Hong Kong health care reform must focus on nursing workforce for long-term sustainability

On top of the HK$500 million recently injected for short-term relief measures, additional recurrent funding of nearly HK$6 billion will be allocated to the Hospital Authority to increase hospital beds, outpatient services and manpower, according to the 2018-19 Hong Kong budget.

Health care manpower shortage has existed for decades in Hong Kong. The additional funding helps, but, ultimately, this chronic shortage should be addressed strategically and holistically at the policy level. Apart from the Voluntary Health Insurance Scheme, comprehensive health care reform may be needed.

With tax deduction, the Voluntary Health Insurance Scheme may be attractive in the first few years, as expected, thereby reducing pressure on the public health care system. However, insurance premiums increase with age and inflation. The hospitalisation rate of people aged over 70 is particularly high. As most of them are retirees with no income, they are likely to go back to public hospitals, especially as health care inflation was double the city’s inflation rate in the past decade. Strategies ensuring private health care can be provided at an affordable cost are urgently needed.

Controlling inflation in health insurance and providing efficient, cost-effective care are important in the future health care landscape. Inevitably, the roles and scopes of practice of all allied health professions, and the skewed health care resources on hospital care should be revisited, to ensure sustainable health care development.

Nursing is the largest health care sector in Hong Kong. Long-term nursing workforce planning should take into account services and manpower needs in different settings, changes in care models, and challenges, including multiple educational pathways. Targeted education plays a key role in preparing nurses with high capabilities and critical-thinking skills to support future health care reform.

Admitting the right candidates to study nursing is important. Public debates should be invited on whether there is a need to have a licensing examination for local nurses; revisit the existing licensing examination for overseas nurses; review the 70/30 proportion of registered nurses to enrolled nurses; and shorten the five-year bachelor’s nursing degree to four years.

Sek-ying Chair, director and professor, Nethersole School of Nursing, CUHK