• Wed
  • Aug 27, 2014
  • Updated: 9:44am
NewsHong Kong

Concern over high death rates in Hong Kong's public hospitals

Overcrowded wards and lack of intensive-care beds cited as report notes high mortality figures at three major public infirmaries

PUBLISHED : Wednesday, 08 January, 2014, 11:42pm
UPDATED : Thursday, 09 January, 2014, 4:37pm

Hong Kong's overstretched public medical sector has been dealt another blow with a major report revealing an "unsettling" death rate at one of the city's biggest public hospitals and expressing concern at the number of post-surgery deaths at two others.

The latest annual Hospital Authority report into surgical outcomes across the 17 public hospitals it oversees, found that the 25-year-old Tuen Mun Hospital recorded a "high" death rate for the fifth year in a row.

The hospital's continuing shortcomings led Dr Kenneth Fu Kam-fung, the head of the Public Doctor's Association, to pinpoint overcrowded surgical wards and a lack of intensive-care beds as potential problem areas.

He said the situation at Prince of Wales Hospital in Sha Tin and Queen Elizabeth Hospital in Yau Ma Tei, which recorded the highest death rates along with Tuen Mun, was due to the same problems.

Tuen Mun rated poorly in both emergency and non-urgent surgery in a 12-month period to June 30. Prince of Wales for the first time showed a split performance with its death rate in non-emergency surgery being one of the lowest, while that for emergency procedures had risen for the past four years.

Queen Elizabeth showed signs of improvement, according to the Hospital Authority's surgical outcomes monitoring and improvement programme, which has conducted the study since 2008.

"Tuen Mun Hospital has rated poorly for five consecutive years. This is unsettling to us," programme director Dr Yuen Wai-cheung said.

"What went wrong with Prince of Wales Hospital this year? The difference in its emergency and elective performances is very strange. No other hospital has had this difference and such polarisation is seen for the first time."

The death rates in the report were calculated by the ratio between actual and expected death rates in the 30 days after surgery. Yuen said this eliminated the effect of risks from the patient's condition before surgery.

The ratio of actual to expected deaths in emergency surgery was 1.33 at Prince of Wales and 1.28 at Tuen Mun, with figures below zero indicating a lower rate.

The report said Prince of Wales had the lowest rate of patients being sent to intensive care after emergency surgery, meaning some might not have received the care they needed. The rate was 19 per cent, compared with 54 per cent at Queen Mary Hospital in Pok Fu Lam.

Fu, president of the Public Doctors' Association and a urology surgeon at Queen Mary, said not all major emergency surgery required intensive care.

Yuen suggested that Prince of Wales consider introducing a high-dependency unit like that in Queen Mary for elective cases, to make room for emergency cases in intensive care.

The report found a strong correlation between the high death rate and high use of surgical beds in hospitals - with the average at Tuen Mun being 106 per cent, with the use of temporary beds the most of all hospitals.

Tuen Mun Hospital said it would add more beds in the surgical ward. Studies would be made on improvements to operating theatres and a reduction in the waiting time for operations.

Fu did not think crowded wards would increase the death rate but said a lack of experienced doctors or ample supervision of junior doctors could be factors.


For unlimited access to:

