Specialist care is under way for 100-week waiting list

Demand keeps growing, and a tendency to seek help beyond primary health care doesn't help

PUBLISHED : Thursday, 24 April, 2014, 3:26am
UPDATED : Thursday, 24 April, 2014, 3:26am

To many Hongkongers, specialist services at the Hospital Authority offer the health care their families rely on. Therefore, timely access to such services is a contentious social and political issue.

The problem of waiting times is basically that of an imbalance between demand and capacity. New specialist outpatient (SOP) bookings at the authority rose an annual average of about 3 per cent in the past three years, with more than 800,000 bookings in 2012/13. Within that period, SOP clinics catered to about 680,000 new patients, in addition to six million follow-up cases a year.

The result is a waiting list in which the 90th percentile waiting time - an index adopted internationally to denote the longest wait - is now more than 100 weeks in some of the clinics.

An ageing population and increasing prevalence of chronic illnesses appear to be behind the rising demand.

A tendency in the local culture to seek specialist care is also an important factor. An internal audit of the authority revealed more than 10 per cent of new patients who booked orthopaedic services suffered from lower back pain, a condition that for many of them could well have been managed by primary health care.

In terms of capacity, medical manpower shortage is a major factor limiting services. Albeit the problem will be alleviated with more medical graduates emerging from next year, it is still an acute problem in specialties such as ophthalmology where staff turnover is high.

In some hospitals, physical space limits clinic expansion. Furthermore, subspecialisation in medicine has also brought along fresh demand-capacity imbalance. Notable examples include paediatric dermatology and infertility treatment.

Aside from demand and supply, SOP management in the authority is not without room for improvement. Data verification, performance monitoring and planning all need beefing up.

There is no easy fix. The authority has introduced some short-term solutions, and plans to boost capacity and manpower in the long run.

To ensure patients with the most sinister conditions are seen without delay, the authority adopted a triage system in 2004 to segregate cases into three categories. For urgent and semi-urgent patients, the authority is able to maintain across all specialties a median waiting time of less than two weeks and eight weeks, respectively.

The waiting times of non-urgent cases vary among clusters, so a cross-cluster referral mechanism was launched in 2012 allowing suitable patients to visit clinics with shorter waiting times.

This measure is available at ear, nose and throat, gynaecology and ophthalmology clinics, and their waiting times are posted on the internet. More than 200 patients each month use the arrangement - reducing their waiting times from more than 100 weeks to about 20 weeks.

Alternatively, many SOP patients could be managed by primary health care. Some hospitals have set up collaboration clinics offering family medicine and major specialties. These clinics have the advantages of allowing patients to be assessed earlier, to receive more comprehensive treatment, and to reserve SOP quotas for those more in need.

In the short term, the authority uses a special staff-remuneration scheme to create extra SOP sessions. It is indebted to the many health care workers who sacrifice their rest to help more patients. Retired clinicians and private doctors are also invited to help.

In recent years, research has revolutionised the management of waiting times, and new tools are in place to help the authority's administrators and clinicians track waiting lists.

It is no mere management of numbers. Behind these numbers are patients, and behind the patients are their loved ones. The authority is aware of their needs and expectations, and is determined to make improvements with the resources available.

Dr Alexander Chiu is chief manager of quality and standards at the Hospital Authority