Medical staff at work at Kwong Wah Hospital in Yau Ma Tei amid the winter flu outbreak in January. The city’s public hospitals have seen occupancy rates of over 100 per cent. Photo: Nora Tam
Anson Au
Anson Au

How Hong Kong public hospitals can ease overcrowding without turning to the private sector

  • Anson Au says more medical residencies, services such as telemedicine and streamlining administrative procedures would reduce the stress on Hong Kong’s public hospitals
Just this week, the Hong Kong Public Doctors’ Association proposed that the government subsidise patients seeking private health care while capping private medical fees, the latest attempt to lighten the load of the city’s overburdened public health care system.
Patient waiting times are a perennial problem in Hong Kong. It takes about 80 days from diagnosis to first treatment for patients with colorectal cancer and 66 days for those with breast cancer. It can be years before people receive other procedures. An article widely circulated on social media early this year noted that North District Hospital had a waiting time of 17 months for an MRI scan and a staggering 29 months for a mammogram.

Such terrible time lags can become drivers of disease themselves, due to the failure to take preventive steps and treat patients within an appropriate time frame. Drawing on studies in health care management, one of my areas of research, we should push for other ways to improve the system’s efficiency.

First, we need strategies that shift more doctors into the public sector. Turning to the private sector pool is a commonly touted idea, but relying on private health care creates bigger problems in the long run. Research shows that private health care systems like the US’ are prone to overdiagnosis in the quest for greater profits. Overdiagnosis engenders paranoia in patients and the tendency to rush to a doctor for every minor ailment, which takes up precious time that doctors could use to tend to more serious cases.

Instead of turning to the private sector, Hong Kong must focus on channelling more doctors into public health care, subsidising increased quotas for medical students at publicly funded universities and increasing the number of medical residency placements in public hospitals. Even if this means patients won’t see the same resident doctor more than once, more residencies would provide public hospitals with additional manpower. Some studies in the US have found that, after adjusting for the severity of cases, teaching hospitals have better survival rates and quality of care than non-teaching hospitals.

More than 100 doctors met health officials on January 26 to appeal for more resources at the city’s public hospitals. Photo: Felix Wong
Second, the authorities can provide alternative modes of care, such as telemedicine. Now legal in countries such as Canada and the US, telemedicine would allow doctors to communicate with patients without them having to make a trip to the hospital. Although this wouldn’t replace the need to see doctors in more serious cases, it would divert some of the less serious cases from emergency rooms. This is particularly important since queues at public hospital accident and emergency departments are not only long, but over 60 per cent of the cases between July 2017 and July 2018 were non-urgent.

Third, we must simplify health care administration. An expert has noted that 20 per cent of health care spending in the US is wasteful and of no benefit to patients, with administrative complexity contributing significantly to this. Confusingly in Hong Kong, the average publicly funded health care clinic has four stations: one for patients to register and pay, another for measuring blood pressure, the actual doctor’s office and a post-consultation referral desk.

We should cut the blood pressure and post-consultation referral stations. Having each of them run by multiple nursing assistants is a waste of time and funding. Not every case needs a blood pressure test, and doctors can measure blood pressure themselves quickly enough if needed. Post-consultation, follow-up appointments can be handled by the front desk and referrals to a specialist can be handled by the doctor. We should also move the registration, referral and record-archiving processes to electronic databases, so no patient or staff member needs to handle a stack of different coloured papers at each appointment.

These practices have been implemented in the Canadian public health care system and have shown promising results. While Canada has a significantly lower physician-to-population ratio than other Organisation for Economic Co-operation and Development countries, it has historically exhibited better patient satisfaction and health outcomes.

Finally, we must do research on clinical performance across different districts in Hong Kong and implement more feedback systems at the clinic level. Studying patient numbers for different doctors and clinics from the same district can throw light on the variation in demand for different health care providers and how to bridge the gap between them. To identify the challenges to efficiency, we should ask the patients themselves. This will help detect problems with health care providers and reduce patient dissatisfaction, information that can in turn be used to improve efficiency.

Anson Au is currently a visiting professor in the School of Humanities, Social Science and Law at Harbin Institute of Technology and a PhD student in sociology at the University of Toronto

This article appeared in the South China Morning Post print edition as: Ways to reduce pressure on our public hospitals