In pluralistic Hong Kong, residents never hesitate to take the government to task over real or imagined deficiencies in public services. But this vocal community is rarely heard complaining about the inaccessibility of healthcare services or exorbitant hospital charges. Even the poorest group is assured of good health services, thanks to the government's fundamental philosophy - no one should be denied proper medical care.

Comprehensive Social Security Assistance (CSSA) recipients are exempted from paying their public healthcare services bills. The government also has a fee-waiver mechanism for three non-CSSA vulnerable groups - those with low-incomes, chronically ill patients and senior citizens - to protect them from undue financial burden.

This patient-first public health approach is in sharp contrast to the mainland's health system, marked by medical services that are increasingly being priced beyond the reach of ordinary people, especially the underprivileged such as rural residents, the urban poor and migrant workers.

The seething discontent among those that feel hard done by and resent the profit-driven medical system has led even the Ministry of Health itself to acknowledge the mainland's medical reform programme has been "unsuccessful."

Just three decades ago, the World Health Organization hailed China's public health system as a model for the world. The goal of the health programme then was to provide medical care for every member of society. The quality of services may have varied between rural and urban areas but no one was plagued by the fear of being left unattended.

Today, things are starkly different. It is true that from 1990 to 2000 the average income rose five-fold in urban areas and three-fold in rural regions. But it is also true that increases in medical costs have far outpaced those rates - to be precise, they have increased by a factor of nine.

The poor, low-income earners and even a large percentage of the middle-class just cannot take care of their ailing or chronically ill relatives. Rural areas on the whole have very poor environmental and sanitary conditions - a breeding ground for disease.

Primary healthcare has come to mean low quality healthcare services for the poor. Profit-hungry hospitals have built barriers that only the affluent can cross.

Even State-run medical facilities, supposed to provide "safe, reliable and inexpensive" services, rely on income from patients for further development. That statement came from none other than Minister of Health Gao Qiang. He said hospitals motivated by profit, instead of caring for the sick, were to blame for some of the problems plaguing the country's health system.

"Patients' medical bills are being used to cover almost everything, from the cost of medicines and wages and subsidies for doctors and nurses to new medical apparatus and hospital facilities."

But Gao held out hope, too, when he said the "next step of medical reform will focus more on public interest and affordability of medical services for all."

But how will that be done? We can make medical services more affordable in three ways - by increasing citizens' income, by increasing insurance cover or by controlling medical costs. The government has been trying on all three fronts. But success has come more on the income front than on insurance and cost-control.

Investment in healthcare must not be seen as an unnecessary burden. Government funding is just as important as cash pumped into roads, buildings and bridges, or national security and a sound legal system.

A healthy population means a healthy workforce. Only a healthy workforce will be able to continue to keep up the pace of China's economic development.

To achieve that goal, the government must not leave healthcare at the mercy of market forces. It has to provide basic medical services for the population in areas where the market fails to deliver.

An estimated 50 per cent of the population will be living in cities in 15 years' time. We must urgently begin to plan for meeting the disparate needs of the rural and urban floating populations.

To build a better health system, we not only need sound policies, but also a critical mass of well-informed, open-minded and highly-responsible officials at all levels that will be able to effectively implement the directives.

For that we need not look further than Hong Kong. It is the best possible model that will help us provide, as Gao has said, "health for all."

(China Daily 09/30/2005 page4)