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=== Background ===
=== Background ===
The Voluntary Health Insurance Scheme (VHIS) is one of the major medical healthcare reforms proposed by the government. In Hong Kong, the public and private sectors complement each other under a well-established dual-track healthcare system. However, there is an increasing imbalance between the two sectors. Public hospitals take up more than 88% of in-patient services with heavy government subsidies<ref><sup>[18]</sup> Legislative council. (2016). Background brief prepared by the Legislative Council Secretariat for the meeting on 19 April 2016 on Voluntary Health Insurance Scheme. Retrieved from
The Voluntary Health Insurance Scheme (VHIS) is one of the major medical healthcare reforms proposed by the government. In Hong Kong, the public and private sectors complement each other under a well-established dual-track healthcare system. However, there is an increasing imbalance between the two sectors. Public hospitals take up more than 88% of in-patient services with heavy government subsidies<ref>Legislative council. (2016). Background brief prepared by the Legislative Council Secretariat for the meeting on 19 April 2016 on Voluntary Health Insurance Scheme. Retrieved from


<nowiki>http://www.legco.gov.hk/yr1516/english/panels/hs/hs_hps/papers/hs_hps20160419cb2-1314-2-e.pdf</nowiki>
<nowiki>http://www.legco.gov.hk/yr1516/english/panels/hs/hs_hps/papers/hs_hps20160419cb2-1314-2-e.pdf</nowiki>
</ref>. Due to aging population, the rising demand of citizens on good quality healthcare service provision and escalating medical costs, the recurrent expenditure of the government on medical and health care services increased continuously, from $32 billion in 2007 to $ 52 billion in 2014<ref><sup>[19]</sup>Information Services Department. (2014). Government launches public consultation on Voluntary Health Insurance Scheme. Retrieved from
</ref>. Due to aging population, the rising demand of citizens on good quality healthcare service provision and escalating medical costs, the recurrent expenditure of the government on medical and health care services increased continuously, from $32 billion in 2007 to $ 52 billion in 2014<ref>Information Services Department. (2014). Government launches public consultation on Voluntary Health Insurance Scheme. Retrieved from


<nowiki>http://www.info.gov.hk/gia/general/201412/15/P201412150257.htm</nowiki>    
<nowiki>http://www.info.gov.hk/gia/general/201412/15/P201412150257.htm</nowiki>    
</ref>. With such huge demand on public medical services, the quality of healthcare provided would inevitably be affected by the heavy workload of the medical staff and proportionally less medical resources per person. Thus, the government proposed the VHIS to recalibrate the balance between public and private healthcare systems by encouraging more well-off citizens, especially the middle-class, to use the private healthcare services as an alternative. Thus, the public sector can focus on providing services in its target areas, thereby enhancing the long-term sustainability of the dual-track healthcare system.
</ref>. With such huge demand on public medical services, the quality of healthcare provided would inevitably be affected by the heavy workload of the medical staff and proportionally less medical resources per person. Thus, the government proposed the VHIS to recalibrate the balance between public and private healthcare systems by encouraging more well-off citizens, especially the middle-class, to use the private healthcare services as an alternative. Thus, the public sector can focus on providing services in its target areas, thereby enhancing the long-term sustainability of the dual-track healthcare system.


The scheme requires the insurance companies to fulfill 12 minimum requirements and private hospitals to disclose the charges of common medical procedures so as to increase transparency and enhance customers’ protection <sup>[3]</sup>.  The government has pointed out that this scheme is not intended as a wholesome solution to the existing problems, but just one of the measures to take forward the reform <sup>[3]</sup>. The VHIS has already undergone three stages of public consultation since 2008. It will be launched earliest by 2017 if consensus can be reached among the public. 
The scheme requires the insurance companies to fulfill 12 minimum requirements and private hospitals to disclose the charges of common medical procedures so as to increase transparency and enhance customers’ protection<ref>Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from <nowiki>http://www.vhis.gov.hk/en/consultation_document/index.html</nowiki>.    </ref>.  The government has pointed out that this scheme is not intended as a wholesome solution to the existing problems, but just one of the measures to take forward the reform<ref>Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from <nowiki>http://www.vhis.gov.hk/en/consultation_document/index.html</nowiki>.    </ref>. The VHIS has already undergone three stages of public consultation since 2008. It will be launched earliest by 2017 if consensus can be reached among the public. 


=== Policy Development Process ===
=== Policy Development Process ===


==== '''The Harvard Report (1999)'''<ref>The Harvard Team. (1999). Improving Hong Kong’s Healthcare System: Why and for Whom? Retrieved from <nowiki>http://www.fhb.gov.hk/en/press_and_publications/consultation/HCS.HTM</nowiki>.    </ref> ====
==== '''The Harvard Report (1999) <sup>[4]</sup>''' ====
The Health and Welfare Bureau (predecessor of the Food and Health Bureau (FHB)) appointed scholars from the Harvard University to conduct a research on the financing and organization of health care in Hong Kong. A report titled “Improving Hong Kong’s Healthcare System: Why and for Whom?” was published. While they suggested that Hong Kong had an equitable and efficient healthcare system, there was insufficient oversight on the system. The report also raised doubt on the long-term financial sustainability of the system. The report suggested that, in the short run, the government should adopt a two-tier mandatory health insurance scheme comprising of the “Savings Account for Long Term Care (MEDISAGE)” and “Health Security Plan (HSP)”, which require both employers’ and employees’ contribution. Also, the “Competitive Integrated Health Care Option” should be adopted in the long run. It refers to the establishment of a Health Security Fund to pay a standard payment rate to public or private healthcare provider chosen by a patient, thereby realizing the principle of ‘money follows the patient’. Under the plan, Government funding would not automatically go to the public health sector. 
The Health and Welfare Bureau (predecessor of the Food and Health Bureau (FHB)) appointed scholars from the Harvard University to conduct a research on the financing and organization of health care in Hong Kong. A report titled “Improving Hong Kong’s Healthcare System: Why and for Whom?” was published. While they suggested that Hong Kong had an equitable and efficient healthcare system, there was insufficient oversight on the system. The report also raised doubt on the long-term financial sustainability of the system. The report suggested that, in the short run, the government should adopt a two-tier mandatory health insurance scheme comprising of the “Savings Account for Long Term Care (MEDISAGE)” and “Health Security Plan (HSP)”, which require both employers’ and employees’ contribution. Also, the “Competitive Integrated Health Care Option” should be adopted in the long run. It refers to the establishment of a Health Security Fund to pay a standard payment rate to public or private healthcare provider chosen by a patient, thereby realizing the principle of ‘money follows the patient’. Under the plan, Government funding would not automatically go to the public health sector. 


Consultation was conducted alongside the publication of the Harvard Report. But it was shelved due to public resentment.
Consultation was conducted alongside the publication of the Harvard Report. But it was shelved due to public resentment.


