We are now in a crucial stage of health care reform as the government has just announced it will review the structure and functions of the Hospital Authority. It also says strategies like public-private hospital co-operation and primary care are set to be implemented in the near future.
It is vital to ensure that the public health care system is managed effectively before any reform proceeds, or else it will be disastrous to rely on an ill authority in the driver’s seat.
The first major problem revealed during the controversy is the authority’s low initiative in supervising its seven clusters (or groupings of hospitals). The central authority showed up to intervene only after Dr Yu went public with his complaints.
The clusters have high autonomy in different aspects of administration and management. But it does not mean that the central authority has no responsibility in actively looking into disputes within a certain hospital or cluster.
Moreover, it appears there is no viable way for the concerned doctors to request for direct intervention from the central authority, which is why Dr Yu had to make the issue public.
It is a failure of effective corporate governance, which requires a fair and independent third party to audit and investigate different issues in the organisation.
The central authority should require regular reports from the clusters about different disputes. And it should act independently to avoid conflict of interest when a cluster appoints an internal team to handle the issue.
In addition to the failure of effective governance and communication, the possible root cause of the power struggle – resource allocation -- further showed another weakness in the current public health care system.
Resource allocation, especially research funding, has been the cause of disputes in different sectors. In Hong Kong, the two clusters affiliated with medical schools are more resourceful than other clusters. While it is good for the cluster to decide how to use the funds, which upholds academic autonomy, the Hospital Authority should pay extra attention to the other five clusters which don’t have much research support.
On the other hand, the authority should actively guide the direction of research as that will immensely improve the development of the public health care system. Resources should be directed to areas that can benefit the whole population and create the largest impact, such as primary care engagement.
A central authority that collaborates and governs its clusters more strongly is needed to drive reforms in the public health care system so that we are ready to face future challenges posed by an ageing population, epidemics and non-communicable diseases.