HONG Kong's public hospitals account for about 85 per cent of the territory's hospital care - except when it comes to delivering babies. Despite a potential price tag of a minimum of $25,000 for a maternity care package involving a third class bed, and as much as $80,000 for a package involving a first class bed, it seems that thousands of women feel it is worth paying in return for the more personal care offered by private hospitals. Of the 72,200 babies who were brought kicking and screaming into the territory's hospitals last year, half of them caught their first glimpse of the world in the plush environment of a private hospital. The other half were delivered in Hong Kong's busy and crowded public hospital system. But apart from price and the personal touch, do Hong Kong women know what they're really getting when they choose whether to deliver their baby in the private or publichospital system? What are the real differences between private and public hospitals when it comes to the standards of care or types of treatment they offer mothers and their new-born babies? And do obstetricians themselves know what is going on in other hospitals in the territory? THE answer, according to Professor Allan Chang, president of the Hong Kong College of Obstetrics and Gynaecology, is ''no''. ''Hong Kong has widely different styles of practice,'' said Professor Chang, who is also the acting chief executive of Prince of Wales Hospital. ''We have large-volume obstetrics units in big public hospitals which are very busy and lots of individual care in private practice. ''Yet there is no database in Hong Kong to establish what should be the standard of care, or to identify what the problems of women in Hong Kong are.'' That situation is soon to change with the launch early next year of the first study of maternity care practices throughout the territory. The audit is being organised by the College of Obstetrics and Gynaecology and is believed to be the first territory-wide study in Hong Kong of any medical discipline. While individual hospitals do carry out their own internal audits, nothing has been done to look at maternity practices across Hong Kong, said Professor Chang. The College audit will investigate maternity practices in both public and private hospitals. All 10 of Hong Kong's public hospitals with obstetric units have agreed to take part, and the response from the private sector has been enthusiastic, with one hospital already having begun its audit and others in preparation to join the study. The audit will initially look at performance and outcome only - ''how we actually go about our job, whether there are too many Caesarian sections, for example, and how many die or fall ill''. With Hong Kong having one of the lowest mortality rates for mothers and infants in the world - far out-performing the United States, for example - the number of deaths through childbirth is unlikely to cause any ripples, according to Dr Vivian Taam Wong Chi-woon, head of the College's scientific committee and chief executive of Queen Mary Hospital. But little is known about the kind of complications women suffer here, she said. ''We want to identify the problems so that we can advise the community, patients and doctors on what should be done about them.'' Although it is difficult to predict what kind of problems might be uncovered, Professor Chang said they could include interventions being carried out when they were not needed, areas of funding not being made available or lax supervision. ''We have vague suspicions in the backs of our heads but we don't know what the problems are because we don't have any information,'' he said. Hong Kong doctors and midwives were confident that the territory's maternity care - both in private and public hospitals - would stand up to the audit's scrutiny. ''I think the quality is good, there's no doubt about that,'' said one private general practitioner who cannot be named for reasons of medical ethics. ''It's just that the private sector is expensive and in the public sector you can't choose your doctor''. Although the general practitioner said she usually dealt with the private sector, she had had several patients who had opted for the public sector for financial reasons. ''They thought that apart from being one in a hundred, the care was excellent - the equipment was great, the doctors and nurses were great. They complained about the antenatal care - the long queues, the waiting, not knowing which doctor they would see -but it was good, competent care.'' Ms Manbo Man Bo-ling, president of the Hong Kong Midwives Association, agreed: ''I think the quality is good,'' she said. Despite the fact that half of Hong Kong mothers are willing to pay up to $80,000 to get the kind of care they want, one area which will not be covered by the audit is patient satisfaction. Professor Chang said this would probably be addressed later - once the College knew what was actually happening on Hong Kong's maternity wards, it would ask women for their views. When it does, it might find some complaints about the rigidity of care available. According to the Midwives Association's Ms Man, all births in Hong Kong now take place in hospitals and it is not possible for those wishing to give birth at home to have a midwife attending. ''We are limited by the living environment here,'' she said. ''Most Hong Kong people don't have enough room.'' And while a small minority of hospitals provide special birthing beds or chairs for women to deliver their babies sitting upright, most provide only traditional delivery beds. Giving birth in water is unheard of here, and inviting fathers into the delivery room is not standard. ''This is rather a new concept in Hong Kong,'' Ms Man said. Not all hospitals, whether private or public, allow the babies to stay with their mothers, with some opting to keep new-borns together in a nursery.
