The public system; definitely cheap, not so safe.

Posted on Aug 28, 2009 by Sergio Ulloa (G+)

The performance of the public healthcare services in Hong Kong has been far from ideal in recent years, with chains of blunders happening one after the other in public hospitals throughout the city. Some of the more recent incidents include newborn babies who were injected with outdated anti-tuberculosis vaccines, two babies were mixed up in the hospital postnatal ward - the mothers breast-fed each other's baby for at least 36 hours - a doctor wrongly administered a chemotherapy drug to a leukemia patient, and a public hospital refused to send medics to help a patient dying on its doorstep. The persistent and continual failure of the public healthcare system in Hong Kong over the last several months is starting to raise some serious concerns.

The Hong Kong Government's health care policy is that no one should be given inadequate medical treatment, regardless of their financial status/condition. The healthcare system in Hong Kong consists of both a public and a private sector. Public healthcare services are provided by the Department of Health and the Hospital Authority. The former supports primary care, including preventive and outpatient services, while the latter handles the public hospitals. About 70 percent of primary healthcare services in Hong Kong are provided by the private sector.

The breaking news of the week (23^rd August 2009) in Hong Kong is that five newborn babies at Queen Elizabeth hospital were injected with an anti-tuberculosis vaccine which had already been diluted for 2 days, well past its expiry period. The vaccine comes in a powder form and is supposed to be diluted and used within 4 hours of the initial preparation. The consequence of using an expired TB vaccine usually include death. Two weeks prior to this incident, at the same hospital, two nurses and a health assistant working in the postnatal ward mixed up the ID bracelets of two new born infants. This, in turn, lead to the mothers breast feeding, and bonding with, the wrong children for a period of 36 hours before the mistake was spotted and rectified. One of the contributing factors which led to the occurrence of these incidents was the failure of staff in following the established verification procedures and guidelines. Human error has been attributed as the main factor for these incidents.

The Public healthcare sector is highly subsidised by the Government, which means that the costs associated with healthcare in the territory are relatively low for Hong Kong permanent residents. As such, there is always a long queue in the public hospitals, average waiting times can easily exceed one hour. The ratio of doctors to population in Hong Kong is about 1: 574, whereas ratio of nurses to population is 1:187. With these figures, it is very hard for medical staff to consistently take any personal interest in every patient. Public hospitals operate with maximum efficiency, so minimal personal service is expected. Low resources and lack of oversight from medical staff are major contributing factors leading to occurrence of medical blunders mentioned above.

Another example of a medical mishap took place in the Prince of Wales Hospital. A 21-year old female patient who had acute lymphoblastic leukemia, was given a dose of vincristine (an chemotherapy drug) via her spine instead of into the vein, as is the correct procedures with this type of medication. The doctor wrongly administered the medication, threatening the patient's life. A shortage of doctors in the public sector also threatens the efficiency and quality of care given to the HK public. In past years, 10-15% of doctors in public hospitals would leave each year, either to go into retirement or to earn even higher salaries in the private sector. Due to the recent economic downturn, the Hospital Authority has imposed a 5.38% pay cut onto their staff, meaning that thousands of senior doctors and managers are at the edge of losing their job if they refuse to accept this proposal. The HK Government is also trying to ride out the financial crisis by reducing the health authority subsidy budget in a similar percentage. This however contradicts with the speech given by the Chief Executive Donald Tsang on 2009 budget, which stated that healthcare expenditure is to increase to 17 per cent of recurrent expenditure by 2012. Whatever the HK Government's future plans may be, the hidden truth here is that in Hong Kong, the chance of getting better quality medical treatment is higher in private sector than in the public care.

It is very hard to find a perfect healthcare system in any country; unfortunately, medical mishaps are bound to happen. The key however, is to learn from these unfortunate incidents and work towards safer and better hospital environment for patients. Although public hospitals in general can provide affordable and quality care to the public, comparatively, private hospitals do provide a more flexible and readily accessible service. Private hospitals in Hong Kong are now operating in a similar manner to hotels. Going for treatment at private medical institution would be more akin to checking into a hotel for a short overseas trip rather than having an operation in a hospital. Staff in private hospitals are very customer oriented. In general, they speak very good English and will not have any communication problems with foreigners. There is a wide range of food selection on the hospital menu offered by the private hospitals. The benefit of using private medical facilities include shorter waiting times for out-patient services, easier booking options and more attentiveness from hospital staff compared to public hospital system. The major drawback to the public system is the extortionary expensive costs associated with treatment. In fact, the private healthcare system in Hong Kong is one of the most expensive ones in the world; 2^nd most expensive after the USA and on a par with Israel.

However, costs probably won't be the most important issue when you are in the position of this 56 year old man. He collapsed outside the doorstep of Caritas Medical Centre in Hong Kong (approximately 20m away). His son urgently sought help from the hospital. Upon requesting assistance at the hospital's reception desk, the son was informed that there was nothing the hospital could do, and the receptionist told him to call emergency number 999 for an ambulance by himself. In fact, she did not even call the hospital accident and emergency unit for him. The old man was eventually admitted to the emergency unit after 26 minutes but died 17 minutes later, 43 minutes after collapsing with a heart attack outside the Caritas Medical Centre.

If this old man collapsed outside a private hospital, he would have been immediately taken into the emergency room, setting aside all the rigid rules and procedures of the bureaucracy set up in the public hospitals. From this incident, it is clear that the purpose of saving lives in the HK public has been set at a lower priority, with the red-tape procedures taking precedence. Jokingly though, if the old man is Jasmine Fiore and the receptionist is Ryan Jenkins, it is possible that he would leave Jasmine outside dying at the doorstep of the hospital, saving his plot to murder his ex-wife, stuffed her body inside a suitcase and placed in a garbage bin.

While the health care delivery system is different than in other parts of the world, patients can get very good medical care in Hong Kong. Other than the reasons stated above on the advantages of private hospitals, the other main advantage in seeking medical care from the private sector is more on a psychological front. The sense of security in knowing that you would be getting good quality medical treatment anytime you need is very important. Establishing a good relationship with a primary care doctor is essential, because the physician could act as the patient's advocate to secure the best possible medical care and to provide continuity. Knowing your doctor before an emergency arises is always most desirable. Good medical treatment however comes in a cost, which is why a global health insurance policy would be handy when you travel or live abroad. While some people may disagree, with the health insurance policy in place at least you will know you will receive attentive medical treatment in a professional and efficient manner. Most important of all, you have no worries on the medical costs at the time of treatment.

The truth is that the HK Government is reducing the health budget, and overcrowded public hospitals will continue to be the trend. As an individuals, we have no control over Government policy, the only way to ensure that you receive the medical treatment you deserve is to give yourself an option to go to private hospitals. Given that all these incidents happened in the public hospitals in Hong Kong, it is only natural to think that private hospitals are much better than the public hospitals.

The healthcare system in Hong Kong consists of two main options, either public or private services. Public healthcare provides cheap but, often slow care while private sector provides flexible, attentive and readily accessible service. There are always pros and cons to each option, depends on your individual needs, the final decision is very much relying on your own discretion.