Treat the disease
Do we have enough doctors in Hong Kong? Is protectionism to blame for this perceived manpower crisis in hospitals? As soon as the people of Hong Kong decide how much to spend on public health care, it is easy to calculate the number of doctors to train (or import). We have about 1.8 doctors per thousand people in Hong Kong. If we want 2.2 doctors per thousand, like Singapore, we need to either train or import 2,800 more doctors.
It is all relative. Compared to the mainland (with fewer than one doctor per thousand people), we have too many doctors. A more pertinent question to ask is whether we have utilised our manpower effectively.
The government sees importing foreign graduates as a quick fix. Morphine does ease pain, but what next? Increasing the supply of doctors by whatever means may reduce doctors' salaries for the Hospital Authority and further widen the income gap between public and private doctors. In fact, the salary of new public-sector recruits has been cut twice since 1997. This strategy will work until the day the already poor morale of public doctors hits rock bottom. Parents may even begin to discourage their children from studying medicine.
No supply will ever satisfy demand for cheap but good-quality services. Take a look at the phenomenal surge in demand for obstetric services in Hong Kong recently. The reason is glaringly simple: HK$39,000 for a Hong Kong identity card is cheap for mainland Chinese.
What about hiring doctors in private practice to work part-time in the public sector? Junior specialists who are willing are being paid 70 per cent of the base salary of full-time staff, which equates to an average of HK$400 per hour. They are obviously not 'greedy protectionist doctors'. According to the Hospital Authority, the HK$1,200 per hour requested by some private specialists is ludicrously excessive. In my opinion, it is cheap compared to the hourly charge of my lawyer and my accountant.
Specialist medical care is expensive and needs to be rationed. For example, relatively straightforward hypertension and diabetes cases could have easily been referred to private-sector GPs in order to shorten the waiting time for complex medical cases in the specialist clinics. Hiring more overseas-trained doctors to be GPs in our specialist outpatient clinics is not a long-term solution.
To spend the public health dollar wisely, it is important to dissect every waiting list to weed out optional or non-essential tests and procedures. 'Medical need' should be given more weight than 'medical want'.
Specialists among us nickname this phenomenon the 'inverse care law' (a catchphrase modified from the 'inverse square law' in physics). It means that the person who does not need treatment gets treated while the sickest one is asked to wait. At present, public-sector specialists sometimes need to rush through a GP case in the clinic while patients with serious and complex diseases need to pay for consultations with private specialists because they can't wait for treatment. Those who can't wait and can't pay turn up in the accident and emergency department of public hospitals.
Medical services are rationed in Canada, too. Even a simple X-ray service cannot be abused because doctors are monitored by the government and penalised for overservicing. Is it not ironic that we are complaining in Hong Kong that the waiting time for an MRI scan is too long? We want it fast, and for free. Note that our marginal tax rate is only 15 per cent. There is currently no incentive for public hospitals - grouped into seven clusters by the Hospital Authority - to increase efficiency. Keeping the waiting lists long and making sure no surplus fund is left over ensure that one's cluster gets at least the same cut in next year's budget. The arbitrary division into clusters actually encourages unhealthy competition.
Rather than arguing that we should import overseas-trained doctors to work in the Hospital Authority and calling potential part-timers from the private sector greedy, it is far more important for the authority to define its scope of services realistically.
What has been done by the government to encourage our citizens to see private GPs to ease the workload of public doctors? The rental cost of a 600 sq ft GP clinic on a busy street can easily exceed HK$30,000. The government is the biggest landlord of Hong Kong. Has it done anything to help GPs and their patients to counter the rising rental costs in Hong Kong?
Many patients who attend the public specialist clinics are actually only interested in the four months' worth of expensive medicine, each sold at just HK$10. Many are already seeing private specialists but want to keep their public 'accounts' open since it is almost free of charge.
All the so-called public-private partnership programmes have failed dismally simply because no ingenious service model can beat expensive medication that costs the patient only HK$10 each.
When was the last time you heard a patients' rights group lobby the international drug companies for cheaper drugs, or The Link Reit for cheaper rents for estate doctors? Rather than ask the doctors to put 'public benefit above personal greed', it is time for the government to show some leadership and put 'public benefit above administrative incompetence'.
It is human nature to choose the path of least resistance but we should stop kicking the can down the road. I suspect the morphine effect of our 29 new overseas-trained recruits will wear off before long.
Dr Edmond Wong Man-lok is an associate consultant cardiologist at the Hospital Authority's Pok Oi Hospital. These views are the author's own
