Proposed cure for public health system will not give hospitals the lifeline they need, experts warn
Originally published at the South China Morning Post on September 17, 2016.
Medical experts warn that government plans to address the acute manpower shortage plaguing Hong Kong’s health system are unlikely to ease the pressure.
In recent years, public hospitals have faced a chronic shortage of about 300 doctors, leading to massive spikes in waiting times and a system that is often stretched to breaking point. The number of doctors needed is projected to increase by about 28 per cent from 6,310 in 2016 to 8,050 in 2026, according to a 2015 Food and Health Bureau report.
The city’s nurse-to-patient ratio is also behind the international standard of 1:6. The average ratio of nurses to patients in public hospitals was 1:11 but could reach 1:24 at night, the Association of Hong Kong Nursing Staff reported earlier this year.
The shortages are the result of many factors, including a lack of new doctors, stringent requirements for non-locally trained doctors to practise in the city, a lucrative private health sector, and an emphasis on secondary care such as specialist and hospital services over primary care like health promotion and prevention.
The issue was raised this week by a study that predicted a massive rise in patient admissions by 2041, with the number of inpatient days almost doubling as a result of a growing elderly population. There were about 1.07 million Hongkongers aged 65 or over in 2014, but that number is expected to more than double to 2.58 million by 2064.
Patients in New Territories East seeking a first consultation at an orthopaedics and traumatology clinic, for example, must wait over three years for an appointment.
Paul Yip Siu-fai, professor of social work and administration at the University of Hong Kong, said: “If the government continues to use the same methods, I’m not sure they will be able to cope with this problem. We do not produce enough doctors, and the private sector is also drawing people out [of the public system]. We have to think about how we can increase our manpower base.”
The public sector serves about 90 per cent of the city’s patients but only employs 40 per cent of the doctors. In contrast, the private sector serves 10 per cent of patients and employs 60 per cent of doctors.
Doctor groups have also said that the shortfall was a result of the government’s move to reduce the number of medical school openings from more than 300 in 2003 to about 250 in 2009, when the city was facing a surplus of doctors. There are only two medical schools in Hong Kong and the Hospital Authority currently employs about 5,500 doctors and 20,000 nurses.
As concern at the shortage grows, the government has increased the number of medical school places to 470 by 2018 and raised the retirement age for specialist doctors from 60 to 65. It has also earmarked HK$200 billion to implement a 10-year plan to boost the city’s medical infrastructure. Measures include redeveloping or expanding more than 10 hospitals, as well as providing 5,000 extra beds and more than 90 new operating theatres.
To further ease the strain, this year, the authority hired 363 new resident trainee doctors and re-employed about 63 retired doctors. As of July, there were more than 350 part-time doctors and 2,669 part-time nurses.
Although such measures would help to stem the shortage in the long run, they were not enough to tackle the crisis in the short and medium term, according to Tim Pang Hung-cheong, patients’ rights advocate for the Society for Community Organisation. Increasing the number of medical openings was a necessary step, but the effects of this would not be felt for more than a decade.
The problem, Pang said, was compounded by the fact that not all doctors would serve in the public sector and that demand for services would rise rapidly. Hong Kong’s planning standard stipulates there should be 5.5 beds per 1,000 population, but the current ratio was about three to 1,000.
“It’s a delayed measure that should have been implemented years ago,” he said.
Both Pang and Yip said the city must find a way to make it easier for doctors trained overseas to return to Hong Kong to practise. There have been attempts to relax the city’s licensing exam requirements for overseas doctors, yet they were met with great opposition by various professional medical groups and eventually halted when a Medical Council reform bill failed to pass in the Legislative Council this summer.
Although he disagreed with relaxing the qualification requirements for overseas doctors, Pang said the city should make it easier for qualified doctors to work in Hong Kong. “Other countries are recruiting doctors from overseas ... why not Hong Kong? I think it’s just protectionism.”
The Food and Health Bureau said the Medical Council had increased the frequency of the licensing exam to twice a year and shifted its internship requirement to be more flexible.
For the situation to improve, the government needed to implement more extensive short-term measures and enhance primary care like prevention and community-based services, Pang said.
“The government has to show a financial commitment [and] set aside enough resources.”