In Hong Kong, there are many livelihood problems that need to be solved urgently, among which the "difficulty in seeing the sick" is a "big problem"!
At present, 18 public hospitals under the Hospital Authority have emergency services, but the problem of long waiting times has been criticised – during the peak influenza season, patients are classified as sub-urgent and non-urgent, and even have to wait for 8 hours or more, and the scene of emergency and emergency rooms has become "normalized".
To alleviate the pressure on public healthcare services, the HKSAR Government and the Hospital Authority have been encouraging patients with mild illnesses to use community primary care and family doctor services, and have launched a number of public-private partnership schemes. Some Members of the Legislative Council have pointed out that although these measures have achieved certain results, the waiting time is still not satisfactory.
Eyesight becomes a "long wait"
In fact, the demand for medical services in Hong Kong's public hospitals has been outstripping supply, and the waiting time for both accident and emergency departments and general out-patient clinics has been very long. The HA has acute care services in 18 public hospitals, and under the patient triage system, patients are classified into five categories according to their clinical conditions: critical, critical, urgent, sub-urgent and non-urgent. In the past 10 years, the number of critical, critical and emergency cases has increased from an average of about 61,000 cases per month in 2014 to an average of about 68,000 cases per month in 2018 and an average of about 73,000 cases per month in 2023.
According to the information of the Health Bureau, sub-emergency and non-emergency cases account for as much as 50% to 60% of the cases, and these patients classified as sub-urgent or non-emergency are generally in relatively stable and non-life-threatening condition, such as influenza infection or stable episodic diseases such as gastrointestinal discomfort, most of which can be managed by general out-patient clinics, private doctors or private hospitals.
As for general out-patient services, the HA's General Out-patient Clinics provide more than 5 million non-emergency out-patient services annually, with a focus on low-income and disadvantaged groups, and for patients with stable chronic illnesses and occasional illnesses with relatively mild symptoms. The majority of the public's primary healthcare needs are mainly provided by the private healthcare sector, with about 20 million outpatient visits per year.
The waiting time is still long
In the face of the short supply of public hospital services, the HKSAR Government and the Hospital Authority have introduced a number of measures in the past. On 28 February this year, the Secretary for Health, Lo Chung-mau, said in a written reply to a Member's question that in the face of a rapidly ageing population, the increasing prevalence of chronic diseases and the increasing demand for medical care, it is necessary to concentrate resources on prioritising some acute diseases, specialties and secondary and tertiary care that require complex technology. The Government has put forward a reform package in the Primary Healthcare Blueprint to strengthen primary healthcare services and ease the pressure on the public healthcare system, especially specialist out-patient clinics in public hospitals.
The Government will continue to promote the "one person, one family doctor" and launched the "Co-management of Chronic Diseases Pilot Scheme" in November last year to hand over the health management of people with more financial means to the private healthcare sector under the "co-payment model" through the establishment of a family doctor system and screening.
At the same time, the Government needs to consider pooling the limited resources of public general out-patient clinics, prioritizing the provision of primary healthcare services to those who may not be able to afford private healthcare services, and gradually repositioning general outpatient clinics to focus on caring for low-income people and the disadvantaged.
Regarding the various public-private partnership (PPP) projects launched by the Hospital Authority in recent years, DAB Legislative Council member Mir Quat believes that they have achieved certain results and can help alleviate the pressure on medical treatment. She quoted experts as saying that the maximum waiting time for a new patient to be stabilized in medicine has now dropped to 102 weeks, and the maximum waiting time for a new case to be stabilized in ophthalmology specialties, which are of concern to many members of the public, has been reduced from 143 weeks to 100 weeks recently, but she believes that "these figures are still not ideal".