==== '''Consultation: The Life Long Investment Document (2000) <sup>[5]</sup>''' ====
==== '''Consultation: The Life Long Investment Document (2000)'''<ref>Health and Welfare Bureau. Lifelong investment in health consultation document on healthcare reform. Hong Kong: Government of the Hong Kong Special Administrative Region; 2000.    </ref> ====
The document rejected the HSP proposed by the Harvard Report. A mandatory medical savings scheme called Health Protection Accounts (HPA). The proposal requires individuals aged 40 to 64 to contribute 1 to 2 percent of his earnings to a personal account to cover both the individual and his/her spouse’s medical expenses after retirement. However, this consultation was also shelved due to public resentment.
The document rejected the HSP proposed by the Harvard Report. A mandatory medical savings scheme called Health Protection Accounts (HPA). The proposal requires individuals aged 40 to 64 to contribute 1 to 2 percent of his earnings to a personal account to cover both the individual and his/her spouse’s medical expenses after retirement. However, this consultation was also shelved due to public resentment.


==== '''Discussion paper “Building a Healthy Tomorrow” (2005) <sup>[6]</sup>''' ====
==== '''Discussion paper “Building a Healthy Tomorrow” (2005)'''<ref>Health and Medical Development Advisory Committee. (2005). Building a Healthy Tomorrow: Discussion Paper on the Future Service Delivery Model for our Health Care System. Retrieved from <nowiki>http://www.info.gov.hk/archive/consult/2005/hmdac_paper_e.pdf</nowiki>    </ref> ====
The discussion paper was issued by the Health and Medical Development Advisory Committee (HMDAC). Recommendations on different aspects of the future service delivery model were made. It foretells that the Advisory Committee will proceed with discussion on the possible financing options and will bring forth relevant recommendation early 2006.
The discussion paper was issued by the Health and Medical Development Advisory Committee (HMDAC). Recommendations on different aspects of the future service delivery model were made. It foretells that the Advisory Committee will proceed with discussion on the possible financing options and will bring forth relevant recommendation early 2006.


==== '''First Stage Public Consultation on Health care Reform: ‘Your Health Your Life’ (2008)''' ====
==== '''First Stage Public Consultation on Health care Reform: ‘Your Health Your Life’ (2008)''' ====
Based on the recommendations by the HMDAC, the government conducted the first consultation on healthcare reform in March to June 2008. The three-month consultation aimed at collecting public views on general health care reform in two areas. First, the four service reform proposals, namely (i) enhance primary care; (ii) promote public-private partnership; (iii) develop electronic health record sharing; and (iv) strengthen public healthcare safety net. Second, the six possible supplementary healthcare financing options, including (i) social health insurance; (ii) out-of-pocket payments; (iii) medical savings accounts; (iv) voluntary private health insurance; (v) mandatory private health insurance; and (vi) personal healthcare reserve (a combination of (iii) and (v)). Some pros and cons of the six proposals, and the underlying societal values they represent were spelt out, with the aim to assist the public in their expression of preferences <sup>[7]</sup>.
Based on the recommendations by the HMDAC, the government conducted the first consultation on healthcare reform in March to June 2008. The three-month consultation aimed at collecting public views on general health care reform in two areas. First, the four service reform proposals, namely (i) enhance primary care; (ii) promote public-private partnership; (iii) develop electronic health record sharing; and (iv) strengthen public healthcare safety net. Second, the six possible supplementary healthcare financing options, including (i) social health insurance; (ii) out-of-pocket payments; (iii) medical savings accounts; (iv) voluntary private health insurance; (v) mandatory private health insurance; and (vi) personal healthcare reserve (a combination of (iii) and (v)). Some pros and cons of the six proposals, and the underlying societal values they represent were spelt out, with the aim to assist the public in their expression of preferences<ref>Food and Health Bureau. (2008). Your Health, Your Life: Healthcare Reform Consultation Document. Hong Kong: Food and Health Bureau. Retrieved from <nowiki>http://www.fhb.gov.hk/beStrong/files/consultation/exsummary_eng.pdf</nowiki>.    </ref>.


A total of 4900 written submissions were received. The consultation report was published in December 2008. It suggested that there was a broad consensus over the service reforms. However, there were divergent views on the supplementary financing options, no single option commanded majority support, though private PHI shows a relatively higher preference. It was also shown from the response that the public embraced five societal values, namely, individual need, voluntary participation, equity, freedom to choose and employer’s responsibility. The FHB undertook to formulate a detailed proposal based on these public preferences to launch the second-stage public consultation <sup>[8]</sup>.
A total of 4900 written submissions were received. The consultation report was published in December 2008. It suggested that there was a broad consensus over the service reforms. However, there were divergent views on the supplementary financing options, no single option commanded majority support, though private PHI shows a relatively higher preference. It was also shown from the response that the public embraced five societal values, namely, individual need, voluntary participation, equity, freedom to choose and employer’s responsibility. The FHB undertook to formulate a detailed proposal based on these public preferences to launch the second-stage public consultation<ref>Food and Health Bureau. (2008). Your Health, Your Life: Report on First Stage Public Consultation on Healthcare Reform. Hong Kong: Food and Health Bureau. Retrieved from <nowiki>http://www.fhb.gov.hk/beStrong/eng/consultation/consultation_report1.html</nowiki>    </ref>.


==== '''Second Stage Consultation: ‘My Health My Choice’ (2010)''' ====
==== '''Second Stage Consultation: ‘My Health My Choice’ (2010)''' ====
The second stage consultation on health care reform was launched in October 2010 to January 2011. In this consultation, the government aimed at soliciting public views on the design of the government-regulated but privately-operated Voluntary Health Protection Scheme (VHPS) providing standardized health insurance. In addition, the government pledged to earmark $50 billion from the fiscal reserve to finance the scheme, opinion was sought on how this fund should be allocated <sup>[9]</sup>.
The second stage consultation on health care reform was launched in October 2010 to January 2011. In this consultation, the government aimed at soliciting public views on the design of the government-regulated but privately-operated Voluntary Health Protection Scheme (VHPS) providing standardized health insurance. In addition, the government pledged to earmark $50 billion from the fiscal reserve to finance the scheme, opinion was sought on how this fund should be allocated<ref>Food and Health Bureau. (2010). My Health, My Choice: Healthcare Reform Second Stage Consultation Document. Hong Kong: Food and Health Bureau. Retrieved from <nowiki>http://www.myhealthmychoice.gov.hk/pdf/executive_summary_eng.pdf</nowiki></ref>.


