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Flu crisis shows need to reform health services

The circumstances of the death of a three-year-old girl hours after her family took her to hospital for treatment of a cough and fever has, understandably, given rise to public concern. The death has come at the height of the flu season, when hospitals are struggling to cope with an influx of patients.

Health authorities reacted yesterday by introducing sweeping infection controls reminiscent of those taken during the Sars outbreak five years ago. Such measures should have been put in place earlier, given the stresses on the system already caused by the number of flu cases. Overcrowding has left our hospitals ill prepared to cope with a more serious emergency.

The new measures are sensible, if overdue. They do not, however, tackle public unease over the little girl's death, which followed the still-unexplained death of a two-year-old boy in Prince of Wales Hospital hours after he was admitted with vomiting and a fever.

The girl died the same day she was seen by a doctor at Tuen Mun Hospital's accident and emergency department. She was sent home after the doctor diagnosed an upper respiratory tract infection. When finally admitted to hospital hours later, her heart had already stopped. Tests later showed she had a strain of H3N2 flu called Brisbane flu, but that may not be the reason she died. The case will go to the coroner's court, where the circumstances will be examined. But officials should swiftly make public any information which helps explain her death. This is the only way public concerns will be eased.

What we know of her treatment and illness raises troubling questions, not least for her family. Given the pressure on hospitals, the worry is that further tragedies may occur. In the girl's case, there is no suggestion that overcrowding, or the workload that puts on doctors and nurses, were decisive factors in the girl's treatment or the decision not to admit her in the first place for further observation of her condition. It remains a worry, however, that on the same weekend, frontline doctors warned that overcrowding had exposed the inability of Hong Kong's public hospital system to cope with the growing ranks of elderly people or with the possibility of a flu pandemic. Private hospitals report a similar predicament.

It does not take much to tax our hospital system. There are few beds or doctors and nurses to spare at the best of times. The Hospital Authority says the cold weather means occupancy rates on most medical wards are above 100 per cent. At the five busiest hospitals they are above 110 per cent.

The flu season occurs every year, but hospitals were caught unprepared. Some have begun capping accident and emergency admissions and delaying non-urgent treatment to accommodate flu patients. Given their mission of providing affordable care to all, it is difficult to see what more they can do now.

Our massively subsidised hospital system remains the envy of many other countries. But the rising demands of an ageing population, and the cost of modern medical technology, put ever bigger strains on the public purse. The current hospital crisis is a reminder of the urgency of reforming the delivery and financing of health services. Plans for greater participation by the private sector, with more emphasis on preventing illness and disease and promoting the role of the family doctor, call for a new financing model. A consultation expected to be announced next week on six financing options is unlikely to lead to concrete proposals until late this year at the earliest. Reform is needed - and should not be delayed any longer.

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