The "old difficulties" can be solved from many aspects
Mr Quat said that the shortage of medical resources and the difficulty of the public in seeing the sick are the "perennial problems" of Hong Kong, and he believes that the government should address them in various aspects. In terms of increasing the number of healthcare personnel, although the Government has relaxed the requirements for non-locally trained doctors to practise in Hong Kong in recent years, she believes that there is still room for improvement, and suggested that the Government should set policy performance indicators to increase the ratio of local doctors per 1,000 population to the average level of the Organisation for Economic Co-operation and Development (OECD) members by 2032, strengthen overseas publicity efforts to attract overseas doctors to Hong Kong, and enhance the Greater Bay Area Doctor Exchange Programme. She also believes that the Government should train more local doctors in the long run and consider the establishment of a third local medical school.
In addition, Mr Quat also suggested that the Government should set up a "Child Health Care Voucher", expand the screening programme of Women's Health Centres, strengthen the procurement of private healthcare services and allocate additional resources to enhance the use of technology in the public healthcare system.
There is a blueprint for primary healthcare reform
In response to the challenges posed by Hong Kong's ageing population and rising incidence of chronic diseases, the HKSAR Government promulgated the Primary Healthcare Blueprint (the Blueprint) in late 2022 to strengthen Hong Kong's primary healthcare system and shift the focus from treatment to disease prevention, so as to enhance the health of the population and improve the quality of life of the people.
Strengthen the concept of "one person, one family doctor".
The blueprint proposes five major directions for primary medical and health reform.
First, establish a community-based primary health care system. To further develop a community-based and family-centred community healthcare system based on the District Health Centre (DHC) service model, strengthen the concept of "one person, one family doctor", launch the "Co-management Scheme for Chronic Diseases" to provide targeted funding for the public to receive diagnosis and management of targeted chronic diseases in the private healthcare sector, and integrate the primary healthcare services under the Department of Health into a district-based community healthcare system in phases to reduce service duplication.
Second, strengthen the management of primary medical services. To restructure the Primary Healthcare Office (PHO) under the Health Bureau into the Primary Healthcare Department (PHC) in phases with a view to managing the provision of PHS, standard-setting, quality assurance and training of PHPs through a single framework; To establish a two-way referral mechanism between primary healthcare services and specialists and hospitals, so as to strengthen the case management role and gatekeeping role of primary healthcare service providers.
Integrate grassroots resources and plan professional manpower
Third, integrate primary medical and health resources. Broader use of market power to implement government-funded primary healthcare programmes on a "shared shoulder" basis, enhancement of the Elderly Health Care Voucher Scheme and other subsidised services, overseeing the development and implementation of strategic primary healthcare procurement programmes through the Strategic Procurement Office, and strengthening co-ordination in the development and redevelopment of government buildings and premises for community healthcare facilities.
Fourth, plan the manpower of primary health care. To review the manpower projection model and formulate strategies to project the needs of primary healthcare professionals and increase the supply of manpower, and to strengthen the primary care-related training of all primary care providers, as well as the role of Chinese medicine practitioners, community pharmacists and other primary care professionals in the provision of primary care services.
Fifth, improve data exchange and health surveillance. Transform the Electronic Health Record Sharing System (eHRSS) into a comprehensive and integrated healthcare information infrastructure that integrates healthcare data sharing, service delivery and process management, require all primary healthcare service providers to use eHealth, build a population health dataset and conduct ongoing data analysis and surveys to support the Government in formulating healthcare policies.
A few days ago, the Health Bureau (DHB) organised a briefing session on the progress of primary healthcare development to introduce the concept and latest progress of the Primary Healthcare Blueprint to District Council members and the public.
【Business Daily Review】
To solve the difficulty of seeing a doctor in Hong Kong, we must rely on the strength of the Bay Area
Hong Kong Commercial Daily commentator Su Xin
According to a document submitted to the Legislative Council yesterday by the Hong Kong Hospital Authority, the attrition rate of full-time doctors in 2023/24 is 6.1%, an improvement from last year, but the attrition rate of young healthcare workers is still high, and the trend is worrying. There is a long-standing shortage in the supply of medical staff in Hong Kong, which has not only led to heavy work pressure on on-the-job medical staff, but also caused many members of the public to suffer from difficulties in seeking medical treatment. There is no doubt that strengthening retention efforts, speeding up the recruitment of foreign aid, and increasing the training of new blood are the most direct ways to solve the shortage of public healthcare manpower. At the same time, Hong Kong should also be good at leveraging its strengths to make up for Hong Kong's shortcomings by relying on the Greater Bay Area to provide more choices and convenience for the public to seek medical treatment, which is believed to help alleviate the difficulties of medical manpower shortage and reduce the burden on the public healthcare system.