The consultation report was published in July 2011. Subsequent to the consultation, the FHB proposed a three-pronged action plan, including (i) review healthcare manpower strategy by setting up the Steering Committee on Strategic Manpower Review; (ii) Formulate a supervisory framework and propose financial incentives for the HPS by setting up a working group under the HMDAC; and (iii) facilitate healthcare service developments, like develop essential infrastructure and promote packaged services. <sup>[10]</sup>
The consultation report was published in July 2011. Subsequent to the consultation, the FHB proposed a three-pronged action plan, including (i) review healthcare manpower strategy by setting up the Steering Committee on Strategic Manpower Review; (ii) Formulate a supervisory framework and propose financial incentives for the HPS by setting up a working group under the HMDAC; and (iii) facilitate healthcare service developments, like develop essential infrastructure and promote packaged services.<ref>Food and Health Bureau. (2011). My Health, My Choice: Report on Second Stage Public Consultation on Healthcare Reform. Hong Kong: Food and Health Bureau. Retrieved from    </ref>


==== '''Government Consultant Report (2013)''' ====
==== '''Government Consultant Report (2013)''' ====
The private consultant PricewaterhouseCoopers Service Limited was hired by the FHB to review on the current private health insurance system, as well as to provide suggestions to the implementation of the HPS. <sup>[11]</sup>
The private consultant PricewaterhouseCoopers Service Limited was hired by the FHB to review on the current private health insurance system, as well as to provide suggestions to the implementation of the HPS. <ref>PricewaterhouseCoopers Service Limited. (2013). Consultancy Study for the Health Protection Scheme Final Report. Retrieved from

<nowiki>http://www.vhis.gov.hk/doc/en/information_centre/hps_consultancy_report.pdf</nowiki>.
</ref>


==== '''Third Stage Consultation: Voluntary Health Insurance Scheme (VHIS) (2014)''' ====
==== '''Third Stage Consultation: Voluntary Health Insurance Scheme (VHIS) (2014)''' ====
This consultation lasted from December 2014 to April 2015. To better reflect the objectives and nature of the scheme, it was renamed to “VHIS”. The government proposed the ‘12 minimum requirements’ of the standard insurance plans in the VHIS, aiming at (i) Improving accessibility to and continuity of health insurance (ii) enhancing the quality of insurance protection; and (iii) promoting transparency and certainty. In addition, a “high risk pool (HRP)” mechanism was proposed, so that individuals of high risk and have pre-existing medical conditions will also be able to purchase the health insurance <sup>[12]</sup>. A total of 600 written submissions were received.
This consultation lasted from December 2014 to April 2015. To better reflect the objectives and nature of the scheme, it was renamed to “VHIS”. The government proposed the ‘12 minimum requirements’ of the standard insurance plans in the VHIS, aiming at (i) Improving accessibility to and continuity of health insurance (ii) enhancing the quality of insurance protection; and (iii) promoting transparency and certainty. In addition, a “high risk pool (HRP)” mechanism was proposed, so that individuals of high risk and have pre-existing medical conditions will also be able to purchase the health insurance<ref>Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from <nowiki>http://www.vhis.gov.hk/en/consultation_document/index.html</nowiki>.    </ref>. A total of 600 written submissions were received.


==== '''Latest Development''' ====
==== '''Latest Development''' ====
The public consultation report has been completed but yet to be published. The government admitted that the HRP mechanism was the most contentious issue in the public consultation, and further exploration and consultation is required. In April, 2016, the government said that legislation work was underway <sup>[13]</sup>.
The public consultation report has been completed but yet to be published. The government admitted that the HRP mechanism was the most contentious issue in the public consultation, and further exploration and consultation is required. In April, 2016, the government said that legislation work was underway <ref>Information Services Department. (2016). 積極推動自願醫保立法. Retrieved from <nowiki>http://archive.news.gov.hk/tc/categories/health/html/2016/04/20160416_151232.shtml</nowiki>.    </ref>.


In December 2016, the government announced the decision to drop three controversial features temporarily, the HRP, and two of the “12 minimum requirements” - guaranteed acceptance and portable insurance policy <sup>[14]</sup>. The government is confident that the remaining ten minimum requirements would be implemented by next year through the Insurance Authority’s issuance of guidelines to the insurance sector. It is estimated that the dropped features will be implemented in the next stage through legislation, probably after two to three years. <sup>[15]</sup>
In December 2016, the government announced the decision to drop three controversial features temporarily, the HRP, and two of the “12 minimum requirements” - guaranteed acceptance and portable insurance policy <ref>South China Morning Post. (2016). Two controversial items put on hold in Hong Kong voluntary health insurance plan. Retrieved from <nowiki>http://www.scmp.com/lifestyle/health/article/2051260/two-controversial-items-put-hold-hong-kong-voluntary-health</nowiki>    </ref>. The government is confident that the remaining ten minimum requirements would be implemented by next year through the Insurance Authority’s issuance of guidelines to the insurance sector. It is estimated that the dropped features will be implemented in the next stage through legislation, probably after two to three years. <ref>Information Services Department. (2016).食物及衞生局局長談自願醫保計劃及墟市(只有中文). Retrieved from

<nowiki>http://www.info.gov.hk/gia/general/201612/02/P2016120200741.htm</nowiki>    
</ref>


=== Organization ===
=== Organization ===
The Food and Health Bureau (FHB) was responsible for the formulation and implementation of the Voluntary Health Insurance Scheme (formerly known as Health Protection Scheme) <sup>[16]</sup>. After the second public consultation in 2010, the Healthcare Planning and Development Office (HPDO) was set up under the Bureau, in order to ‘take forward the healthcare reform initiatives’. <sup>[17]</sup>
The Food and Health Bureau (FHB) was responsible for the formulation and implementation of the Voluntary Health Insurance Scheme (formerly known as Health Protection Scheme) <sup>[</sup><ref>Food and Health Bureau. (2014a). Welcome message Voluntary Health Insurance Scheme website. Retrieved from <nowiki>http://www.vhis.gov.hk/en/welcome_message/index.html</nowiki>.    </ref>. After the second public consultation in 2010, the Healthcare Planning and Development Office (HPDO) was set up under the Bureau, in order to ‘take forward the healthcare reform initiatives’. <ref>Healthcare Planning and Development Office. (2012a). Introduction. Retrieved from <nowiki>http://www.hpdo.gov.hk/en/aboutus.html</nowiki>.    </ref>


In the period from 2012-2014, a Working Group and a Consultative Group were set up under the Health and Medical Development Advisory Committee (HMDAC). <sup>[18]</sup> Both groups were consisted of a chairman, non-official and ex-officio members. The Working Group was chaired by the Permanent Secretary of the Food and Health Bureau, the most senior civil servant in the Bureau. Meanwhile, the Consultative Group was chaired by the head of the Healthcare Planning and Development Office in the FHB.  <sup>[19]</sup>While the Working Group has the responsibility to formulate the details of the policy, the Consultation Group gives suggestions to the Working Group <sup>[18]</sup>. In terms of membership, the two groups are composed of civil servants, medical and other professionals. <sup>[19]</sup>
In the period from 2012-2014, a Working Group and a Consultative Group were set up under the Health and Medical Development Advisory Committee (HMDAC). <ref>Health Planning and Development Office. (2012b). Working Group and Consultative Group on Health Protection Scheme. Retrieved from <nowiki>http://www.hpdo.gov.hk/en/hpsworkinggroup.html</nowiki>.    </ref> Both groups were consisted of a chairman, non-official and ex-officio members. The Working Group was chaired by the Permanent Secretary of the Food and Health Bureau, the most senior civil servant in the Bureau. Meanwhile, the Consultative Group was chaired by the head of the Healthcare Planning and Development Office in the FHB.<ref>Healthcare Planning and Development Office. (2012c). Membership of Working Group on Health Protection Scheme. Retrieved from <nowiki>http://www.hpdo.gov.hk/en/hpswgmembership.html</nowiki>.    </ref> While the Working Group has the responsibility to formulate the details of the policy, the Consultation Group gives suggestions to the Working Group<ref>Healthcare Planning and Development Office. (2012c). Membership of Working Group on Health Protection Scheme. Retrieved from <nowiki>http://www.hpdo.gov.hk/en/hpswgmembership.html</nowiki>.    </ref>. In terms of membership, the two groups are composed of civil servants, medical and other professionals. <ref>Healthcare Planning and Development Office. (2012c). Membership of Working Group on Health Protection Scheme. Retrieved from <nowiki>http://www.hpdo.gov.hk/en/hpswgmembership.html</nowiki>.    </ref>


