ABSTRACT
This chapter uses a revised version of multiple-streams framework to examine the mandatory health insurance reform fiasco in Hong Kong in 1999. It shows that the mandatory health insurance scheme proposed by experts from Harvard University was too radical to be accepted by multiple stakeholders. It could hardly fit into the context of Hong Kong where the idea of free healthcare was deeply embedded in the healthcare system. Poor economic circumstances caused by the 1997 Asian financial crisis did not open a window of opportunity for the government to implement the mandatory health insurance reform. The disjointed political system also made it very difficult for the government to secure majority support for this unpopular reform. The successful implementation of a voluntary health insurance scheme in 2019 shows that a milder reform option is more politically feasible and publicly acceptable. Ensuring the fiscal sustainability of the free healthcare system will remain a challenge for the government. More emphasis on preventive and community care can be helpful in reducing the immense pressure on the free healthcare system.
