Friday, June 13, 2008

香港醫療與健康促進會

吳歷山、周伯展、林永佳﹕先醫療改革 再醫療融資
2008年6月13日

【明報專訊】香港食物及衛生局推出的醫療改革諮詢文件,彩色封面佔一半版面的是一張攤開的大手掌,據說5個手指分別代表醫療改革的五大措施,但攤開的手掌更像是伸手要錢,而政府也並不諱言眼下香港醫療系統正面對沉重的壓力和負擔,不融資遲早「爆煲」。我們認同香港醫療有融資的必要,這是今後整個社會要面對的現實問題,不覑手考慮將後患無窮。我們並不認同某些人把伸出的手形容為「打市民荷包」,因為錢拿來用於市民,如果此說成立,豈非強積金稅收也是「打荷包」,這種極端性意見只有煽情作用,沒有建設意義。

其實所謂「融資」本來就是「要錢」不必大驚小怪,而錢決不可能從天上掉下來,也不會像中東一些國家從地底冒出來。說來說去還是得向市民,特別是向佔香港大部分又出得錢的中產階級要錢。然而既然叫人掏錢,人家必定要問一聲,為什麼和要多少?假如管理得不夠好?改善管理後情又如何?

改革 融資 能一起想不能一起做

諮詢文件的5項建議措施,前4項屬醫療改革措施,分別是﹕加強基層醫療服務;推動公私營醫療協作;發展電子健康記錄互通;強化公共醫療安全網,第5項則是包含6個「套餐」選擇的醫療融資方案。政府不時強調醫療改革和醫療融資「不能割裂」,必須「一起想,一起做」。

然而,我們認為改革和融資之間並沒有必然的聯繫,能一起想,但不能一起做。理由是,第一,上述前3項改革措施,社會上不存在任何爭議,必須立即推行。第4項是強化安全網必須在成功推行醫療融資後才能實現,只能押後。第二,醫療融資最快要5年後實施,與改革措施存在至少5年的時差。第三,這些措施切中時弊,只要得到順利實施,香港醫療面貌將出現重大改善,屆時作出的融資選擇將更加合理,也更能說服市民出錢融資。

除了上述3項改革措施以外,在諮詢文件的融資方案中提到幾味「菜式」也可以立即推行,如「用者付錢」逐步提高公營醫療收費、鼓勵和推廣自願購買醫療保險(配合政府的扣稅優惠和對保險公司的利潤監管),及擴大醫療券等「錢跟人走」措施。這些「醒目菜式」受到社會的普遍接納和歡迎,應該立即拿出來給市民「品嘗」,從而加強市民對於自身醫療承擔的認識和體驗。

多項改革先行 醫療面貌即改觀

我們贊成此刻就開始討論醫療融資,但必須明白,今次是香港政府由始以來第一次提出的醫療融資方案,是影響我們下幾代人的長遠而龐大的改革工程,在社會未達到基本共識前,必然有一段「認知」和「磨合」的過程。依香港目前的社會和政治現狀來看,短期內達到共識的機會甚微,保守估計至少需要3、5年甚至更長時間的討論和消化。難道在社會尚未達至共識前,或者市民沒有選定何項融資方案前,一切改革都要停頓不成?其實,上述提到可以先行實施的改革措施只會促進市民對醫療融資的必要性和迫切性有更深刻的認知,為盡快達至社會共識鋪路。

我們建議在展開醫療融資討論的同時,用3年的時間大力推行上述的改革措施,必要時可以由500億備用金中抽調部分資金予以配合。

攤開的手掌若能暫且收起,團結力量,改革各項醫療弊端,也許更能達至掌握健康人生的目標。

作者是香港醫療與健康促進會成員

1 comment:

ipro said...

Medical reform should not be misguided as to focus on Financial Reform.

Many have missed these points that:
1. Food and Health Bureau executes a discriminative policy towards Modern Medicine as the primary treatment for all types of illnesses and diseases

2. Protectionism accounts for a critical reason in making up an unnecessarily prohibitive budget of our health care system

3. Protectionism is seen from
- posing obstacles to allow imports of medical professionals from Modern Medicine (MM), Traditional Chinese Medicine (TCM), Nature Therapy and other alternatives
- comparing medical bills charged in public hospitals
MM $45 (more heavily financed)
TCM$120
- no market freedom to operate a pure TCM (or other therapy) hospital as obstructed by law
http://www.legislation.gov.hk/blis_export.nsf/chome.htm


4. Policy makers are ignorant (or choose to ignore the fact) that
- TCM has been so economically effective to cure most of the illnesses (chronic type especially) such as cancer that Modern Medicine cannot heal
- Modern Medicine only cures <10% of the illnesses as named by MM itself
- MM does not know how to and cannot cure various types of Cold, Influenza. Indeed, there are many illnesses that MM simply acknowledges it does not understand their causes
- As seen in many modern cities, too many people are superstitious, simply take MM for granted as the most effective medicine to tackle illnesses. Many overlook the problems of evidence-based MM and the issues of marketing gimmicks played by the pharmaceutical giants.



The much misunderstood and undervalued medicine
http://www.hantang.com/chinese/ch_Articles/clinictraining.htm

http://www.hantang.com/chinese/ch_Articles/story.htm

http://tw.myblog.yahoo.com/il1942/

http://hk.geocities.com/dhammachanda_1/mscmc/bookindex.htm

The much exaggerated value of Modern Medicine

http://silver.neep.wisc.edu/~lakes/iatrogenic.pdf

"The Truth About the Drug Companies"

http://sa.ylib.com/book/bookshow.asp?FDocNo=909&DocNo=1443&CL=12

http://www.wanttoknow.info/truthaboutdrugcompanies

http://www.hms.harvard.edu/dsm/WorkFiles/html/people/faculty/MarciaAngel.html

Limits of evidence-based medicine

http://www.ccachiro.org/client/cca/cca.nsf/web/Limits%20of%20evidence-based%20medicine?OpenDocument

http://www.medicalnewstoday.com/articles/100038.php

http://www.thinktwice.com/secret.htm