On life support: Doctors' pay a ticking time bomb for Hong Kong's ailing public health system
Albert Cheng says unless the government injects more funding, and salaries are pegged to the civil service, the recent rise has simply stalled more inevitable protests
The Hospital Authority last month averted a crisis with its senior doctors by granting them an additional three per cent salary rise out of its own pocket. However, that offer does not mean the two sides are no longer set on a collision course.
The treasury allocated HK$49 billion to the authority in the current budget to cover staff remuneration and annual adjustments. However, the doctors were angry when management decided not to match pay hikes for senior civil servants.
The civil service has been conducting reviews to see whether its employees' packages are in line with the private sector. Based on its 2013 pay-level survey report, the government gave senior officials an additional three per cent. Such pay adjustments, every six years, are on top of any annual rises.
The Hospital Authority had insisted it was not obliged to follow the government but caved in after some 1,300 doctors staged a sit-in on its doorstep. The extra rise will cost it an additional HK$200 million a year, which, given the authority's current balance sheet, hardly seems sustainable.
The government is adamant it will not foot the bill. So, in the long run, the authority would have to reduce other expenses to bridge the funding gap. That would inevitably hit services. We cannot let this happen; the government must absorb the extra cost.
Established in 1990, the authority has had at least three major run-ins over pay with disgruntled medical staff over the past 25 years.
Public-sector doctors can be divided into three broad categories. The department of medical and health was split into two divisions in 1989 to pave the way for the Hospital Authority's takeover of all public hospitals. Some doctors under the then hospital services department migrated to the authority on existing civil service terms. Others took up cash and retirement incentives to give up their civil servant status. The third group was recruited after a new system was introduced in 1999. It is these doctors who have been treated most unfairly.
In theory, the authority's remuneration system is separate from that of the government. There is, however, an unspoken consensus between the authority and its employees that terms and conditions should be in line with civil servants'.
In 2000, the authority followed the government to slash the salaries of newcomers. It also sought to reform doctors' pay structure by reducing the three grades of public sector doctors to two. As a result, doctors doing the same jobs might be paid differently. But management back-pedalled after 5,000 doctors protested at its headquarters.
There was another stand-off in 2007, after the government restored the starting point for civil servants to the 2000 level. The authority failed to convince its staff of a similar plan. Some 1,300 doctors mounted a sit-in at Queen Elizabeth Hospital, pushing the authority into making concessions.
Eight years later, the doctors took action once more. This time bomb will continue to tick until the government agrees to re-peg public hospitals' pay adjustments to those of the general civil service.
As an increasing number of disgruntled public doctors move to the private sector, public hospitals' standards will decline. The recent list of medical incidents and mishaps is hardly accidental.
Two immediate steps should be taken to restore doctors' morale and confidence, to stem the exodus. First, their pay adjustments should at least be on a par with civil servants'. Their promotion prospects should be improved and incentives introduced to retain the best. Second, more overseas practitioners should be allowed in, as long as locals' interests are not compromised.
Our public medical service is on a slippery slope; it may only be a matter of time before we are faced with third-world standards.
The government does not have a comprehensive plan to tackle these issues. Its primary concern is to cut costs. We cannot afford our public medical system to become another failure of Chief Executive Leung Chun-ying's administration.
Albert Cheng King-hon is a political commentator. [email protected]