The three key directions in the way forward for the Hospital Authority are to modernise it, reduce avoidable hospitalisation, and expand patient choice and access, its Chief Executive Shane Solomon says.

Speaking at the Hospital Authority Convention 2006 today, Mr Solomon said it is important to modernise staff roles around the concept of "right function, right skill".

"This involves taking more mundane tasks away from highly-trained professionals, such as our scarce doctor and nurse resources doing administrative tasks. On the other hand, possibilities for extending the scope of practice for nurses into more specialised areas need to be explored, consistent with practices in other parts of the world.

"Second, facilities need to be modernised to reflect modern clinical practice, improve the patient experience, and reduce the potential for cross-infection. Investment in new, upgraded, or replacement facilities needs to be placed on a well considered Health Services Plan for Hong Kong which considers among other factors, the population distribution, future demand projections, and consolidation and rationalisation of services to achieve a critical mass."

He also highlighted the importance of introducing modern management systems to make the best use of public resources. Modernisation of information technology is also needed to automate clinical processes more extensively.

On reducing avoidable hospitalisation, Mr Solomon said there is much scope to reduce demand pressures on hospitals. Much of the reduction in hospital length of stay has been achieved by new technologies, such as minimally invasive surgery and improved anaesthetic technique, but offering alternative services in the community or in step-down facilities has played a big part.

Chinese medicine

Mr Solomon said traditional Chinese medicine (TCM) is likely to have a stronger role in reducing hospitalisation. The authority's strategy of progressive implementation of TCM in partnership with the private sector will establish the evidence-base and collaborative model to further respond to community demand for TCM.

On patient choice and access, Mr Soloman said the authority has a role to play in expanding choices as it has many patients already with the capacity and willingness to pay for these additional service choices.

"Data shows that among users of HA hospitals, 23% have medical insurance or subsidy, compared with 37% in the total Hong Kong population. The top 10% of HA users have monthly incomes over $35,000 per month - that is about 200,000 of our existing patients earn more than three times the median income for all of Hong Kong."

Mr Solomon said more work needs to be done on what extra choices should be offered in the authority and in expanding choice for patients. The authority will need to be mindful of the wider community impacts and have adequate community debate, but the focus should remain on expanding choice for existing patients through both the private and public hospital systems.

"If more people can choose to contribute to the cost of their own care in the public hospital, then HA's own scarce resources can be directed to lower income patients who are waiting long periods of time for elective surgery and only have the choice of HA."

Finance reform

On the forthcoming financing reform, Mr Solomon said it will need to create the right incentives to encourage the public to use services sensibly and take some responsibility for their own healthcare.

"The incentive should be to reinforce the most appropriate service option, which is most often at the lower end of the service continuum, for example, a primary care physician rather than an accident and emergency department, or an aged care home rather than a hospital.

"The HA is concerned to ensure patients are not denied service because of a lack of financial means, so we will naturally look for a safety net which caps people's out-of-pocket payments for HA services over an extended period, and this safety net needs to cover all income groups, particularly low and middle income HA users."