=== Controversies ===
=== Controversies ===


==== '''Medical Sector''' ====
==== '''Medical Sector''' ====
The Hong Kong Medical Association expressed concerns on the effectiveness of VHIS regarding the sustainability of the scheme, scheme attractiveness to the youngsters, patients’ right and customers’ choice. They specifically emphasized their doubt on the high-risk pool as the use of $50 billion earmarked reserve was not made clear in the consultation paper. They also urged the government to set up an independent regulatory agency to regulate the VHIS and establish a proper mechanism to monitor the appropriateness of premium loading by insurance policyholders in VHIS migration <sup>[20]</sup>.  For public sectors, the Hospital Authority supports the proposed VHIS but they would like the government to address the challenges in manpower and capacity planning <sup>[21]</sup>. For private sectors, the Hong Kong College of Pediatricians and the Hong Kong Private Hospitals Association expressed their support on the scheme but they urged the government to revamp the private healthcare facilities before the implementation of VHIS <sup>[22]</sup>. Also, they expressed worries over the transparency of medical fees, especially the disclosure of historical pricing which was largely determined by doctors <sup>[23]</sup>.
The Hong Kong Medical Association expressed concerns on the effectiveness of VHIS regarding the sustainability of the scheme, scheme attractiveness to the youngsters, patients’ right and customers’ choice. They specifically emphasized their doubt on the high-risk pool as the use of $50 billion earmarked reserve was not made clear in the consultation paper. They also urged the government to set up an independent regulatory agency to regulate the VHIS and establish a proper mechanism to monitor the appropriateness of premium loading by insurance policyholders in VHIS migration<ref>Hong Kong Medical Association. (2015). HKMA's views on the Voluntary Health Insurance Scheme. Retrieved from <nowiki>http://hkma.org/english/newsroom/news/20150315.htm</nowiki></ref>.  For public sectors, the Hospital Authority supports the proposed VHIS but they would like the government to address the challenges in manpower and capacity planning <ref>Hospital Authority. (2015). Hospital Authority’s Response to the Government’s Consultation Document on the Voluntary Health Insurance Scheme. Hospital Authority. Retrieved from <nowiki>https://www.ha.org.hk/haho/ho/cc/ga_response_to_Govt_Consultation_E1.pdf</nowiki></ref>. For private sectors, the Hong Kong College of Pediatricians and the Hong Kong Private Hospitals Association expressed their support on the scheme but they urged the government to revamp the private healthcare facilities before the implementation of VHIS <ref>Hong Kong College of Pediatricians. (2015). Response to Public Consultation on Voluntary Health Insurance Scheme (VHIS) and Regulation of Private Healthcare Facilities (PHF). Hong Kong College of Pediatricians. Retrieved from

<nowiki>http://www.paediatrician.org.hk/index.php?option=com_docman&task=doc_view&gid=982&Itemid=66</nowiki>
</ref>. Also, they expressed worries over the transparency of medical fees, especially the disclosure of historical pricing which was largely determined by doctors<ref>Hong Kong Private Hospitals Association. (2015). Re: Voluntary Health Insurance Scheme Consultation Document. Hong Kong Private Hospitals Association. Retrieved from

<nowiki>http://www.privatehospitals.org.hk/doc/Appendix%205%20-%20HKPHA%20Submission%20on%20Voluntary%20Health%20Insurance%20Scheme%20Consultation%20Document%202015.pdf</nowiki>
</ref>.


==== '''Insurance and Business Sector''' ====
==== '''Insurance and Business Sector''' ====
The Hong Kong Federation of Insurers has great divergences on the fundamental operating principles with the government in the scheme. They believe that the suggested premium level at $3600 is unrealistic and misleading, because it fails to take into account the effect of medical inflation. The one-off funding to the HRP and Guaranteed Acceptance is insufficient and unsustainable without the government’s long-term commitment <sup>[24]</sup>.  In addition, there are several uncertainties, such as the lack of proper definition of high risk and the transparency of medical fee by the hospitals <sup>[25]</sup>. The Hong Kong Women Professional & Entrepreneurs Association has strong reservation towards the proposed VHIS as they think the scheme is not favorable to the majority middle class in Hong Kong. The VHIS is not cost effective to induce citizens to purchase, specifically to the young generation <sup>[26]</sup>. The Institute of Financial Planners of Hong Kong questioned the effectiveness of risk pooling with a voluntary scheme and the coordination with private healthcare sectors if there is no effective control on costs and quality of services <sup>[27]</sup>.
The Hong Kong Federation of Insurers has great divergences on the fundamental operating principles with the government in the scheme. They believe that the suggested premium level at $3600 is unrealistic and misleading, because it fails to take into account the effect of medical inflation. The one-off funding to the HRP and Guaranteed Acceptance is insufficient and unsustainable without the government’s long-term commitment<ref>The Hong Kong Federation of Insurers. Voluntary Health Insurance Scheme (VHIS). The Hong Kong Federation of Insurers. Retrieved from <nowiki>http://www.legco.gov.hk/yr15-16/english/panels/hs/hs_hps/papers/hs_hpscb2-1596-1-e.pdf</nowiki>    </ref>.  In addition, there are several uncertainties, such as the lack of proper definition of high risk and the transparency of medical fee by the hospitals <ref>The Hong Kong Federation of Insurers. (2015). Consultation on Voluntary Health Insurance Scheme (VHIS) and Regulation of Private Healthcare Facilities. The Hong Kong Federation of Insurers. Retrieved from

<nowiki>http://www.legco.gov.hk/yr14-15/chinese/panels/hs/hs_hps/papers/hs_hpscb2-1098-1-ec.pdf</nowiki>    
</ref>. The Hong Kong Women Professional & Entrepreneurs Association has strong reservation towards the proposed VHIS as they think the scheme is not favorable to the majority middle class in Hong Kong. The VHIS is not cost effective to induce citizens to purchase, specifically to the young generation <ref>Hong Kong Women Professional & Entrepreneurs Association. (2015). “Voluntary Health Insurance Scheme” (“VHIS”) Consultation Response Paper. Hong Kong Women Professional & Entrepreneurs Association. Retrieved from

<nowiki>http://www.legco.gov.hk/yr14-15/chinese/panels/hs/hs_hps/papers/hs_hpscb2-1098-1-ec.pdf</nowiki>
</ref>. The Institute of Financial Planners of Hong Kong questioned the effectiveness of risk pooling with a voluntary scheme and the coordination with private healthcare sectors if there is no effective control on costs and quality of services <ref>Institute of Financial Planners of Hong Kong. (2015). IFPHK’s Response to the Consultation Document Issued by the Food and Health Bureau on the Voluntary Health Insurance Scheme. Institute of Financial Planners of Hong Kong. Retrieved from

<nowiki>http://www.ifphk.org/pdf/Policy_and_Regulatory_Affairs/Response_to_Voluntary_Health_Insurance_Scheme_final.pdf</nowiki>
</ref>.


