association President Spencer Chan Chiu-yee said the economic damage to the business of local dentists would be significant if all Hong Kong elderly residents on the mainland opted to use dental services there. But Professor Leung Wai-keung, president of the College of Dental Surgeons of Hong Kong, believes the impact on local dentists would be minimal. Our think tank is of the view that the Pilot Scheme will not chip away at the competitive advantages of local dentists. As Professor Leung has correctly pointed out, patient considerations also include the quality of services, the background of patients and other factors (ibid).
There is a growing perception that the Pilot Scheme is a correct response to the increasing demand for healthcare voucher services in the GBA mainland cities. After examining the pros and cons of the program, our think tank believes that the ambitious expansion plan provides a hard-to-miss opportunity for the HKSAR government to kill several birds with one stone. Most importantly, it will not only provide better medical services for EHVS users residing in the GBA mainland cities, but also will serve the needs of local patients by alleviating pressure on public hospitals in the city. Nevertheless, the benefits of the program should be weighed against the financial risks associated with it. Besides approaching the program with a keen awareness of our financial constraints, the government should subject it to rigorous financial scrutiny in order to prevent it from becoming a white elephant.
Dr Frederick Chu Cho-shun is dental services senior consultant of the Chinese Dream Think Tank, and former assistant dean and clinical associate professor of the Faculty of Dentistry of the University of Hong Kong.
Kacee Ting Wong is a barrister, a part-time researcher at the Shenzhen University Hong Kong and Macao Basic Law Research Center, chairman of the Chinese Dream Think Tank, and a district councilor.
The views do not necessarily reflect those of China Daily.