SCMP.com SCMP Tablet Edition SCMP Mobile Edition 10-year news archive



This article is now closed to comments

The numbers of medical graduates are probably not the issue. Regardless of the numbers, they just opt out of public hospitals to set up their own money-spinning little clinics. Maybe the salaries of hospital doctors should be increased to match their potential private earnings?
I would have hoped that this serious article might have been able to contain some actual numbers
instead of a set of 'ratios' which mean very little , or nothing , to the general public .
Or is there a suppression of these numbers from "official sources" , one wonders ? .
Come on SCMP you can do better than this , give us the numbers ! .
Demand for free medical services is basically infinite. Most countries that offer free healthcare (HK is almost free) have been overwhelmed and had to ration. Canada offers almost 3rd-world medical services even though it's a very rich country, and it costs the taxpayers there a lot (free for the patients except for long waits). Yes, you can give more to the Hospital Authority in HK, have more doctors, more beds, but patients will want more.
Intuitively, demand for medical services should be flat, but in practice, it increases when more is offered for free. HK can offer more, it will never be enough.
People aren't as sick when they have to pay for it. The Hospital Authority will also say they don't have enough, that they need more.
I'm familiar with HK public sector hospitals as an occasional patient. It's basically fine except for the waits sometimes. Hey, it's free.
Canadian medical care is being burdened by politics not logistics or finances.
We cannot put much blame to the hospitals which are heavily overloaded but short of manpower resources and necessary support facilities. The one to blame is definitely our government under Tung and Tsang. Did you remember at Tung's time, it was their decision (together with Leung Kam Chung) to reduce the medical student uptake without considering the long term impact. When the economy recovered strongly, Tsang simply voice out support on increasing population but did nothing to build up the corresponding facilities and manpower bank. The Prompt action is needed to deal with the problem. Firstly, Hospital Authority has to reallocate more resources to the frontline by reducing the bureaucracies and cutting the number of those highly paid administrators sitting in the headquarter. Also the authority needs to revamp the current practice say how to co-operate with private sector in order to reduce the demand of the public service. Secondly, the government needs to inject more resources to improve the working environment so as to retain the experienced doctors and other medical staff . We can spend 6 billion to build the RTHK building for simply more TV programmes which are only nice to have. Our government is not short of money but they don't use the money wisely. We have to appreciate those hard working medical staffs who are so committed to serve the public with their heart but there is a limit people can bear.
But the government wants to increase subsidies to the private sector instead of putting the money and taking the necessary steps to bring up the standard of care in the public hospitals. One might think this is an attempt to get people so unhappy with public health that they will accept going to a private health insurance model. But a look at the nation with the largest health insurance sector, the USA, makes it clear that the only ones who benefit from this model are the insurance companies and the doctors while millions of the public are left out entirely and many of those covered face a loss of savings and bankruptcy due to lifetime limits, high deductibles, exclusions and co-pays.
One of the most attractive aspects of the U.S. private medical insurance model is that, through either employer-sponsored insurance or private purchase, almost anyone (except people on government-run Medicaid) has access to and can afford to be treated by the top medical specialists in the country. When you or your loved one is seriously ill, that's the only thing that matters, and the 55% of Americans covered by employer-provided insurance like that a lot. Because Medicaid rather arbitrarily pays doctors less than private insurance does, specialist doctors in demand or those with full patient rosters routinely refuse Medicaid patients. Private insurance is not just about greedy corporations and doctors; crucially, it also leads to better care for sick people.
"The death rates in the report were calculated by the ratio between actual and expected death rates in the 30 days after surgery. Yuen said this eliminated the effect of risks from the patient's condition before surgery."
Surely this calculation will cause skewed results if you dont take into account the patient's condition before surgery? It would be interesting to see how they calculate the expected mortality rate as well before jumping to conclusions.
Also note that this article doesnt cover the all the main reasons for the problems - yes the public hospitals are overcrowded and maybe underfunded but what about the public abusing the services provided by the emergency services and the A&E departments? No wonder the doctors and staff are struggling if everyone with a cold goes to A&E... Factor in all the admin and bureaucracy that HK is infamous for and it will always be a mess. Throwing money at these problems wont fix them, its more an efficiency issue.
The public hospitals are being slowly strangled to death because of greedy Medical Council as well as those doctors who are only interested in usurping powers and personal glory....
Many good doctors who simply wanted to treat patients left the public medical services to practice privately....
When will the govt stop the greedy and selfish agenda of the Medical Council in restricting foreign trained doctors to practise here?
World class city with billions in surplusses?
The private medical industry is also to blame for the current crises concerning mainland babies born here - can they help set up some kindys, contribute to their social assistance, etc?
How about investing/spending more in the geriatic department in anticipation of the surge in demand instead of spending billions on the new arrivals?




SCMP.com Account