Official Statements, Guildelines and Documents
Response of the Hong Kong College of
Paediatricians to the Report on 'Improving Hong Kong' Health Care System: Why
and For Whom?' by the Harvard Team
The Hong Kong College of Paediatricians would like to express our
appreciation to the Government of Hong Kong SAR for commissioning a team of
economists, physicians, epidemiologists, and public health specialists from
Harvard University to conduct a study on Hong Kong's health care system in
November 1997. This reflects the Government's determination to review the
strengths and weaknesses of the current system of financing and health care
delivery and to propose strategic options for improving the system in Hong Kong.
The Hong Kong College of Paediatricians is one of the 15 constituent
specialty colleges of the Hong Kong Academy of Medicine. The main objects for
which the College is established are:
- to promote for the public benefit the advancement of
knowledge of the science and art of Paediatrics;
- to act as a body for the purpose of consultation in matters of educational
or public interest concerning Paediatrics; and
- to develop and maintain the good practice of paediatrics by ensuring the
highest professional standards of competence and ethical
Hence, the College, acting as child advocate, is obliged to express our
views on the Harvard Report, to ensure that quality health service must be
provided to all children in need without any barrier, be it financial,
administrative or otherwise.
The Harvard Report has put much emphasis on options to improve financial
sustainability of the health care system; however, the College would like to
focus on the more important issues of improving equity, quality and efficiency
of health care delivery for children in Hong Kong.
What the 'Harvard Report' did not address
- The report did not address issues relating to children. Children cannot
speak for themselves. Children have no income and cannot insure for themselves.
They are most vulnerable to adverse influences. They need their family and the
society to nurture and protect them during this vulnerable period of growth and
- The report did not address the important issues of promotive and preventive
health care for children. Health of children has a great effect on productivity
and output of a society, as it will influence a child's ability and motivation
to learn. These effects, in turn, influence adult productivity and advancement
of a society. The protection of health and improvement of health status of
children must be of paramount importance and priority. Actions must be taken
principally by health services to promote child health and development and
prevent childhood illness and handicap.
- The report did not address rehabilitation service to children with chronic
illnesses and disabilities. There is no well defined policy for rehabilitation
service and the Government has relied heavily on voluntary agencies for the
provision of such services. These children are at greatest risk to suffer from
adverse influences if they are not provided with a comprehensive, accessible,
equitable quality health service.
College is of the opinion that the Government should take up the responsibility
to provide primary, secondary and tertiary prevention in child care.
- Primary prevention aims to reduce the incidence of disease
in children and its subsequent sequelae. The childhood immunization programme
has been successful in preventing diseases, such as poliomyelitis, hepatitis B,
etc. Services provided by the Maternal and Child Health Centres should be free
and have been very successful in providing vaccination coverage of over 95%.
The Government should also take up the responsibility to promote positive
parenting to prevent child abuse and child behavioural problems and to promote
healthy diet and life style to prevent future chronic diseases.
- Secondary prevention aims to treat patients either in order
to cure them or to reduce the more serious consequences of disease through early
diagnosis and treatment. This will reduce the prevalence of the diseases.
Hence, the neonatal screening programme provided by the Clinical Genetics
Service and the developmental screening programme provided by the Child
Assessment Centres should be free.
- Tertiary prevention aims to reduce the progress or
complications of established disease. It consists of measures to reduce
impairments and disabilities from the disease or injury and so minimize any
handicap which may result. Thus after developmental screening has revealed
motor, visual or hearing impairments before disabilities have become apparent,
consequent early application of remedial measures may limit the adverse effects
of such impairments. For example, tertiary prevention through the
rehabilitation of children with physical handicap can enable them to take part
in daily social life and bring about a great improvement in the well-being of
these children. The Government should coordinate and subsidize these
multidisciplinary rehabilitation programmes.
Organization of Child Health Services
The bulk of primary health care is currently provided by the private sector
(curative) and the Department of Health (preventive). The more sophisticated
medical problems are referred to specialists in the Hospital Authority and the
private sector. At present, child health services are fragmented and
Proper interface and collaboration among
the Department of Health, Hospital Authority and the private sector should be
promoted. This could be achieved by:
- establishment of effective communication channels;
- streamlining of referral and follow-up services;
- development of shared care programmes;
- formulation of clinical practice guidelines and protocols; and
- setting up a common database for continuity of care.
A dual system of public and private practice could co-exist and
provide the freedom of choice for patients and avoid monopoly of services.
There should also be better coordination between health care services and
other service providers, such as education and social
Professional Accountability and Quality
The College opines that improving safety and quality of care should be a
central concern for all those in the health care system: policy makers,
government, governing bodies, managers, health practitioners and consumers
alike. The professional regulatory bodies, i.e. the Hong Kong Medical Council,
would ensure that professional self-regulation keeps pace with public
expectations and is more open and accountable. The health care professionals
should take up the key responsibility of ensuring health care safety and
quality. The general principles would be:
- Those organizing and managing the health care system should be responsible
for creating and maintaining a system which provides safe and high quality care:
- Those practising within the system should be responsible for the standard
of their own practice and should share responsibility for creating and
maintaining a system which provides safe, high quality health care: peer
review practice, medical record review, etc.
- All those managing and working in the system should work together and with
consumers to improve the safety and quality of health care: incident
monitoring and development of valid safety and quality of care
The College is committed to training and professional development of its
members. Since its inauguration in 1991, the College has published its own
journal, organized postgraduate training courses and update series and conduct
examinations in Paediatrics to ensure the highest professional standard of
competence and ethical integrity among paediatricians in Hong Kong. The
maintenance of a high professional standard among our paediatricians is the best
way to ensure that quality health care is delivered to children in our society.
The Hong Kong College of Paediatricians believes that the Government of Hong
Kong SAR is committed to improving the health care system in Hong Kong. We
believe that the central goal of quality improvement in health care is to
sustain what is good about the existing system while focusing on the areas that
require improvement. We believe that quality improvement could be achieved by
partnership between the Government and the clinical profession. We believe that
the ultimate aim of this partnership is 'HEALTH FOR ALL'.
We would like to conclude by quoting from the United Nations Convention
on the Rights of the Child (1989) which embodies the right of every child
- Equity regardless of race, religion, nationality or sex
- Special protection for full physical, intellectual, moral, spiritual and
social development in a healthy and normal manner
- Adequate nutrition, housing and medical services
- Special care if handicapped
- Love, understanding and protection