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香港特区政府在2010年提出自愿医疗保障计划,落实计划的关键是私营医院和保险业界的参与。政府提出以500亿港元的公帑作为启动资金,鼓励私营医院和保险业界参与,条件是私营医院和保险业界接受更多政府的监管。不过,从一开始,保险业界的反应就是观望。它们质疑政府对于参与人数的估计过分乐观。但是,它们更关心私营医院是否愿意接受套餐式收费。如果私营医院不愿意接受,保险公司将难以计算医疗成本,最终也难以计算保费。至于私营医院方面的态度就更消极;它们对套餐式收费的安排尤其有保留。从医院的行政管理角度看,它们面对一线医生的专业意见,难以挑战,尤其医疗专业的核心价值是医生必须尽全力救治病人,这令医院的管理层难以用控制成本的理由去干预。更重要的是,前任特首曾荫权在任内提出发展六大产业的主张,其中包括医疗产业化。这个医疗发展的策略性方向与加强对私营医院的监管,有互相矛盾和抵触之嫌。不幸的是,正当政府提出医疗保障计划的时候,内地孕妇来港产子的人数大幅增加,令私营医院更加肯定医疗产业化的方向。它们曾经抱怨的公私营失衡问题,忽然消失于无形。这可能是政府所始料不及的,也是私营医院对医疗保障计划态度消极的根本原因。当香港下一阶段的发展需要政府更积极干预的时候,社会不同界别却因为习惯于过去非常宽松的监管,而抗拒政府更积极的干预。各界对医疗保障计划的反应,可以折射出香港未来改革所面对的困难。
The Hong Kong SAR Government proposed a voluntary medical protection scheme in 2010. The key to implementing the plan is the participation of private hospitals and the insurance industry. The government proposes to use a total of 50 billion Hong Kong dollars as a start-up fund to encourage private hospitals and the insurance industry to participate in the light of the government regulation in the private hospitals and the insurance industry. However, from the very beginning, the response from the insurance industry was wait-and-see. They question the government’s over-optimism in estimating the number of participants. However, they are more concerned with the willingness of private hospitals to accept package charges. If private hospitals are unwilling to accept it, insurers will find it hard to calculate the cost of health care, and ultimately it will be hard to calculate premiums. As for the private hospitals, their attitudes are even more negative; they have particular reservations about package pricing arrangements. From the perspective of hospital administration, they face challenges from the professional advice of first-line doctors. In particular, the core value of medical profession is that doctors must do their utmost to treat patients. This makes it difficult for hospital management to intervene on the grounds of cost control. More importantly, his predecessor, Donald Tsang, raised the idea of developing six industries during his tenure, including medical industrialization. The strategic direction of medical development and the enhancement of supervision over private hospitals are suspected of being contradictory and contradictory. Unfortunately, just when the government proposed a medical protection scheme, the number of pregnant women coming to Hong Kong in the Mainland has increased substantially. This has given private hospitals more certainty of the direction of medical industrialization. The public-private imbalances they once complained suddenly disappeared intangible. This may be beyond the expectations of the government and is also the root cause of the negative attitude towards the medical insurance scheme in private hospitals. When the next phase of Hong Kong’s development requires a more active intervention from the government, different sectors of society resist the government’s more active intervention because of its accustomed to the very loose supervision of the past. The response of various sectors to the health protection plan can reflect the difficulties Hong Kong faces in future reforms.