HEALTHCARE, HONG KONG STYLE

[defrog]

Some people have been asking me about the Hong Kong healthcare model. And seeing as how US Republicans love to point our way whenever they want to “prove” that flat taxes and laissez-faire capitalism works a treat and the US should copy it, whilst conveniently ignoring the fact that we have socialized medicine, public housing and govt investment in infrastructure, I thought I’d oblige with a little info.

First of all, as you might expect, as a former UK colony, Hong Kong’s healthcare system is based more or less on the NHS (National Healthcare Satan) model. We have the Hospital Authority (HA), which runs the public hospitals off a budget that works out to something like 15% of the total govt budget. We also have about a dozen private hospitals.

It’s not single-payer as I understand the term (and I confess I don’t, really) – you either pay the doctor/hospital directly, or you hand them a medical insurance card and they submit the bill to the insurance company who then decides how much if any they’ll cover. Or you pay the bill and then submit it with a form to the insurance company for compensation (if any).

The good news is that the quality is overall pretty good (though certainly not perfect). The bad news is that we’re competing with Israel for the position of second-highest healthcare costs in the world after the US – which is problematic because while the private sector accounts for over half of primary-level care (which is pretty cheap), with the rest split between public doctors and Chinese medicine practitioners, the public sector handles over 90% of secondary care, which is way more expensive.

Ironically, the fact that we have the second-highest life expectancy is also creating a problem as the size of the elderly population grows. And for years the HA has been under a lot of strain with the budget it has – a fact that was made all too clear with the SARS crisis in 2003.

So the HK govt has been looking at reform issues as well, though as far as I know they still haven’t come up with a plan. It may just be a question of better money management and interactivity with the private sector (at the moment they’re completely separate in terms of records, referrals, etc). But it’s worth pointing out we’re financing most of this on a flat-tax system in a city of 7.2 million people. So higher taxes are also a possibility.

I can’t say how much of this applies to the US, but there is a similar theme here: rising costs and system inefficiencies. If yr going to do universal healthcare, you need to get the money from somewhere, and with costs as high as they are, you need the most efficient system possible to deal with it. That’s why Medicare is the elephant in the room in the US healthcare debate, and it’s why I feel that one genuine criticism I’ve heard of the Obama/Demo plan to date is that they haven’t yet worked out a concrete way to fund it 100% yet – and in a way that allows for the likelihood that initially it’s probably going to cost more than they think.

That’s not an argument against reform, of course. And the current system, frankly, isn’t going to get any better without at least the threat of govt intervention. Here on the LJ, bedsitter23 and dydan have good insider explanations as to why. But if the HK example is anything to go by, a govt plan by itself is no guarantee of healthcare costs going down, and it’s not an easy thing to keep in the black.

But then I know dick about healthcare, so don’t take it from me. I’d suggest reading this article to get a sense of what HK is up against, and this really long article from Paul Krugman and Robin Wells that breaks down the problems with the US healthcare system. If you can figure out what any of them are saying, let me know.

Okay, that’s all I got on healthcare. You may now go back to shaking yr fist at the television. I'll be back shortly with retro babe pictures or something.

Turn yr head and cough,

This is dF

Comments

[thelastaerie.livejournal.com]

my own and my family's experience with the HK healthcare system is that: for minor illnesses, nearly everyone can afford pretty high standard healthcare - extra comfort and convenience when you pay more and go private.

For more serious health problem though, a private insurance will help a lot - you get treated faster and stay in a better room etc. But still, we aren't talking about the crazy numbers they have in US when you go private and don't have insurance cover.

On thing I'd like to point out is that, when my mom was ill (cancer, stage 1), she first got diagnosed by a private family doctor, then we (her children) all chipped in and sent her go private to have the first surgery done. The after-treatment of radiotherapy though - she was referred back to a government hospital which had been a smooth run and "nearly" free (about HK£200 for each check-up). And the whole private-then-public transition/referral thing was pretty smooth and done without much headaches.

A friend of mine who work in a major government hospital mentioned that in HK, the most advanced hospital equipment are actually in government hospital.

[def-fr0g-42.livejournal.com]

Good extra points to make. I'm just glad I got the basics right (though I'm assuming you'd have pointed it out if I got anything wrong).

The other thing too is that, on the whole, people in Hong Kong are generally way better at saving money than Americans. So even where the insurance companies fall short, the majority of people can cover the shortfall somehow – not always painlessly (so to speak), but not to the point of having to declare personal bankruptcy.

here's my simplification of their article

[loissanborn.livejournal.com]

i read the second article. my mother has been in medicine for over 25 years, and i am very familiar how the system works. for those who are not familiar with how the health care system works, i can see why this would be confusing.

this is a WONDERFUL article... though they do undermine my main objections to universal healthcare. i have not yet seen one this comprehensive before. i'll simplify what they say the problems are (which i agree with their analysis).

in terms of a government funded healthcare, they first talk about the rising cost of healthcare and what causes it.
:::cost:::
they surmise that one of the causes of the rise in cost is the advancement in medical technology. advancements are thought to be a good thing. it saves more lives and makes for a healthier population HOWEVER, these new medical advances cost exponentially more than previous, less effective treatments.
they also attribute a lot of the cost to the fact that there are so many different branches of the healthcare system, but no one entity to reign the whole system in and make it more efficient and cost effective.

