Medical voucher scheme needs changes to be more effective
The government medical voucher scheme for the elderly has been a topic of discussion among a great many people in recent weeks. Some suggest that the vouchers are being abused by being used to pay for expensive preserved seafood delicacies and eyeglasses rather than for medical care.
Professor Yeoh Eng-kiong, former secretary for health and welfare, has jumped into the discussion, calling the system flawed and not cost-effective. He noted that 78 percent of elderly patients go to public clinics today, more than the 73 percent who did so before the introduction of the voucher scheme.
He was so right in recommending that a portion of the vouchers’ value should be assigned to disease prevention, such as screenings for diabetes, which affects one in 10 Hong Kong residents — although half of those are unaware they have the disease. He suggested a new voucher program to help younger residents screen for diabetes because people as young as 40 could develop the disease.
From the standpoint of this layman, the medical voucher initiative, designed a decade ago, was a step in the right direction, though it can, and should, be improved upon. Narrowing the scheme, say, by dropping eyeglasses, is certainly defensible but thought should also be given to widening it so as to include more doctors and specialists, with a focus on preventive medicine.
Speaking of spectacles, older people may require regular eye checkups, and so there should be no caps on their visits to ophthalmologists or optometrists. But spectacles are different, since they can easily cost thousands of dollars, and fancy eyewear isn’t a medical necessity; medical vouchers should be used for medical needs and not to make a fashion statement.
But in other ways the voucher scheme should be expanded. I offer my own experience over the last year to show how someone intent on using government medical vouchers can find it a frustrating experience.
I have only been able to use the vouchers with my dentist, whose nurse kindly informed me one day that she could simply deduct the dental payment from my medical voucher account that I didn’t realize I had. Since then, every time I saw a private doctor, I asked if medical vouchers were acceptable. So far, not a single one has answered yes, and there must have been about half a dozen doctors that I saw during that period.
When I had my regular physical check-up in late summer, I had to go to private medical laboratories for various kinds of tests. Every time I visited a clinic, I asked if they accepted government vouchers; none did. I was told that specialists generally don’t accept vouchers since patients are referred to them by other doctors. But it’s not clear to me why referrals should affect the acceptance of these vouchers.
I then decided to find a list of doctors in private practice who accept vouchers.
I began by studying the webpage introducing the medical care voucher scheme. I was at the time looking for a podiatrist but could not find foot-care specialists listed on the webpage on government vouchers. But the website helpfully provided an email contact, so on Jan 21, I wrote asking for help. I explained that while I would appreciate a list of doctors who accept vouchers, I was looking in particular for a podiatrist.
On Jan 30, I received a reply from Elaine Lo, executive officer of the Health Care Voucher Unit of the Department of Health. She explained that her department did not keep information about the specialties of Enrolled Healthcare Service Providers. With her help, I was able to navigate the website and discover the names of doctors who accept government vouchers.
I spent hours looking up each entry for doctors in various districts on Hong Kong Island and in Kowloon. Since doctors often don’t identify themselves by specialty, it is a time-consuming process to go through long lists of doctors to find those who might be podiatrists. But in the end I had to admit failure. I was unable to identify individual podiatrists, though there were hospitals who offered podiatric services.
I then checked the Medical Council website. I may have missed it somehow, but it seems podiatrists aren’t included in their 60 categories of medical specialists.
Through the internet, I found the names of some individuals and medical organizations involved in foot care. I approached them, by phone and email and, surprisingly, discovered that not a single one would accept government vouchers. I am sure that they could have provided the care that I needed, but for some reason they preferred credit cards to health vouchers.
One theory I have is that many private practitioners, especially specialists, have a well-to-do clientele and they are reluctant to display in their clinic a signboard that says that they accept government vouchers, which may suggest to some that they have patients who are welfare recipients. Of course, there is nothing wrong with having welfare recipient patients but there may be people who don’t want to share a doctor’s waiting room with them.
I wonder if the voucher system can be simplified so that doctors don’t have to sign up to join, and to display a big eye-catching sign saying that they accept government health vouchers. Evidently, a lot of private practitioners do so well that they don’t need to enlarge their clientele by accepting government vouchers.
To maximize the effectiveness of this voucher scheme, the government can take a leaf from the organ donation opting-out scheme adopted by some countries under which all persons are considered donors unless they make their objections clear. Applying this concept to doctors and the voucher scheme, it may be possible to stipulate that unless a specific indication to the contrary is shown, all medical and healthcare practitioners in private practice are presumed to be part of the scheme. And, yes, have their specialties made known as well in a centralized government website. That way, elderly patients may have more choices and vouchers may perform their intended function of paying for medical care, particularly for preventive medicine, rather than for eyeglasses.
If more private practitioners accepted health vouchers, we wouldn’t have to compete for the time and attention of overworked doctors in the public sector, further clogging up the public hospital system, leading to a more manageable distribution of patients.
The author is a writer and columnist based in Hong Kong and veteran foreign correspondent who opened The Wall Street Journal’s Beijing bureau in the 1970s.