Regulate private hospitals in Hong Kong for better quality of care
Shalini Mahtani backs having a doctor on duty at all times and publicising clinical outcome data
Hong Kong's private hospitals account for about half of all hospital expenditure and 20 per cent of all hospital admissions. With our burgeoning ageing population, there is an obvious need to reduce the pressure on public hospitals - but how?
The government wants to encourage people to switch from public to private medical care. Is this a good idea and will a patient who makes the investment to go private today be assured of high-quality care, regulated by the government? The simple answer is no.
Private hospitals are governed by a weak and archaic piece of legislation enacted in 1936. It is therefore left to the goodwill, or not, of an individual hospital to have certain clinical standards.
We do have a code of practice for private hospitals but this is not mandated by law. Why is this? Surely even advocates of free markets and a "laissez-faire" economy would, morally at least, agree that health care should be regulated. After all, it is a public good and concerns life and death.
Furthermore, we can hardly rely on market forces in Hong Kong to help us reward the best and penalise the worst private hospitals. This presupposes information is freely available and markets will therefore self-correct. But in Hong Kong, there is limited information about clinical outcomes and patient satisfaction at each individual hospital. And we also know that, with the huge demand for hospital beds, there is hardly a need for private hospitals to compete and therefore perhaps improve.
We need to rely on the government - as do other places, like England, Singapore and New South Wales in Australia - to regulate private hospitals. Thankfully, the government realises there is a need and has been consulting the public over the regulation of private health care facilities. The consultation ends today.
Patient safety must be paramount, and our private hospitals could do much more in this regard. My top three recommendations to improve patient safety would be as follows:
First, we need doctors in hospitals at all times. I was shocked to learn that Hong Kong private hospitals are not required by law to have doctors employed by the hospital. Most of the time, a visiting doctor admits a patient, does what is required of them - for example, performs surgery - and then goes off to see other patients in other hospitals or clinics.
We have many fine doctors in Hong Kong who prioritise patient safety, but they are only human. As patients, we should not expect them to be on call every single moment. What happens if the visiting doctor is not contactable? Things may go wrong. It should therefore be mandatory for the hospital to have doctors on-site at all times and for the relationship between these doctors and the hospital to be legally binding and clear, for example either one of employer/employee or agency.
I am not suggesting visiting doctors be replaced. Instead, we need to ensure that when he or she is not contactable or available, there is another doctor who is ready to help.
Hong Kong's private hospitals should perhaps employ doctors to only work in one hospital and liaise directly with the visiting doctor in charge. In the visiting doctor's absence, the physician employed by the hospital would be able to deal with problem situations.
This is the case in many hospitals in the US, while in Singapore, regulations require hospitals of 50 or more beds to have at least one doctor on duty.
Secondly, people need information to decide which hospital to use. Private hospitals need to be mandated to provide clinical outcome data to the regulator and for this information to be made public and be easily accessible. Available data should include re-admission rates, infection rates, morbidity and mortality rates. This is a standard requirement in other markets.
Such information is critical too for policymakers to see where the problems are and to decide where further regulation is needed.
In the UK, the Care Quality Commission conducts checks on all hospitals and uploads detailed inspection reports onto its website with an overall rating for hospitals. Clinical data is also available publicly, thereby empowering patients to make fully informed choices.
Thirdly, private hospitals must be required to have a board of governors, for whom patient safety and quality of care is a priority. Evidence shows that when a board prioritises patient safety and has oversight of complaints, a climate of security is created, leading to improvements in the quality of care. It's just common sense: boards at private hospitals must prioritise quality of care in addition to financial sustainability.
I am encouraged that the government knows work needs to be done to bring our regulation of private hospitals to world-class levels. It is certainly time for change; all parties will benefit when patient safety is at the core of reform.
Shalini Mahtani is founder of The Zubin Foundation, a non-profit think tank with a focus on social justice and equality