Chronically ill welfare recipient Chow Chin-sun will start seeing his life savings of HK$60,000 evaporate from next month when he has to start paying monthly bills of HK$20,000 for medications that will no longer be subsidized for a disease public hospital doctors have been unable to diagnose. 

Chow, 59, is suffering from a respiratory tract condition that leaves him constantly short of breath. 

He can breathe properly only with the aid of a medical device and a course of expensive drugs that are not on the Hospital Authority's central drug list introduced a year ago, meaning his medication is no longer subsidized. 

Until now, Chow has been fortunate enough to be included in the clinical trial of a new treatment, which has spared him a HK$20,000 monthly bill, but he'll have to start footing it when the trial period expires on July 14. 

The authority's rationale for introducing the drugs list, known as the Standard Drug Formulary, is to "eliminate discrepancies in drug dispensing among different hospitals by drawing up a list of subsidized drugs that all public hospitals will use." 

But Chow and other chronically ill patients requiring treatments that are not on the list now face crippling financial burdens as previously subsidized drugs are deemed "self-financing items." 

Chow is now counting his remaining days of free medicine. 
"Of course, I'm worried, but I can't do anything," he said. 
"It is so ironic. I remember Hong Kong's health-care system during the colonial days was very caring and I was so proud of it. If you were seriously ill, the system would take care of you." 

The government announced its policy on health-care services in its first White Paper, entitled Development of Medical Services in Hong Kong, in 1964, claiming to provide "directly or indirectly, low cost or free medical and personal health services to that large section of the community which is unable to seek medical attention from other sources." 

Chow said: "Those objectives have vanished. Look at me, I'm sick and I can only blame my bad luck." 

In the "good old days," Chow was a hawker and could carry a heavy load. "Now, I can hardly breathe and cannot work anymore." 

The Hong Kong Medical Association said the government's drug list is an excuse to cut costs and evade its health-care responsibilities. 

Apart from the drug list, various Hospital Authority proposals have been criticized for falling prey to privatization or for blurring the line between welfare and business. 

The authority's new chief executive, Shane Solomon, said last month adjusting fees would be one way to reduce demand for hospital services, but he would not speculate on the bottom line for fee increases. "The Hospital Authority is concerned with serving patients and helping the community ... the bottom line is that the people's basic needs have to be dealt with," he said at an earlier media briefing. 

Solomon also said that if the authority wanted to do more to cope with the aging population and the rising cost of medical technology, it should "look increasingly to private revenue opportunities." 

He said 23 percent of public hospital patients had private medical insurance or subsidies, but this justification for increasing medical charges has failed to convince the medical sector and academics. 

"I have grave concerns about the privatization of Hong Kong's medical health care," said Polytechnic University sociology lecturer Ho Wing-chung.
 
"The fundamental problem for health-care development is that the government is detaching [itself from] its responsibility and having it replaced by the private sector. For ordinary citizens, health care is a matter of life and death and can involve a lot of money. 

"The government still has a moral responsibility to take care of those who cannot afford adequate health care. 

"Sickness afflicts us equally and we are all poor when we have a serious disease." 

He agreed that the aging population will put financial pressure on the health- care system, but says it's not an imminent crisis. 

"Especially when we look at the Hospital Authority's data, we see that staff costs account for more than 80 percent of expenditure. 

"Either cutting costs or boosting revenue, it should not target ordinary citizens who rely heavily on the health- care system." he said. 

Ho's concerns were echoed by medical sector legislator, Kwok Ka-ki, who claimed senior doctors at public hospitals are facing pressure from their supervisors to accept more private patients to increase revenue. 

"Professors and consultants are being pressured into treating private patients, leaving them less time to treat ordinary or low-income public patients," he said. 
Kwok added that earnings from clinical practices by the Hong Kong University's medical school increased from HK$25.9 million in 2000-2001 to HK$44.8 million in 2004-2005 - a rise of 73 percent. 

Boosting revenue is an important task for medical financing but this can be achieved without targeting the patients the system was designed to protect, said Peter Yuen Pok-man, a Polytechnic University management and marketing professor who has studied Hong Kong's medical financing extensively. 

"There're many ways to increase revenue" he said, adding that tax reform could be a possible solution to minimize change. 

"Tax-based medical financing is not necessarily unsustainable," Yuen argued, saying reform of Hong Kong's low tax policy - which has intrigued Solomon - could be a way out. 

Speaking at an impromptu media gathering at the authority's headquarters in late February, Solomon said: "Of course, my view is superficial at this stage, but from my observation, [Hong Kong is a place] with very low taxation and a highly subsidized health system ... which is a bit unusual."