Speech on the “Motion of Thanks” (Translation):

　　President, I would like to talk about medical problems when there are still some Members present. I have heard long enough to have a view that most Members are comparably laymen. For example, the dissatisfaction with the services of the Hospital Authority (HA) is often said to be the result of the shortage of healthcare manpower, which leads to excessively long working hours, unduly long waiting time of patients and the recruitment by private hospitals with very attractive remunerations, and so on. And then they came to the conclusion that overseas doctors should be imported and the number of medical students should be increased, and so on.

　　Regarding the Policy Address, I am in fact very disappointed too because the major part of paragraph 14 concerning medical services is, as I see, old content which is about the established planning of the last-term Government only. Surprisingly, he has also incorporated the development of the twin-track healthcare system as a main selling point, but the twin-track system for public and private healthcare sectors in Hong Kong has actually been developed since the past century. I really cannot see any new idea in mentioning it again at present.

　　Besides, it is also proposed in the Policy Address that a few patient beds will be added but they only account for less than 1% of the total number of HA's existing beds, while the new hospital and the redevelopment of hospitals mentioned in the Policy Address are all old content. The only new element is to set up a steering committee to conduct a review of the operation of HA, but no direction is mentioned at all. If it is the blueprint of the Government's medical policy in the next five years, both the industry and I will be very disappointed. Let me explain a simple reason why the public are still not satisfied with HA's services even the Government has allocated considerable resources to HA in the past many years.

　　The general public and Members evaluate HA's services based on the waiting time of patients. It is often heard that the waiting time of a patient is three years for the cataract surgery and five in the case of enteroscopy in individual cases. From this, it can be inferred that HA is certainly very ineffective. According to the new data on waiting time, it is found that in HA ― although I have repeated numerous times, I have to say it again as Members are not always present ― the waiting time for the Ear, Nose and Throat Department is, for example, 54 weeks in the New Territories East (NTE) Cluster and two weeks in the Central Kowloon (CK) Cluster, rendering a big difference in waiting time between the two. Why is the difference so big? It is because there is a problem with the resource allocation. For instance, in the example that I have just cited, the funding allocated to the NTE Cluster for every 1 000 people in the population annually is some $4.9 million. Why is the waiting time in the CK Cluster so short? It is because the funding allocated to the CK Cluster for every 1 000 people in the population last year was some $11 million, more than double the amount received by the NTE Cluster.

　　With the difference in funding between the two clusters exceeding a double, it is quite natural for a difference in manpower to exist too. There are only 0.7 doctors for every 1 000 people in the population in the NTE Cluster, while there are 1.3 doctors for every 1 000 people in the population in the CK Cluster. Was it a problem for one year only? Can the Government solve the problem by increasing its funding to the cluster with fewer resources and manpower? Yes, in theory, but has it done so?

　　In the review of the past six years, the provision for HA has increased from $28 billion to $41 billion, which is actually quite generous. However, we have to take a look at the allocation of funding among clusters. Let me give another example: the Kowloon East (KE) Cluster, which is one of the clusters which lack resources and manpower most, served 13.6% of Hong Kong's population in 2006-2007, but obtained only 10.1% of the funding allocated to HA, with 30% less. With the passage of six years, the catchment population served by the KE Cluster has changed little, accounting for the same percentage of about 13.6%. Although HA has increased its funding to the KE Cluster by more than $10 billion, but the ratio of funding obtained by the KE Cluster is, and has all along been, 10.1% which has not been increased at all. Is it actually a problem of inadequate manpower?

　　Let us look further back at some data. As a matter of fact, the number of HA doctors has increased in each of the past 14 years. In 1998, there were only 3 500 doctors in HA and the number of doctors has increased to 5 300 last year, with a rise of 40% to 50%, far more than the growth of Hong Kong's overall population and the increase in HA's service throughput. In short, it is basically a problem of uneven allocation of resources. Regardless of the amount of increase in government provision to HA, if the ratios of resources obtained by the clusters without adequate manpower have not increased, their manpower will still be inadequate even though the Government has further doubled its provision of resources and manpower for HA. Where does the problem lie? It lies with HA's internal resource allocation system.

　　In a nutshell, the worse HA's governance becomes, the more rewards HA can get. This is because regardless of the amount of increase in government provision to HA, if the internal resources are allocated unevenly, some departments and clusters of HA will never have adequate resources. This will lead to HA's poor governance and when its services are poor, waiting time is long and the detailed reasons are not known, the public and Members will exert pressure on the Government to continue increasing provision for HA to increase its manpower. That is to say, institutionally, the worse HA's governance becomes, the more rewards and funding HA can get.

　　Therefore, the problem cannot be solved by merely increasing HA's provisions. Instead, it is necessary to introduce the "money follows patient" concept to HA's resource allocation mechanism. That is to say, if a cluster is under great work pressure and serves more patients, it is necessary to allocate more funding to it. Why can the "money follows patient" approach solve the waiting time problem? I gave an explanation on it earlier. For example, when my wife was going to give birth in a private hospital last month, the doctor recommended her to receive an ultrasound scan of the brain. My wife was intended to be discharged from the hospital at 10 am, but she was informed by the hospital that such scanning service could only be arranged for her at 4 pm. My wife then said if she had to wait for more than six hours, she would rather be discharged from the hospital to find another one. The private hospital said that in such case it could, quite simply, arrange for her to receive an ultrasound scan of the brain immediately. With the "money follows patient" concept, service providers naturally have a great incentive to refrain from asking patients to wait because if they are required to wait, money will follow them away. Therefore, if the waiting time problem is to be solved, the "money follows patient" concept is very critical at the macro level of the institution.