==== '''Other Sectors''' ====
==== '''Other Sectors''' ====
1000 residents were interviewed in a survey co-organized by the Radio Television Hong Kong and the Public Opinion Programme. More than 40% of the respondents supported the VHIS and 22% of them opposed to the scheme <sup>[28]</sup>. This survey revealed that citizens are willing to support the scheme under the condition that the government resolves the ambiguity in policy implementation.
1000 residents were interviewed in a survey co-organized by the Radio Television Hong Kong and the Public Opinion Programme. More than 40% of the respondents supported the VHIS and 22% of them opposed to the scheme<ref>Public Opinion Programme, the University of Hong Kong. (2015). Voices from the Hall – Would Citizens Support the Voluntary Health Insurance Scheme? Public Opinion Programme, the University of Hong Kong. Retrieved from

<nowiki>https://www.hkupop.hku.hk/english/features/rthkdf20150301/</nowiki>
</ref>. This survey revealed that citizens are willing to support the scheme under the condition that the government resolves the ambiguity in policy implementation.

⚫
The New People’s Party shared the same view. They requested the government to tighten the regulation on the private medical sector by amending the existing legislation <ref>New People's Party. (2015). NPP's response to Voluntary Health Insurance Scheme and Regulatory Regime for Private Healthcare Facilities Consultation Papers. New People's Party. Retrieved from <nowiki>http://www.npp.org.hk/en/node/17088</nowiki></ref>. The Equal Opportunities Commission and the Consumer Council also voiced their concerns. The former questioned about the premium loadings under anti-discrimination principles, suggesting that patients with certain illness should not be excluded <ref>Equal Opportunities Commission. (2015). Consultation Documents on Voluntary Health Insurance Scheme and Regulation of Private Healthcare Facilities. Equal Opportunities Commission. Retrieved from

<nowiki>http://www.hpdo.gov.hk/doc/fhsd/submissions/organizations/O022.pdf</nowiki>
</ref>. While the latter raised queries over the availability of choices for customers, and the need to facilitate information transparency by disclosing claim records and benefits schedules online. <ref>Consumer Council. (2015). Consumer Council Submission to the Food and Health Bureau on Voluntary Health Insurance Scheme. Consumer Council. Retrieved from


<nowiki>https://www.consumer.org.hk/ws_en/competition_issues/policy_position/2015041602.html</nowiki>
⚫
The New People’s Party shared the same view. They requested the government to tighten the regulation on the private medical sector by amending the existing legislation <sup>[29]</sup>. The Equal Opportunities Commission and the Consumer Council also voiced their concerns. The former questioned about the premium loadings under anti-discrimination principles, suggesting that patients with certain illness should not be excluded <sup>[30]</sup>. While the latter raised queries over the availability of choices for customers, and the need to facilitate information transparency by disclosing claim records and benefits schedules online. <sup>[31]</sup>
</ref>


==See also==
==See also==

Revision as of 08:52, 18 January 2017

Demographics and culture of Hong Kong
Demographics
Culture
Other Hong Kong topics

Hong Kong's medical infrastructure consists of a mixed medical economy, with 11 private hospitals and 42 public hospitals.[1][2] There are also polyclinics that offer primary care services, including dentistry.

Overview

Hong Kong is one of the healthiest places in the world.[3] Because of its early health education, professional health services, and well-developed health care and medication system, Hongkongers enjoy a life expectancy of 85.9 for females and 80 for men,[4] which is the third highest in the world, and an infant mortality rate of 2.73 deaths per 1000 births, the ninth lowest in the world.[5][6] The proportion of the population over 65 years old is expected to grow from 14% in 2013 to 18% in 2018, and the number of people with a long term condition is expected to increase by 33% over the same period.[7]

Hong Kong has high standards of medical practice. It has contributed to the development of liver transplantation, being the first in the world to carry out an adult to adult live donor liver transplant in 1993.[8]

Staffing

Hong Kong has only about 1.7 doctors per 1000 people. Only 11 doctors qualified outside the country work in the public hospital system because the Medical Council places barriers to the employment of foreign doctors. There are about 6000 registered practitioners of Traditional Chinese medicine.[9]

Public healthcare

Free treatment, with small co-payments, is available to people with a Hong Kong identity card and to resident children under the age of 11.

Between 2007 and 2011 public spending on healthcare increased by 30%. In 2014/5, it was about 17% of all government expenditure.[10]

  • A Dennis Sabre Fire Engine belonging to the Hong Kong Fire Services Department.
    A Dennis Sabre Fire Engine belonging to the Hong Kong Fire Services Department.
  • A Mercedes-Benz Axor truck belonging to the Hong Kong Fire Services Department.
    A Mercedes-Benz Axor truck belonging to the Hong Kong Fire Services Department.
  • A motorcycle belonging to the Hong Kong Fire Services Department.
    A motorcycle belonging to the Hong Kong Fire Services Department.
  • St. John Ambulance Brigade Hong Kong Island Area Headquarters.
    St. John Ambulance Brigade Hong Kong Island Area Headquarters.
  • The Mercedes-Benz Vito 115CDI ambulances for St. John Ambulances Hong Kong.
    The Mercedes-Benz Vito 115CDI ambulances for St. John Ambulances Hong Kong.
  • MacDonnell Road, Hong Kong AlbertCotton.
    MacDonnell Road, Hong Kong AlbertCotton.

Department of Health

Main article: Department of Health (Hong Kong)
Hospital Authority Headquarters

The Department of Health, under the Food and Health Bureau, is the health adviser of Hong Kong government and an executive arm in health legislation and policy. Its main role is to safeguard the health of the community through promotive, preventive, curative and rehabilitative services in Hong Kong.[11] The main function of the department includes child assessment service, immunisation programmes, dental service, forensic pathology service, registration of healthcare professionals etc., though boards and councils (i.e. Medical Council of Hong Kong, Pharmacy and Poisons Board of Hong Kong) are independent statutory bodies established under the relevant ordinances that operate independently to discharge their statutory functions.[12]

Hospital Authority

Main article: Hospital Authority

The Hospital Authority is a statutory body established on 1 December 1990 under the Hospital Authority Ordinance to manage all 42 public hospitals and institutions in Hong Kong. It is mainly responsible for delivering a comprehensive range of secondary and tertiary specialist care and medical rehabilitation through its network of health care facilities. The Authority also provides some primary medical services in 74 primary care clinics.[13]

Emergency medical services

Main article: Emergency medical services in Hong Kong

Medical and Healthcare Education

Main article: Medical education in Hong Kong

Hong Kong has only two comprehensive medical faculties, the Li Ka Shing Faculty of Medicine, University of Hong Kong and the Faculty of Medicine, Chinese University of Hong Kong, and they are also the sole two institutes offering medical and pharmacy programs. Other healthcare discipline programs are dispersed among some other universities which do not host a medical faculty.

