Hong Kong Healthcare in the Decade Ahead Improving Gender Inequality and Poverty and the Relationship to Access

Hong Kong SAR is a globally recognized leader in health care provision and policy. However, looking forward over the next decade, significant areas of improvement exist in relation to enhancing patient access to healthcare. Too often gender inequality and financial poverty limit patient medical options. By focusing on these variables and what practical health policy options exist to influence them, further improvement can be achieved in the Hong Kong health system.

Paul Yip, Director of the HKJC Centre for Suicide Research and Prevention at the University of Hong Kong writes "The success of a city cannot be measured only by its financial prowess…the well-being of its residents must also be considered." At the turn of the decade, Hong Kong finds itself in a strong position in terms of global healthcare rankings. Hong Kong is one of the healthiest places in the world (Health Care Bureau, 2003). Due to its emphasis on health maintenance and prevention, professional health services and state of the art health care and prescription system, Hongkongers enjoy a life expectancy of 85.9 for females and 80 for men, which are the second highest in the world, and 2.94 infant mortality rate, the fourth lowest in the world (Watt 2001). However, anyone who has worked in the medical system will admit that room for improvement exists. In the decade ahead, more must be done to improve gender equality and poverty as they relate to health access to ensure a system we can all be proud of.

Hong Kong's six million people are one of the healthiest populations in the world. The life expectancy is 84 for women and 78 for men, the second-highest worldwide. Hong Kong has a system of government-operated hospitals, which constitutes the majority of the health care system. If they can afford it, people also have the option of a private hospital if they wish. There are more than fifty public hospitals, and twelve private centers (Health Care Bureau, 2000). Fortunately in Hong Kong, everyone has access to some form of health care regardless of their financial means. Furthermore, services are readily available in all neighborhoods so most residents do not need to travel more than thirty minutes to reach their healthcare provider. Wealthy and poor residents spend a similar portion of their household income for health care, travel similar amount of time to reach a provider and have similar utilization rates. In other words, almost no-one has to reduce their use of health services due to an inability to pay or because they have to travel long distances to receive care. This enviable achievement is largely due to the government's commitment to assure every resident access to adequate hospital care when needed. In particular, the government allocates a significant portion of its budget to health care. Two major flaws exist in the system: 1) Quality is highly variable in relation to the prosperity of a neighborhood and 2) little is being done to protect patients from gender discrimination, which affect health through lower salaries and higher rates of assault vs. men. Overall, Hong Kong does not have effective measures to address these issues which influence whether patients receive comprehensive, high quality medical care, particularly in the private health care sector. For example, Hong Kong lacks grievance procedures that have the confidence of patients and independent external monitoring of clinical practices to safeguard patients' welfare. Through establishing better avenues of communication inroads can be made to improve patient access in light of the effects of gender discrimination and poverty.

Most Hongkongers are surprised by the degree to which sexual inequality influences healthcare access. The distinct roles and behaviors of men and women in a given culture, dictated by that culture's...

Not all such differences between men and women imply inequity - for example, the fact that in many Western societies men generally wear trousers while women often wear skirts and dresses is a gender difference which does not, in itself, favor either group. Gender norms and values, however, also give rise to gender inequalities - that is, differences between men and women which systematically empower one group to the detriment of the other. The fact that, throughout the world, women on average have lower cash incomes than men is an example of a gender inequality. In Hong Kong, these gender differences and gender inequalities can give rise to inequities between men and women in health status and access to health care. It is undeniable that workplaces in Hong Kong face gender inequality issues, whether at the executive level or among the working classes balancing the dual roles of mom and business woman. However, the situation is changing, this is because more women are being educated and that Hong Kong is more influenced by the western gender equal culture. There are even saying that the gender inequality might shift to women over-ruling men. It is important that medical professions understand the social reality of gender norms and values, and resulting behaviors, are negatively affecting health. The good news is that gender norms and values are not fixed. They evolve over time, vary substantially from place to place, and are subject to change. Thus, the poor health consequences resulting from gender differences and gender inequalities are not static either.
Poverty is another major issue that must be addressed to improve Hong Kong's health system in the years ahead. In Hong Kong, there are approximately 1.22 million people that are currently living in a low-income household. There have been tests shown that there has been an increase in low-income family in the past decade. Studies show that at least one out of four children currently living in a low-income household. There have been major gaps between the high and low income family. For example, a low income family may only 500 while the high-income family may make up to 3500-4000. A gap like that could only mean that the poor will only become poorer while the rich becomes richer. Many times, it is hard to survive with such a low income. Over the past 10 years, the rate of poverty has increased from 1995 to 2005. During 1995, the poverty rate was 14.8% and risen to 17.7% in 2005.

In Hong Kong, about 60% of the population is not secure with any kind of retirement funds of any kind. Almost 90% of the seniors have not gotten their retirement money yet. Most women had to work in factories for little money. The elderly work 10 hours a day and only get paid for about 20 U.S. dollars. Not only do the women have a low payment, but they also have bad working environments as well. About 120,000 of the elderly have to work in the poor conditions in order to survive. Housewives on the other hand don't get pay for their work around the house. They have to be dependent on their husbands to make the money. The problem is that these women don't have the benefits of a retirement protection because of the law. Because of this, more women have to receive special income from the government. Studies show that 52% of the people receiving this kind of special income are women. This shows that there are more women who are under this kind of problems than men.

These financial realities have profound effects on health access in Hong Kong. Health in is very strongly correlated with income. Poor people are less healthy than those who are better off, whether the benchmark is mortality, the prevalence of acute or chronic diseases or mental health. As a consequence, significant steps must be taken to relieve the economic situation of the less fortunate, whether they are immigrants or laborers. The government…