Can cross-border birth quotas work in practice?
The number of expectant mainland mothers coming to give birth in Hong Kong has reached a critical point, pushing our public health system to the limit and prompting public doctors to demand that the government implement an annual quota system to limit their numbers.
Last week, Secretary for Food and Health Dr York Chow Yat-ngok failed to convince private hospitals to downsize services provided to pregnant mainland mothers so that they can give priority to local women. The Private Hospitals Association rejected the idea, saying a quota system or cutting beds for non-local mothers could lead to a waste of resources.
There is room for adjustment to leave some capacity to treat local mothers-to-be, but private hospitals obviously care more about profits than patient welfare.
Amid mounting pressure from local women who complain that obstetrics wards are overcrowded with mainland women, Chow said the government would impose quotas on hospitals to control the number of pregnant mainland women giving birth in the city.
Meanwhile, public hospitals have stopped accepting bookings from non-local mothers for deliveries in the city for the rest of the year.
It Is hoped that these measures will help both public and private hospitals maintain their professional standards and service quality.
But, the government has just put a bandage over the issue and failed to tackle the root of the problem. Not only that, it has created other problems.
First, if the government's quota does apply to all mainland women giving birth in Hong Kong, it will have inadvertently taken away the legal rights of mainland women who are married to local residents, and are thus entitled to give birth in the city. The ban may even breach the Basic Law or cause other undesirable legal and political consequences.
Second, though Chow has said quotas would apply to both public and private hospitals, it is not immediately clear if the government has the regulatory power to enforce quotas on private hospitals.
If private hospitals cannot be compelled to comply, limiting the capacity of public hospitals to provide obstetrics services to expectant mainland mothers will only force them to use private hospitals. And because private hospitals often put profits first, there is no guarantee they will give priority to local residents.
Last year, some 88,000 babies were born in Hong Kong, of whom about 40,000 were born to mainland mothers, and among them 32,000 were born to non-local parents.
In fact, public and private hospitals are intrinsically linked. The training of obstetrics staff and the development of such services in the private sector have either come from the public sector or been subsidised by the government.
The quota system may not alleviate the problem if private hospitals do not co-operate. If, instead, they expand their maternity services, they may need to poach more staff from the public sector. Private hospitals are already causing a brain drain from public hospitals by offering better terms to doctors and nurses.
So, if they needed more experienced medical staff to handle their expanding maternity services, it would have an even more severe impact on the service quality of public hospitals.
In such a case, the government could not give private hospitals a free hand to regulate themselves. It would have to step in.
We have to tackle the root causes. But, first, private hospitals must fully develop their obstetrics and maternity services by providing newborn intensive care units. They have profited from this line of business; now, they must invest in it.
Albert Cheng King-hon is a political commentator. firstname.lastname@example.org