:::selective insurance providers:::
they then point out that because of these more costly procedures, insurance providers try to keep themselves in the black by selecting who they will cover (ie those whose estimated yearly medical costs will be less).

:::the reasons for sub-standard care:::
They also point out that doctors make judgments based on how much treatment will cost because doctors know that the patient will be saddled with a portion or all of the bill. this contributes to sub-standard care due to medical cost.

:::the unraveling of employer based insurance:::
they talk about how employer based insurrence is unraveling because the cost to insure everyone is a financial strain. this issue is a bit more complicated so i'll try my best to simplify. bear with me...

they lay out what happens when everyone is charged the same medical premium(like employers do), and if everyone was insured regardless of medical issues.

let's say a flat-rate premium(how much a person pays for medical coverage per month) was calculated by:

estimating what percent of your insurance recipients will be healthy patients, and what percentage will be unhealthy patients... then factoring healthy individual's estimated medical costs, and the unhealthy individual's estimated medical costs. take the sum of that estimated cost and add it to the administrative costs to run the company. there is your bottom line of estimated medical costs for all of your insurance recipients. divide that overall cost by however many insurance recipients you estimate will buy your inssurance, and you have an individual's premium. thus everyone pays the same amount, and everyone is covered. the authors call this principle 'robbing peter to pay for paul'. sounds good in principle, but here is where they point out the problem with that:

-unhealthy people would flock to that insurance company because they'd be getting a half way decent rate, and no one else will insure them
-healthy people would flock to other companies. the reason for this would be that healthy people would be paying more in premiums at that company to compensate for unhealthy people who have higher medical expenses than they would at another company, whose overall expenses were lower. healthy people would opt for a company that is selective about who they insure, that can offer premiums at a lower rate.

because of this, the insurance company would be forced to raise premiums again and again because the majority of their insurance recipients medical costs would be unusually high. the insurance premiums would be so high, the recipients would no longer be able to afford the premiums.

the reason this is affecting employers is because they do not screen their employees for medical issues. legally they cannot. their unhealthy employees opt for the company insurance, and their healthy employees opt for other private insurance that may be at a lower rate. major funding problems are causing employers to no longer offer healthcare options because they are so expensive to the company.

i had to do this in two parts

[loissanborn.livejournal.com]

cont'd

the people who wrote this article point out that if the US offered a government funded health program, that this same issue would cause major hiccups in the effort. the government would assume that a certain percentage of healthy and unhealthy people would opt for government healthcare which would be offered at a flat rate premium. all the healthy people would opt for a lesser expensive private company, because their premiums would be lower, and the government would then be left with the majority of their healthcare recipients having major health expenses. the only way to even out expenses would be for the government to offer seriously sub-standard care to cover the cost to keep the program afloat.


they talk about the problems with several health care proposals, debunk a bunch of misconceptions. one point that they highlight (thank god someone finally pointed it out) was the unhealthy american lifestyle, and how that contributes to the problem of the cost of medical care. they point out that there is an 80-20 rule when it comes to healthcare costs. 80% of the overall cost of healthcare is attributed to a small percentage of unhealthy people with massive costs, but the problem is in america, we have A LOT more unhealthy people than what is 'normal' for many other countries.

they lay out that some of the reasons, BIG reasons, that health care costs so much here is because there is nothing that unifies the system. so many different insurance companies, drug companies, etc. there is no one entity that huddles them all together and streamlines the process, thus lowering the overall cost.

they argue that the ONLY way to even things out so that everyone gets the same level of care, and the same insurance, is to eliminate private companies, so that no one would have any choices but govnt care. this, of course, goes against free market, and would never be allowed, so there is a real problem here. they say that any half-way plan that will appease both sides will fail miserably, and the only way to successfully create a government run healthcare system is to wipe out the current structure, and completely socialize medical care... but they say that even this won't fix the problem. eventually the government would have to ration healthcare because the current medical climate is to do whatever is necessary to fix the patients medical problem... even if they are much older and have only a few years to live, and the because of medical cost associated with an unhealthy lifestyle.

that's pretty much the simplified version of this article.

do i agree with their estimations on where the problems are?... yes. i do not like the idea of one choice, and rationed care. they do talk about solutions to reform the healthcare system... but what they don't talk about is how they will fund a program that is supposed cover a nation whose population leads an unhealthy lifestyle. that is my biggest issue. you can look at all the other countries healthcare models you want, but america's will never be like other countries models because the majority of our population has adopted a sedentary, fast-food lifestyle which contributes to massive medical costs. that massive cost WILL eventually lead to sub-standard, and seriously rationed care for all in order to provide care for all, no matter which way you look at it.

serious problems indeed.