Why our medical system is sick
Updated: 2014-01-15 07:11
By C.K. Yeung(HK Edition)
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One woman's smile is Hong Kong medical protectionists' shame. Yik Siu-ling, whose jaw was shattered by a hijacker's bullet in the Manila hostage tragedy, was put through the agony of no fewer than 33 botched reconstructive surgical operations before going to Taiwan where doctors in their first attempt restored her looks and her hopes.
The hospital where she "was reborn" (her words) is the Chang Gung Hospital, belonging to the same group as the Chang Gung Medical School, one of 149 medical schools across the world recognized by Singapore, to whose graduates it grants the permission to practice medicine in the Lion City without any licensing examinations as a means to attract medical talent.
But the Hong Kong medical lobby is either too arrogant or too selfish - or both - to adopt Singapore's "recognition without examination" solution to our acute shortage of medical doctors. Indeed, the local medical lobby is so powerful that even the government is wary about taking it on.
The immediate past chairman of the Hong Kong Hospital Authority, Anthony Wu, not being a doctor and therefore without any vested interest in medical protectionism, had the moral courage to call for lowering the barriers to let foreign-trained doctors in. But he might as well be a voice crying in the wilderness. His campaign produced no results except strident calls by the local medical lobby for him to vacate the chairmanship.
His successor, medical man Dr John Leong Chi-yan, began his tenure last month by mechanically voicing objections to admitting more foreign-trained physicians, even before his seat was warm. He is singing the same old song as the protectionist lobby, pontificating on the need to maintain standards of medical services. His solution to the acute shortage of doctors? Wait for the two local medical schools to produce more.
If we wait for the medical sector to solve this problem, we will be waiting till kingdom come. Their protectionism precludes any positive outcome in the foreseeable future. As my fellow columnist, Dr Feng Chi-shun, a recently retired consultant pathologist, correctly noted recently, whatever measures they suggest are mostly self-serving and don't even begin to scratch the surface of a widening, worsening crisis.
While our patients are crying for help, our Medical Council is navel gazing at their own self-satisfied status, willfully blind to the abundant foreign-trained medical talent, who could enrich our medical expertise and enlarge our healthcare manpower pool to the benefit of other Yik Siu-ling's in Hong Kong.
By now, it is clear that any real solution will have to be a political one. Healthcare provision is a vital public issue requiring political courage and bold action. Instead, the government has been busy peddling the idea of a medical insurance system. This is a misdiagnosis of what ails our health system; the insurance scheme is no more than a fig leaf that covers up the government's failings in dealing with the all-powerful medical lobby.
Instead, what the government has been practicing can be described as demand-side management: If you can't wait two years for a surgery on your enlarged prostate in a public hospital, then check yourself into a private hospital, where your doctor can do it on a date of your choosing and a bill to his liking. This is one way of suppressing demand for public healthcare services, ensuring that our public hospitals are not overwhelmed, while keeping private surgeons busy and happy. The only problem is that with the wealth gap widening, and the population aging, the patient queue is lengthening. In the meantime, the government has ignored the supply side of the equation, content to let the doctors call the shots in a vital public service.
A medical insurance scheme is just another supply-side tool - a big and blunt one. With the stated objective of encouraging patients to use private health care, health insurance would suck in billions of dollars in taxpayers' money for scheme roll-out plus annual premium payments. Without a corresponding increase in the supply of doctors, into whose pockets will all the billions go?
An unintended, but inescapable outcome of health insurance is the flight of doctors from public hospitals to the private sector, further widening the already scandalous income gap between the two sectors.
An insurance scheme without first addressing the shortage of medical personnel in public hospitals would not only be unfair to dedicated public sector doctors who remain at their posts, it may prove to be the straw that breaks the camel's back, pushing our public hospital service into crisis mode. One should not be surprised if these chronically overworked and grossly underpaid (by private doctors' standards) doctors decide to jump ship and join the exodus. The result would put our public healthcare under serious threat, as only affluent people can afford the services of private hospital fat cats.
The author teaches at Chinese University of Hong Kong's School of Journalism and Communication. He was former director of University Development and Public Affairs at the Hong Kong University of Science and Technology.
(HK Edition 01/15/2014 page1)