SHAPING UP FOR THE 21ST CENTURY
Authority is able to introduce reforms in management. Hospice care for the terminally ill is the new form of care advocated by voluntary agencies, but the units that already exist are financed by charitable donations. However, the costs will soon move the service beyond the scope of private fund raising.
In one respect medical thinking seems to be going backwards. In the early post-war years a great battle was fought to eliminate the practice of Chinese medicine in the Tung Wah Hospitals. Chinese medicine is still widely practised and patronised. It is not going away so it is now being studied more objectively with a view to separating genuine practitioners from the quacks. No doubt more will be done in the field of other health care services so that in the future the various disciplines will treat each other with more understanding than is sometimes displayed today.
At the same time research in wealthier countries is producing more and more expensive procedures whose efficacy is being questioned. 'America devotes nearly 12 per cent of its GNP to its high technology medicine, more than any other developed country. Yet, overall, Americans die younger, lose more babies and are at least as likely to suffer from chronic diseases.' says a recent review of American medicine in The Economist*. In Hong Kong we have boldly declared, in the Hospital Authority Ordinance, that 'no person should be prevented, through lack of means, from obtaining adequate medical treatment.' Owing to the rising costs of medical and health care, insurance will have to play a bigger part than it does today, but the form of insurance, and the way the risk is spread will need considerable ingenuity from the government and industry. The government has set its face against compulsory contributions to a provident fund, yet there will be a need for more funds to be set aside for old age. It could be that insurance for old age will find a bigger place in Hong Kong than it has in the past.
There is no easy solution to the provision of health care for an ageing population nor is there an obvious model from the advanced countries that we should follow.
In social welfare a new White Paper has recently stated government policies for the future and is aimed at ensuring that help reaches those in need regardless of wealth. Social problems are as likely to be found in families of means as in poor ones. Social security will continue to be financed directly by the government but many other services will be provided by the voluntary agencies. Present methods of financing these services through government grants are bureaucratic so it is hoped that some less rigid method can be devised through the contracting for services.
There will continue to be scope for privately financed welfare. In any caring community there will always be those who see a need that is not being met. It is right that they will continue to seek support from private citizens and corporations.
Catastrophe
I have no doubt that many will say that this review is too benign, that it fails to take into account the real risks that a change in sovereignty will bring great changes in life.
It is true that we live in an area that has had its share of catastrophes. In 1938, as a child, I was lucky to get onto a river boat in Canton before the captain cut all the mooring ropes of the surrounding sampans and set off to avoid being swamped by refugees fleeing from war. For nearly four years Hong Kong was occupied by a Japanese force which brought
* The Economist October 20, 1990.
19