Private healthcare

Hong Kong's 11 private hospitals have partnered with the United Kingdom for international healthcare accreditation. All 11 hospitals are "Trent Hospitals" and have been surveyed and accredited by the United Kingdom's Trent Accreditation Scheme.[14] The Hong Kong Academy of Medicine is an independent institution with the statutory power to organise, monitor, assess and accredit all medical specialist training and to oversee the provision of continuing medical education in Hong Kong.[15] In addition, The Royal College of Physicians and Surgeons of Canada has also accredited the postgraduate medical education (1994–present) in Hong Kong and allowed these graduates from the Hong Kong Academy of Medicine seeking RCPSC Certification and practising in Canada.[16]

The government is proposing a Voluntary Health Insurance Scheme in order to encourage more use of the private sector.[17]

Voluntary Health Insurance Scheme (VHIS)

Background

The Voluntary Health Insurance Scheme (VHIS) is one of the major medical healthcare reforms proposed by the government. In Hong Kong, the public and private sectors complement each other under a well-established dual-track healthcare system. However, there is an increasing imbalance between the two sectors. Public hospitals take up more than 88% of in-patient services with heavy government subsidies[18]. Due to aging population, the rising demand of citizens on good quality healthcare service provision and escalating medical costs, the recurrent expenditure of the government on medical and health care services increased continuously, from $32 billion in 2007 to $ 52 billion in 2014[19]. With such huge demand on public medical services, the quality of healthcare provided would inevitably be affected by the heavy workload of the medical staff and proportionally less medical resources per person. Thus, the government proposed the VHIS to recalibrate the balance between public and private healthcare systems by encouraging more well-off citizens, especially the middle-class, to use the private healthcare services as an alternative. Thus, the public sector can focus on providing services in its target areas, thereby enhancing the long-term sustainability of the dual-track healthcare system.

The scheme requires the insurance companies to fulfill 12 minimum requirements and private hospitals to disclose the charges of common medical procedures so as to increase transparency and enhance customers’ protection[20].  The government has pointed out that this scheme is not intended as a wholesome solution to the existing problems, but just one of the measures to take forward the reform[21]. The VHIS has already undergone three stages of public consultation since 2008. It will be launched earliest by 2017 if consensus can be reached among the public. 

Policy Development Process

The Harvard Report (1999)[22]

The Health and Welfare Bureau (predecessor of the Food and Health Bureau (FHB)) appointed scholars from the Harvard University to conduct a research on the financing and organization of health care in Hong Kong. A report titled “Improving Hong Kong’s Healthcare System: Why and for Whom?” was published. While they suggested that Hong Kong had an equitable and efficient healthcare system, there was insufficient oversight on the system. The report also raised doubt on the long-term financial sustainability of the system. The report suggested that, in the short run, the government should adopt a two-tier mandatory health insurance scheme comprising of the “Savings Account for Long Term Care (MEDISAGE)” and “Health Security Plan (HSP)”, which require both employers’ and employees’ contribution. Also, the “Competitive Integrated Health Care Option” should be adopted in the long run. It refers to the establishment of a Health Security Fund to pay a standard payment rate to public or private healthcare provider chosen by a patient, thereby realizing the principle of ‘money follows the patient’. Under the plan, Government funding would not automatically go to the public health sector. 

Consultation was conducted alongside the publication of the Harvard Report. But it was shelved due to public resentment.

Consultation: The Life Long Investment Document (2000)[23]

The document rejected the HSP proposed by the Harvard Report. A mandatory medical savings scheme called Health Protection Accounts (HPA). The proposal requires individuals aged 40 to 64 to contribute 1 to 2 percent of his earnings to a personal account to cover both the individual and his/her spouse’s medical expenses after retirement. However, this consultation was also shelved due to public resentment.

Discussion paper “Building a Healthy Tomorrow” (2005)[24]

The discussion paper was issued by the Health and Medical Development Advisory Committee (HMDAC). Recommendations on different aspects of the future service delivery model were made. It foretells that the Advisory Committee will proceed with discussion on the possible financing options and will bring forth relevant recommendation early 2006.

First Stage Public Consultation on Health care Reform: ‘Your Health Your Life’ (2008)

Based on the recommendations by the HMDAC, the government conducted the first consultation on healthcare reform in March to June 2008. The three-month consultation aimed at collecting public views on general health care reform in two areas. First, the four service reform proposals, namely (i) enhance primary care; (ii) promote public-private partnership; (iii) develop electronic health record sharing; and (iv) strengthen public healthcare safety net. Second, the six possible supplementary healthcare financing options, including (i) social health insurance; (ii) out-of-pocket payments; (iii) medical savings accounts; (iv) voluntary private health insurance; (v) mandatory private health insurance; and (vi) personal healthcare reserve (a combination of (iii) and (v)). Some pros and cons of the six proposals, and the underlying societal values they represent were spelt out, with the aim to assist the public in their expression of preferences[25].

A total of 4900 written submissions were received. The consultation report was published in December 2008. It suggested that there was a broad consensus over the service reforms. However, there were divergent views on the supplementary financing options, no single option commanded majority support, though private PHI shows a relatively higher preference. It was also shown from the response that the public embraced five societal values, namely, individual need, voluntary participation, equity, freedom to choose and employer’s responsibility. The FHB undertook to formulate a detailed proposal based on these public preferences to launch the second-stage public consultation[26].

Second Stage Consultation: ‘My Health My Choice’ (2010)

The second stage consultation on health care reform was launched in October 2010 to January 2011. In this consultation, the government aimed at soliciting public views on the design of the government-regulated but privately-operated Voluntary Health Protection Scheme (VHPS) providing standardized health insurance. In addition, the government pledged to earmark $50 billion from the fiscal reserve to finance the scheme, opinion was sought on how this fund should be allocated[27].

The consultation report was published in July 2011. Subsequent to the consultation, the FHB proposed a three-pronged action plan, including (i) review healthcare manpower strategy by setting up the Steering Committee on Strategic Manpower Review; (ii) Formulate a supervisory framework and propose financial incentives for the HPS by setting up a working group under the HMDAC; and (iii) facilitate healthcare service developments, like develop essential infrastructure and promote packaged services.[28]

Government Consultant Report (2013)

The private consultant PricewaterhouseCoopers Service Limited was hired by the FHB to review on the current private health insurance system, as well as to provide suggestions to the implementation of the HPS. [29]

Third Stage Consultation: Voluntary Health Insurance Scheme (VHIS) (2014)

This consultation lasted from December 2014 to April 2015. To better reflect the objectives and nature of the scheme, it was renamed to “VHIS”. The government proposed the ‘12 minimum requirements’ of the standard insurance plans in the VHIS, aiming at (i) Improving accessibility to and continuity of health insurance (ii) enhancing the quality of insurance protection; and (iii) promoting transparency and certainty. In addition, a “high risk pool (HRP)” mechanism was proposed, so that individuals of high risk and have pre-existing medical conditions will also be able to purchase the health insurance[30]. A total of 600 written submissions were received.