　　As I often criticized last year, it was not possible for the waiting time of various clusters to be so different since under the same roof of HA, the waiting time of one cluster could not impossibly be so many times longer than that of another. Measures are proposed in the Policy Address to provide patchy remedies, that is, HA will adopt an internal administrative measure to transfer waiting patients from some clusters with long waiting time to those with shorter waiting time. For instance, patients seeking treatments from the Ear, Nose and Throat Department in the KE Cluster can be transferred to the CK Cluster. This measure will achieve certain effects at first, but it will become ineffective very soon. Why will it be so? It is because my colleagues in the CK Cluster (that is, those in the cluster with shorter waiting time) will soon complain to me that the waiting time of their cluster is short because they work efficiently and medical consultations are done quickly. They will say, "if our medical consultations are done efficiently and quickly, HA will transfer more patients to us to increase our workload; as such, it is best for us to keep up with general efficiency." If the waiting time of a cluster is a little more than 90 weeks, we should slow down a bit to lengthen the waiting time to 90-odd weeks.

　　The core of the problem is that it is just not feasible to transfer patients only without effecting institutional change in the allocation of resources. The effectiveness of this method can only be maintained for about several months or one year at most and the waiting time of all clusters will be lengthened in a crack.

　　How can the "money follows patient" concept be implemented at the institutional level? It can be implemented from senior grades downward and at the front-line level, simply speaking, it will actually become a "more work, more pay" working-hour mechanism, that is, the standard working hour mechanism. As a matter of fact, are the working hours of my colleagues in the HA really very long? According to HA's own survey, the number of working hours is about 50 only, that is, 5 000-odd doctors work approximately 50 hours a week on average. In fact, it is arguably not very long, but in the absence of the "more work, more pay" working-hour mechanism, many not-quite-senior colleagues will carve a niche for themselves by refraining from working excessively long hours and too hard. If they cannot do so, coupled with the absence of the "more work, more pay" mechanism, they will leave HA.

　　Therefore, if HA intends to shorten waiting time and retain talents, it should implement the "money follows patient" concept at the institutional level and the "more work, more pay" working-hour mechanism at the front-line level. After all, does the implementation of the "more work, more pay" working-hour mechanism ― as I have also mentioned it to the Secretary before ― require a lot of money? The Secretary once said: "It is very difficult to implement the 'more work, more pay' mechanism as the basic salaries of doctors are too high". He said that it would probably be feasible only if the basic salaries of doctors were reduced before overtime pay was given, making the expenditure on the "more work, more pay" mechanism and the level of expenditure on their original salaries comparable. Let us calculate how much money needs to be spent. The annual total expenditure of HA is about $40 billion at present, but the total remuneration paid to doctors is only about $7 billion. If HA sets up a "more work, more pay" mechanism to give overtime pay to its doctors, based on a 50-hour work week ― as doctors work 50 hours a week on average according to HA ― under proper management, no overtime pay will be required to be given in theory if overtime pay is only given for a work week exceeding 50 hours (the calculation is done to my disadvantage because overtime pay is not given for a work week with less than 50 hours). Of course, I do not want to put my colleagues originally working less than 50 hours a week (such as those who work 45 or 46 hours a week) in an unfavourable situation by making them work a few hours more. I only suggest that overtime pay should be given to those colleagues who have all along been required to work excessive overtime, that is, over 50 hours a week. If so, the expenses used to deal with this historical problem are in fact only about $1 billion a year according to my estimation. In the past six years, HA's current expenditure has increased by more than $13 billion. For the $1 billion, it is, I think, absolutely affordable to the Government if the personnel management mechanism can be improved, thereby shortening waiting time and enhancing efficiency.

　　On the contrary, is it practicable if you even want to save this $1 billion and cut the basic salaries of all colleagues by 16% in the first place? This is rather difficult because a lot of colleagues, such as those senior colleagues I mentioned just now, have all along been paid this salary and have secured a nice environment for survival. You, however, suddenly ask them to have their salary cut. I would be surprised if they would accept such a salary cut. If we all and the Government consider that manpower is important, then it is unreasonable to headhunt with low salaries when there is a relative shortage of manpower. Instead, the salaries of the colleagues should be slightly raised so as to retain them. So I hope all of you understand my analysis. In fact, it is very simple. The mechanism of "more work, more pay" should be put in place, while HA should implement the "money follows patient" system in order to provide incentives for reducing the waiting time.

　　As there is still some time, I would like to discuss an issue mentioned by Mr LEUNG Chun-ying in his election manifesto, which is the proposal of introducing tax concessions for health insurance. When he made this proposal, no condition was appended to it. At that time, he said that a study would first be conducted on health insurance, and then he would see what could be done. Moreover, he also proposed that tax concessions could be introduced for health insurance so as to provide an incentive to attract more middle-class people to take out health insurance cover. Yet in the current Policy Address, he seems to have linked the tax rebate for health insurance to the Voluntary Health Protection Scheme previously put forth by the Government. It appears that he will not implement tax concessions for the time being. In addition, if the Voluntary Health Protection Scheme previously put forth by the Government does not come into existence in the end, whether tax concessions for health insurance will be left forgotten? I hope the Government will honour the pledge of the Chief Executive in its Budget. Actually, according to his declared principle of introducing new measures once they are ready, it is unnecessary to link the provision of tax concessions for health insurance to the Voluntary Health Protection Scheme. The former can indeed be launched immediately to alleviate the burden of the middle-class people. I so submit.