Dramatic shortfalls in doctors prepared to work in Hong Kong’s public-hospital system and a looming crisis due to staff shortages are back in the news. At the same time, the recent refusal of the Medical Council of Hong Kong to reform its membership structure to include external observers – after nearly two decades of public pressure to do so – speaks volumes about complex vested interests. Did you suppose the primary function of Hong Kong’s private medical doctors was to heal the sick? Think again.
Hong Kong’s system of public-health doctors has long since passed crisis point, yet calls to import overseas talent are repeatedly rejected. Two arguments are commonly deployed; one maintains that academic and training standards overseas are simply not high enough for Hong Kong. This self-serving excuse ignores the fact Britain and Australia – both of which enjoy excellent public-health services – routinely import overseas-trained doctors.
Until 1997, doctors who had trained in those (and several other) Commonwealth countries were allowed to practise in Hong Kong; standards have obviously collapsed beyond redemption since then. Both countries remain emigrant destinations for Hong Kong-trained medical professionals – frequently refugees from the public sector – who depart in search of a better quality of life for themselves and their families.
The other frequent excuse is physiological exceptionalism – many Hong Kong Chinese, apparently, have such unique ailments that without local training and experience, any outside practitioner would be unable to treat them.
Both arguments suggest a cartel within the medical industry. As with virtually everything that ails contemporary Hong Kong, political dysfunction is the ultimate cause. Close examination of the medical sector’s rotten-borough composition, and of certain directly elected legislators, reinforces this assertion. Most have immediate family members who are medical professionals. It is in no one’s interest to blow the whistle on “closed-shop” licensing practices, and so these alleged public servants remain conspicuously silent whenever this issue arises. And as these people only use private doctors and hospitals anyway, why would they speak up?
Before a second medical school opened at the Chinese University in 1981, the University of Hong Kong was the only local tertiary institution that offered graduate-level medical training, despite the population having quadrupled since the late 1940s. Until the clearance and demolition of the Kowloon Walled City in the early 90s, China-trained doctors and dentists unable to obtain a Hong Kong medical licence (despite qualifications from prestigious mainland medical schools, such as Peking Union Medical College, or St John’s University in Shanghai) practised in that legal wilderness.
The 70s saw an influx of medical practitioners who claimed they were traditional herbalists and so were subject to minimal registration, allowing them to discreetly practise other forms of medicine. Like many such compromises in earlier times, this arrangement benefited all parties concerned. In return for the Hong Kong government looking the other way when it came to these doctors’ lack of local accreditation, reasonably good medical care was provided to those who could not afford the fees charged by private practitioners.
Private medical practice remains among the most profitable rackets in a society dedicated to – and being steadily wrecked by – wholesale economic rent seeking. As that journalistic cliché rightly maintains, turkeys don’t vote for Christmas, and so it is with Hong Kong’s trough-feeder legislators. Sadly, one would like to believe that the interests of the common weal might rank higher with medical professionals than they demonstrably do.
Now, let the howls of wounded outrage from Hong Kong’s rentier successors to Hippocrates commence …