Latest Development

The public consultation report has been completed but yet to be published. The government admitted that the HRP mechanism was the most contentious issue in the public consultation, and further exploration and consultation is required. In April, 2016, the government said that legislation work was underway [31].

In December 2016, the government announced the decision to drop three controversial features temporarily, the HRP, and two of the “12 minimum requirements” - guaranteed acceptance and portable insurance policy [32]. The government is confident that the remaining ten minimum requirements would be implemented by next year through the Insurance Authority’s issuance of guidelines to the insurance sector. It is estimated that the dropped features will be implemented in the next stage through legislation, probably after two to three years. [33]

Organization

The Food and Health Bureau (FHB) was responsible for the formulation and implementation of the Voluntary Health Insurance Scheme (formerly known as Health Protection Scheme) [[34]. After the second public consultation in 2010, the Healthcare Planning and Development Office (HPDO) was set up under the Bureau, in order to ‘take forward the healthcare reform initiatives’. [35]

In the period from 2012-2014, a Working Group and a Consultative Group were set up under the Health and Medical Development Advisory Committee (HMDAC). [36] Both groups were consisted of a chairman, non-official and ex-officio members. The Working Group was chaired by the Permanent Secretary of the Food and Health Bureau, the most senior civil servant in the Bureau. Meanwhile, the Consultative Group was chaired by the head of the Healthcare Planning and Development Office in the FHB.[37] While the Working Group has the responsibility to formulate the details of the policy, the Consultation Group gives suggestions to the Working Group[38]. In terms of membership, the two groups are composed of civil servants, medical and other professionals. [39]

Controversies

Medical Sector

The Hong Kong Medical Association expressed concerns on the effectiveness of VHIS regarding the sustainability of the scheme, scheme attractiveness to the youngsters, patients’ right and customers’ choice. They specifically emphasized their doubt on the high-risk pool as the use of $50 billion earmarked reserve was not made clear in the consultation paper. They also urged the government to set up an independent regulatory agency to regulate the VHIS and establish a proper mechanism to monitor the appropriateness of premium loading by insurance policyholders in VHIS migration[40].  For public sectors, the Hospital Authority supports the proposed VHIS but they would like the government to address the challenges in manpower and capacity planning [41]. For private sectors, the Hong Kong College of Pediatricians and the Hong Kong Private Hospitals Association expressed their support on the scheme but they urged the government to revamp the private healthcare facilities before the implementation of VHIS [42]. Also, they expressed worries over the transparency of medical fees, especially the disclosure of historical pricing which was largely determined by doctors[43].

Insurance and Business Sector

The Hong Kong Federation of Insurers has great divergences on the fundamental operating principles with the government in the scheme. They believe that the suggested premium level at $3600 is unrealistic and misleading, because it fails to take into account the effect of medical inflation. The one-off funding to the HRP and Guaranteed Acceptance is insufficient and unsustainable without the government’s long-term commitment[44].  In addition, there are several uncertainties, such as the lack of proper definition of high risk and the transparency of medical fee by the hospitals [45]. The Hong Kong Women Professional & Entrepreneurs Association has strong reservation towards the proposed VHIS as they think the scheme is not favorable to the majority middle class in Hong Kong. The VHIS is not cost effective to induce citizens to purchase, specifically to the young generation [46]. The Institute of Financial Planners of Hong Kong questioned the effectiveness of risk pooling with a voluntary scheme and the coordination with private healthcare sectors if there is no effective control on costs and quality of services [47].

Other Sectors

1000 residents were interviewed in a survey co-organized by the Radio Television Hong Kong and the Public Opinion Programme. More than 40% of the respondents supported the VHIS and 22% of them opposed to the scheme[48]. This survey revealed that citizens are willing to support the scheme under the condition that the government resolves the ambiguity in policy implementation.

The New People’s Party shared the same view. They requested the government to tighten the regulation on the private medical sector by amending the existing legislation [49]. The Equal Opportunities Commission and the Consumer Council also voiced their concerns. The former questioned about the premium loadings under anti-discrimination principles, suggesting that patients with certain illness should not be excluded [50]. While the latter raised queries over the availability of choices for customers, and the need to facilitate information transparency by disclosing claim records and benefits schedules online. [51]

