During the global financial crisis the government's task force on economic challenges identified medical services as one of six service industries that could be developed as pillars of the city's long-term growth. The sector therefore seemed assured of recognition in long-term planning and allocation of resources. Two years later, however, it is beset with pressures that should have been foreseen. Leaders of the medical profession have sounded warnings over a brain drain to private practice. Public doctors have threatened industrial action over excessive working hours. And both doctors and the government are concerned about the strain on obstetrics services for local mothers caused by the demand from mainlanders for maternity beds.
The emotive issue of maternity care has touched a nerve with the government, which has foreshadowed restrictions on mainlanders. Doctors have called for a ceiling of 88,000 in the total number of births - last year's figure - until resources catch up with demand.
Two years is a short time in which to implement the visionary goal of a pillar industry. But Hong Kong is now paying the price for the repeated failure of governments to act on recommendations and blueprints for reform of health care services dating back to before the handover. We still have to wait until next year at least for a voluntary private health insurance scheme that might relieve the pressure on the public system and kick-start the public-private partnership envisaged by the government, with family doctors taking more responsibility for primary care.
Ironically, the government cannot complain too loudly about the demand from mainland mothers. It is consistent with the concept of a pillar industry, which envisages a centre of health care excellence becoming a magnet for medical tourism. But the demand has outrun the vision. The number of babies born in Hong Kong to mainland mothers has risen from 13,000 in 2004 to more than 40,000. This has led to growing concern about stress on obstetrics and neonatal services, including intensive care for the two-to-three per cent of newborns who need it. Secretary for Food and Health Dr York Chow Yat-ngok rightly says the basic principle is priority for local mothers.
With increasing prosperity on the mainland, the attraction of a Hong Kong identity for their offspring and the hassles of having more than one child at home, expectant mainland mothers are likely to continue flocking across the border. The introduction a few years ago of an obstetrics booking fee of more than HK$40,000 for public hospitals has made little difference. Doctors have suggested capping private hospital deliveries at last year's 45,000, while public hospitals gradually cut their admissions of mainlanders.
The Private Hospitals Association has, understandably, cautioned against interfering in the free market while good quality of care is maintained. The public system could, of course, price itself out of the market for mainlanders, leaving them and private hospitals to discover a price that balances demand with supply of obstetrics beds. If it does not want to lose the HK$400 million a year in current revenue from mainlanders, it could even increase it by lifting charges to what the market will bear and spend it on the cost of more obstetrics services. That said, expectant mainland mothers have not turned up on our doorstep as medical tourists only just now. They have been flooding in for years. This underlines the urgent need for long-term planning of health services and manpower, not least to cope with an ageing population.