Wrong Kong Part 6
Health Care
We’ve already discussed how Mainlanders have greatly exacerbated crowding in Hong Kong hospitals, taking advantage of the services and not paying their bills.
That alone is rightfully galling to the average Hong Konger. But rapidly deteriorating conditions in the city’s public hospitals is also fueling discontent … and this problem is getting worse.
The Good News is the Bad News
In fairness, statistically, Hong Kong’s health care system is a success.
It’s one of the healthiest places in the world. Residents of Hong Kong enjoy a life expectancy of 88 years for women and 82 years for men. And that is rising rapidly.
The combined male/female life expectancy is the third highest in the world, and is accompanied by an infant mortality rate of 3.8 deaths/1000 births, the fourth lowest in the world.
In addition, Hong Kong's public healthcare is virtually free for consumers.
However, HK faces serious challenges due to its rapidly aging population, as well as an increase in lifestyle-related noncommunicable diseases and escalating medical costs caused by advances in technology.
Today, the elderly make-up about 12.5% of HK's total population; this figure will reach 25% by 2030. More old people means more expense. Over-65s require on average six times more inpatient care than under-65s.
One for the rich, one for the poor
Take a stroll through the cities spectacular private hospitals like Matilda International Hospital on The Peak or the Adventist hospitals located on Stubbs Road and in Tuen Mun and you won’t have to climb over any beds in the corridors to find a doctor or nurse to treat you. They’re more like five-star medical hotels.
But, you (or your insurance company) will have to pay for their services—something 90 per cent of Hongkongers can’t afford, leaving the public-health sector stretched to the breaking point.
What’s the patient experience like? From the Hong Kong Free Press:
I went to public hospital with a collapsed lung. The doctor at Ruttonjee performed a relatively minor operation to drain the air out of my chest cavity and properly re-inflate my lung. I was then taken to a general female medical ward, where I would remain bedridden for days.
However, one morning, the doctor came to my bedside with bad news — another surgery would be necessary as the chest drain had been ineffective.
I was then told that I had to go to Queen Mary Hospital, another public hospital, one with a reputation for providing complex and advanced health services. But again, there were no beds available.
The doctor at Queen Mary was unable to specify a time frame for the surgery.
“It might happen tomorrow, this weekend, or next week. We don’t know,” the doctor said.
I got lucky. The very next morning, an appointment was confirmed for the operation, which would take place a few days from then.
During my 1½-week stay at two public hospitals, I witnessed patients with chronic illnesses waiting days – or even weeks – for surgery. The same nurses who attended me in the morning were often there in the evening as well, seemingly pulling double shifts.
One patient I spoke to at Queen Mary told me her operation had been canceled at the last minute because priority was given to an injured person in a traffic accident. Another said the doctor had been forced to perform minor surgery on her in her hospital bed because there was no room in the operating theatre.
My procedure went well, and I was discharged four days later, and apparently just in time. On my last day, a nurse confided she was having trouble finding extra beds for a new group of patients.
Hong Kong’s public-health sector employs only 40 per cent of the doctors plying their trade in the city, yet those doctors treat 90 per cent of the inpatients.
How overworked are HK’s public hospital doctors?
On a normal day, it is usual for a doctor to work 12 hours straight without taking any break, or have the luxury to stop for a quick bite,” said Dr Alfred Wong Yam-hong, a cardiologist at Tuen Mun Hospital.“It is quite common to work overtime even past that, since a doctor can’t just leave patients in the middle of a procedure and wait for the next day.”
He said doctors had to see about 20 patients a day on average, but that number could rise to 60 at weekends.
“It’s unreasonable, even without the winter surge,” he said, referring to the annual flu season, when patients overflow from wards into hospital corridors. That is when non-urgent patients have to wait for up to eight hours at some emergency units, and hospitals ask doctors to work overtime and cancel their days off.
Public doctors know their private-sector counterparts treat far fewer patients and yet, by and large, make much more money. This results in the loss of medical talent, which in turn has further exacerbated manpower shortages.
The Hospital Authority which runs the city’s 43 public hospitals expects a chronic shortage of 300 doctors at all times. The problem is getting worse. In 2017, the Food and Health Bureau, predicted Hong Kong would be short 500 doctors in 2020.
The annual turnover rate for doctors in public hospitals has hovered between 4 and 5 per cent over the past few years, but rose to 5.8 per cent in 2017-18. Many of them quit for the private sector.
More patients and no doctors is a dangerous formula. Nursing is equally stretched.
So, government spending on health care has surged. From $45.1 billion and 14 per cent of total expenditure in 2013 to HK$80.6 billion (US$10.3 billion) and 18.3 per cent of total expenditure. The government is building new hospitals and renovations old ones.
As we’ve learned, it is not keeping up with demand. And conditions get worse by the day.
The dilemma with all public health care: if you give away something for “free” people will use a lot of it. However, as we also pointed out, health care in Hong Kong is not free. Locals essentially pay the tax for their medical through the prices of their expensive and sub-standard housing.
Medical is one of the few good things they get from their government. As it continues to deteriorate, so will the public’s mood.