Constructing options for health care reform in Hong Kong.

The Harvard Report, published in April 1999 for public consultation in Hong Kong, proposed a fundamental restructuring in its health care delivery and financing systems. The Report claims to be evidence-based in its approach (Hsiao et al., 1999a). While 'evidence' has been widely collected by the consultancy team through surveys, consultations and focus groups, the recommendations put forth are not value-free. They carry clear ideological preferences. The value assumptions and ethical presuppositions underlying the report are discussed in this paper. The Harvard consultancy study is in favor of a positive government role in regulation and control, a single central body to administer compulsory health insurance for all citizens, and a purchaser-provider split to induce competition. Such preference is based on pre-existing ideology and generic health care management concepts, which are still in the experimental phase internationally. While value and ideology are inevitable factors in any policy choice, the challenge is to lay these values open for reflection and public debate. For Hong Kong, the challenge is also to take on local substantive issues in health care and deal with them head-on, rather than putting hope in a universal, generic solution.