In recent years, Hong Kong's ageing population has accelerated and the demand for healthcare has risen sharply, which has worsened the problem of medical manpower shortage. According to the data, public hospitals lost 281 doctors and 1,821 nurses respectively last year, and in the past three years, 1,032 full-time doctors left their jobs without retirement, and 6,049 full-time nurses left without retirement. Public healthcare resources continue to be scarce, and the waiting time for the grassroots to visit public hospitals is getting longer and longer, and waiting for specialist outpatient clinics for several years is the norm.
In order to solve the shortage of medical and nursing manpower, apart from trying to retain the existing staff, there are only two ways, one is to expand the cultivation of local doctors, and the other is to speed up the introduction of foreign aid. In recent years, the University of Hong Kong and the Chinese University of Hong Kong have continued to increase their medical places, and the Hong Kong University of Science and Technology (HKUST) is also striving to establish a third local medical school with a target of training 200 medical students per year. As for the latter, the HA has been actively recruiting from the Mainland and overseas over the past year, with 138 non-locally trained doctors working in the HA as at the end of March this year, and the number is expected to increase to 200 by the end of the year. For the time being, the increase in the number of healthcare workers shows that the authorities have taken positive actions to make improvements, which is commendable.
However, the problem of shortage of medical staff in Hong Kong has always existed, and the existing resources and strength alone are not enough to solve the problem of medical treatment. Recently, Hong Kong people have been keen to go north, and in addition to eating, drinking and having fun, more and more people are receiving medical services, including medical check-ups, dental check-ups, and various surgical treatments. The advantages of "affordable prices, good environment, short waiting times and short distances", coupled with the continuous improvement of medical standards and recognition in the Mainland, are the biggest incentives for Hong Kong people to choose to seek medical treatment in the mainland cities of the Greater Bay Area. After all, patients are suffering from illnesses and waiting for a long day, and cross-border medical treatment provides a new channel for Hong Kong people to have an additional choice, which can not only help to quickly get rid of the pain and suffering, but also relieve the pressure on Hong Kong's public hospitals to a certain extent.
The Outline Development Plan for the Guangdong-Hong Kong-Macao Greater Bay Area mentions the need to shape a healthy bay area and strengthen medical and health cooperation. In recent years, Hong Kong has strengthened its co-operation with mainland medical institutions in the Greater Bay Area, including the establishment of a Hong Kong-style public hospital similar to the HKU-Shenzhen Hospital in the Greater Bay Area, the expansion of the "Greater Bay Area Pilot Scheme for Elderly Health Care Vouchers" to cover the core cities of the Greater Bay Area, and the introduction of the "Hong Kong-Macao Medicines and Medical Device Connect" policy to provide treatment convenience for Hong Kong people, so as to ensure that Hong Kong people have access to necessary medical services in the Mainland. It is a win-win move for the HKSAR Government to better leverage the strength of the Greater Bay Area to alleviate the difficulties in seeking medical treatment in Hong Kong, and at the same time promote the high-quality development of medical services in the Greater Bay Area for the benefit of the people of both places. Of course, it is a personal choice for citizens to seek medical treatment in the mainland cities of the Greater Bay Area or in Hong Kong's public and private hospitals, but the convenience of medical treatment is always local, and the authorities should first base themselves and step up efforts to effectively improve the problem of inadequate medical services in Hong Kong.
Reporter: Huang Xuefeng
Editor: Luo Weiwei
Sealing surface: 荷洁
Proofreader: Zhuo Ling
审核:Oriole
Executive Producer: Yushan