See big picture on public health care
Our public hospital system is far from broken, but it could easily get that way without health care reform. Chronic shortages of medical staff, the increasing pressures of an ageing population and demand from mainland patients are straining services, sometimes dangerously. Chief executive-elect Leung Chun-ying knows the challenges and will have to make reshaping the sector a priority. Hard decisions, which successive administrations have shied away from, will have to be taken.
Leung has already broached one of the issues, that of mainland women giving birth in the city. But they represent only the most recent facet of a discussion that has been taking place, with scant resolve, since the early 1990s. In keeping with the government's social contract with Hong Kong, the public health sector provides a good standard of care at exceptionally low prices for all residents, regardless of income. Given the strains being experienced, it is an unsustainable situation.
At the heart of the problem is funding. Medical staff are expensive and increasingly so, especially in the face of a global shortage and with competition from a booming private sector. Public hospitals care for 90 per cent of local patients but employ only 40 per cent of our city's doctors. That means heavy workloads and a brain drain that our two medical schools and schemes to recruit from overseas are failing to avert.
Not until 2018 will an expanded medical school intake provide graduate doctors. Training them takes at least seven years and costs millions of taxpayers' dollars, so bringing in qualified physicians from overseas is a sensible quick fix. Making them sit for overly difficult entrance exams; requiring them to do a year-long internship, no matter how experienced they are; and expecting 44-hour working weeks and 36-hour on-call duty shifts, as presently often happens is no way to attract and retain them. The numbers involved are small enough that the interests of local doctors will not be affected, even if those that are recruited from overseas eventually go into private practice.
But more doctors are only part of the solution. The system needs to be overhauled to ensure that public hospitals are mostly used only by those who cannot afford to go to private ones. It is the perceived unpopularity of such a move that has kept authorities from bringing in means testing, pushing forcefully for voluntary medical insurance and better resource sharing and co-operation between the public and private sectors. Measures over the years have been piecemeal, lacking the big-picture foresight and planning so necessary for the challenges ahead. Numerous consultations have been held and models mooted, only to be set aside to gather dust. After taking office, Leung has to revisit them so that a lasting way forward can be found.