New thinking now is what doctors of 2040 would order

We need to leverage the strengths of an holistic approach as health care demands rise

PUBLISHED : Thursday, 08 May, 2014, 4:00am
UPDATED : Thursday, 08 May, 2014, 4:00am

Since its establishment in early 1990, the Hospital Authority has grown to become one of the most respected and efficient public health care systems in the world. Using the equivalent of just 2.5 per cent of Hong Kong's gross domestic product, we meet close to 90 per cent of inpatient needs.

In 2012/13, our services included 2.3 million accident and emergency attendances, 9.2 million specialist outpatient visits, and 5.9 million primary care visits.

Like many places in the world, Hong Kong's demographics are undergoing a significant change. By 2041, the population is expected to have grown by 1.3 million to 8.5 million. The consequences of these dramatic shifts will be felt in many areas of society, but particularly so in demand for health care.

In terms of general bed use, the requirement for those aged 65 and above is about nine times more than younger people. For those aged 85 and above, it is almost 20 times that of the under-65s.

Our model of care is clearly not sustainable if we are to handle long-term shifts in demand. We must introduce new thinking now as to how to continue providing high-quality care.

Current projections put our 2041/42 recurring financial resources at an estimated HK$169 billion - 3.8 times more than in 2013/14.

Some 18,000 new beds, 6,200 extra doctors, 24,000 more nurses and 7,700 new allied health professionals are among the more important of the many additional resources that will be necessary to maintain a level of service comparable with that of today.

Technology has enhanced clinical workflow and efficiency, treatment effectiveness and patient comfort. For example, refined surgical techniques, including robotic surgery and keyhole surgery, have improved operative treatment and, in some instances, reduced the need for post-operative medical interventions.

But we should not allow the acquisition of technology to become our primary goal. We must be smart and strategic in adopting innovations to ensure they serve our aims rather than drive them. Technology is merely a tool to help us achieve our overarching objective: patient-centred integrated care that leverages the strengths of a holistic approach.

A purely technological approach to improving health creates the risk of focusing solely on what is possible, at the expense of what is practical and what best promotes respect for dignity of life.

It may also serve to reinforce rigid models that emphasise specific treatment over functional outcomes, specific disease management over total patient health, and specific cures over patient comfort and functional needs.

While each part of such fragmented systems may provide treatment for patients, true patient-centred health care must be much more than the sum of these fragmented parts.

We must look beyond traditional models of "sick care" management that only treat individual diseases, and instead focus on treating individual patients and addressing their unique health care needs and concerns. We must also encourage individuals to actively manage their own health.

This will require discussion of how to develop and use rehabilitation, ambulatory, community and patient-administered models to reduce the strain and, at times, misplaced emphasis on acute and inpatient services.

There will be trade-offs and tough decisions to make and we have to explore solutions for the challenges we already know about and for other potential changes that may lie unseen on the road ahead.

It is up to all of us to start looking for the most appropriate actions for the most effective change. The power and potential of any equipment, management system or other assets are ultimately governed by the skills, priorities and ingenuity of the individuals who have these resources at their control. And despite the many technological advances in diagnosis and treatment over recent years, there is still no known substitute for the curative powers of a warm smile, a caring word or a thoughtful gesture of human kindness.

Dr Leung Pak-yin is chief executive of the Hospital Authority. This is an edited extract of his keynote address at yesterday's opening of the Hospital Authority Convention