See also

References

  1. ^ http://www.dh.gov.hk/english/main/main_orhi/list_ph.html
  2. ^ http://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10084&Lang=ENG&Dimension=100&Parent_ID=10042&Ver=HTML
  3. ^ "Hong Kong health indices among world's best". Government of the Hong Kong SAR. 2003-01-28. Retrieved 2008-02-01.
  4. ^ "http://www.chp.gov.hk/en/data/4/10/27/110.html. Centre for Health and Protection, Department of Health, HKSAR Government. Retrieved 2011-6-3.
  5. ^ https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
  6. ^ "World Population Prospects: The 2006 Revision" (PDF). United Nations. 2007. Retrieved 2008-02-01.
  7. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 32. ISBN 978-1-137-49661-4.
  8. ^ Live Donor Liver Transplantation: Current Status
  9. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 33. ISBN 978-1-137-49661-4.
  10. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 31. ISBN 978-1-137-49661-4.
  11. ^ "Homepage of the Department of Health, the Government of Hong Kong SAR". Hong Kong government. Retrieved 2007-11-13.
  12. ^ "list of main services of the Department of Health, the Government of Hong Kong SAR". Hong Kong government. Retrieved 2007-11-13.
  13. ^ "About Hospital Authority". The Organisation of Hospital Authority. Retrieved 2007-11-13.
  14. ^ "Accreditation Details of Hong Kong Hospitals". Trent Accreditation Scheme. Archived from the original on 2007-08-26. Retrieved 2007-10-31.
  15. ^ "The homepage of Hong Kong Academy of Medicine". HKMA. Retrieved 2007-11-13.
  16. ^ "Postgraduate Medical Education systems (PGME) for International Medical Graduate (IMG) applicants seeking RCPSC Certification". The Royal College of Physicians and Surgeons of Canada. Retrieved 2007-11-13.
  17. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 34. ISBN 978-1-137-49661-4.
  18. ^ Legislative council. (2016). Background brief prepared by the Legislative Council Secretariat for the meeting on 19 April 2016 on Voluntary Health Insurance Scheme. Retrieved from http://www.legco.gov.hk/yr1516/english/panels/hs/hs_hps/papers/hs_hps20160419cb2-1314-2-e.pdf
  19. ^ Information Services Department. (2014). Government launches public consultation on Voluntary Health Insurance Scheme. Retrieved from http://www.info.gov.hk/gia/general/201412/15/P201412150257.htm    
  20. ^ Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from http://www.vhis.gov.hk/en/consultation_document/index.html.    
  21. ^ Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from http://www.vhis.gov.hk/en/consultation_document/index.html.    
  22. ^ The Harvard Team. (1999). Improving Hong Kong’s Healthcare System: Why and for Whom? Retrieved from http://www.fhb.gov.hk/en/press_and_publications/consultation/HCS.HTM.    
  23. ^ Health and Welfare Bureau. Lifelong investment in health consultation document on healthcare reform. Hong Kong: Government of the Hong Kong Special Administrative Region; 2000.    
  24. ^ Health and Medical Development Advisory Committee. (2005). Building a Healthy Tomorrow: Discussion Paper on the Future Service Delivery Model for our Health Care System. Retrieved from http://www.info.gov.hk/archive/consult/2005/hmdac_paper_e.pdf    
  25. ^ Food and Health Bureau. (2008). Your Health, Your Life: Healthcare Reform Consultation Document. Hong Kong: Food and Health Bureau. Retrieved from http://www.fhb.gov.hk/beStrong/files/consultation/exsummary_eng.pdf.    
  26. ^ Food and Health Bureau. (2008). Your Health, Your Life: Report on First Stage Public Consultation on Healthcare Reform. Hong Kong: Food and Health Bureau. Retrieved from http://www.fhb.gov.hk/beStrong/eng/consultation/consultation_report1.html    
  27. ^ Food and Health Bureau. (2010). My Health, My Choice: Healthcare Reform Second Stage Consultation Document. Hong Kong: Food and Health Bureau. Retrieved from http://www.myhealthmychoice.gov.hk/pdf/executive_summary_eng.pdf
  28. ^ Food and Health Bureau. (2011). My Health, My Choice: Report on Second Stage Public Consultation on Healthcare Reform. Hong Kong: Food and Health Bureau. Retrieved from    
  29. ^ PricewaterhouseCoopers Service Limited. (2013). Consultancy Study for the Health Protection Scheme Final Report. Retrieved from http://www.vhis.gov.hk/doc/en/information_centre/hps_consultancy_report.pdf.
  30. ^ Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from http://www.vhis.gov.hk/en/consultation_document/index.html.    
  31. ^ Information Services Department. (2016). 積極推動自願醫保立法. Retrieved from http://archive.news.gov.hk/tc/categories/health/html/2016/04/20160416_151232.shtml.    
  32. ^ South China Morning Post. (2016). Two controversial items put on hold in Hong Kong voluntary health insurance plan. Retrieved from http://www.scmp.com/lifestyle/health/article/2051260/two-controversial-items-put-hold-hong-kong-voluntary-health    
  33. ^ Information Services Department. (2016).食物及衞生局局長談自願醫保計劃及墟市(只有中文). Retrieved from http://www.info.gov.hk/gia/general/201612/02/P2016120200741.htm    
  34. ^ Food and Health Bureau. (2014a). Welcome message Voluntary Health Insurance Scheme website. Retrieved from http://www.vhis.gov.hk/en/welcome_message/index.html.    
  35. ^ Healthcare Planning and Development Office. (2012a). Introduction. Retrieved from http://www.hpdo.gov.hk/en/aboutus.html.    
  36. ^ Health Planning and Development Office. (2012b). Working Group and Consultative Group on Health Protection Scheme. Retrieved from http://www.hpdo.gov.hk/en/hpsworkinggroup.html.    
  37. ^ Healthcare Planning and Development Office. (2012c). Membership of Working Group on Health Protection Scheme. Retrieved from http://www.hpdo.gov.hk/en/hpswgmembership.html.    
  38. ^ Healthcare Planning and Development Office. (2012c). Membership of Working Group on Health Protection Scheme. Retrieved from http://www.hpdo.gov.hk/en/hpswgmembership.html.    
  39. ^ Healthcare Planning and Development Office. (2012c). Membership of Working Group on Health Protection Scheme. Retrieved from http://www.hpdo.gov.hk/en/hpswgmembership.html.    
  40. ^ Hong Kong Medical Association. (2015). HKMA's views on the Voluntary Health Insurance Scheme. Retrieved from http://hkma.org/english/newsroom/news/20150315.htm
  41. ^ Hospital Authority. (2015). Hospital Authority’s Response to the Government’s Consultation Document on the Voluntary Health Insurance Scheme. Hospital Authority. Retrieved from https://www.ha.org.hk/haho/ho/cc/ga_response_to_Govt_Consultation_E1.pdf
  42. ^ Hong Kong College of Pediatricians. (2015). Response to Public Consultation on Voluntary Health Insurance Scheme (VHIS) and Regulation of Private Healthcare Facilities (PHF). Hong Kong College of Pediatricians. Retrieved from http://www.paediatrician.org.hk/index.php?option=com_docman&task=doc_view&gid=982&Itemid=66
  43. ^ Hong Kong Private Hospitals Association. (2015). Re: Voluntary Health Insurance Scheme Consultation Document. Hong Kong Private Hospitals Association. Retrieved from http://www.privatehospitals.org.hk/doc/Appendix%205%20-%20HKPHA%20Submission%20on%20Voluntary%20Health%20Insurance%20Scheme%20Consultation%20Document%202015.pdf
  44. ^ The Hong Kong Federation of Insurers. Voluntary Health Insurance Scheme (VHIS). The Hong Kong Federation of Insurers. Retrieved from http://www.legco.gov.hk/yr15-16/english/panels/hs/hs_hps/papers/hs_hpscb2-1596-1-e.pdf    
  45. ^ The Hong Kong Federation of Insurers. (2015). Consultation on Voluntary Health Insurance Scheme (VHIS) and Regulation of Private Healthcare Facilities. The Hong Kong Federation of Insurers. Retrieved from http://www.legco.gov.hk/yr14-15/chinese/panels/hs/hs_hps/papers/hs_hpscb2-1098-1-ec.pdf    
  46. ^ Hong Kong Women Professional & Entrepreneurs Association. (2015). “Voluntary Health Insurance Scheme” (“VHIS”) Consultation Response Paper. Hong Kong Women Professional & Entrepreneurs Association. Retrieved from http://www.legco.gov.hk/yr14-15/chinese/panels/hs/hs_hps/papers/hs_hpscb2-1098-1-ec.pdf
  47. ^ Institute of Financial Planners of Hong Kong. (2015). IFPHK’s Response to the Consultation Document Issued by the Food and Health Bureau on the Voluntary Health Insurance Scheme. Institute of Financial Planners of Hong Kong. Retrieved from http://www.ifphk.org/pdf/Policy_and_Regulatory_Affairs/Response_to_Voluntary_Health_Insurance_Scheme_final.pdf
  48. ^ Public Opinion Programme, the University of Hong Kong. (2015). Voices from the Hall – Would Citizens Support the Voluntary Health Insurance Scheme? Public Opinion Programme, the University of Hong Kong. Retrieved from https://www.hkupop.hku.hk/english/features/rthkdf20150301/
  49. ^ New People's Party. (2015). NPP's response to Voluntary Health Insurance Scheme and Regulatory Regime for Private Healthcare Facilities Consultation Papers. New People's Party. Retrieved from http://www.npp.org.hk/en/node/17088
  50. ^ Equal Opportunities Commission. (2015). Consultation Documents on Voluntary Health Insurance Scheme and Regulation of Private Healthcare Facilities. Equal Opportunities Commission. Retrieved from http://www.hpdo.gov.hk/doc/fhsd/submissions/organizations/O022.pdf
  51. ^ Consumer Council. (2015). Consumer Council Submission to the Food and Health Bureau on Voluntary Health Insurance Scheme. Consumer Council. Retrieved from https://www.consumer.org.hk/ws_en/competition_issues/policy_position/2015041602.html
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