Last week, Chief Executive CY Leung released the Report on the Work of the Current-term Government before he stepped down on Friday – after five years in the top post.

The report spent six pages to summarise the various progress and achievements on healthcare by the current-term government. While it is undeniable that there were some ambitious and innovative plans initiated by the government, some questions and controversies remain unresolved.

The ambitious 10-year blueprint for hospital development

With Hong Kong’s ageing population estimated to double from 1.07 million in 2014 to 2.58 million by 2064, Leung introduced a ten-year blueprint for hospital development in his Policy Address 2016. A total of HKD200 billion was allocated to implement the blueprint in the next ten years, claiming to provide more than 5,000 additional beds and 90 additional operating theatres.

However, the sufficiency in terms of number of doctors and other healthcare professionals to support the operation of the increased capacity remains a question.

The construction works of HKCH commenced in August 2013 and are expected to be completed by 2017 for service commissioning in 2018. Photo credit: HKCH’s website
The construction works of HKCH commenced in August 2013 and are expected to be completed by 2017 for service commissioning in 2018. Photo credit: HKCH’s website

The Hong Kong Children's Hospital (HKCH) targeted to commence operation by phases in 2018 is one of the examples. Due to a shortage of pediatricians, report revealed it will only provide 230 beds and only four apartments will be available in the initial stage.

The first territory-wide Strategic Review on Healthcare Manpower Planning and Professional Development

The aim of the review is to ensure a stable supply of healthcare manpower in the long term and set the direction for the development and regulation of healthcare professionals. Such initiative was given a high hope as being a rescue to the existing healthcare manpower shortage. However, the forecasts and recommendations made in the report have eventually let many down, and whether the report can still be seen as an accurate indicator for government’s future policies is heavily in doubt.

Despite frontline doctors at public hospitals stretched to a breaking point, the 10 key recommendations made in the report barely mentioned how the government should retain doctors within the public sector. Rehiring retired doctors is considered as only a stop-gap measure rather than a long-term solution. Although the government has also increased the number of openings at medical schools, critics suspected it might eventually result in a surplus of doctors – if it does not have a fully-fledged plan to increase healthcare expenditure and manpower in the public sector.

Additionally, the report has also stirred up heated discussion within the nurses sector. While the report claimed there is a surplus of psychiatric nurses in the city, critics commented the forecast is unrealistic as it is built on the existing service level, where there is indeed a severe manpower shortage. In response to the report, relevant parties suggest the government not to take reference from the report and consider reducing the nurse-to-patient ratio.

Pharmacist is another profession which the report foresees an oversupply. Apart from the recommendations stated in the report, respective parties advocated the government to take the lead to maximise the role of pharmacists. Suggested measures include formulating the public-private partnership (PPP) programme and increase the headcounts for clinical and ward pharmacists in public hospitals.

The controversial Hong Kong Medical Council (MCHK) reform

Due to MCHK’s inefficiency in handling complaints from patients, the government submitted a Medical Registration (Amendment) Bill to the Legislative Council (LegCo) in 2016. The Bill eventually failed to pass Legco.

Although doctors were generally supportive of the idea to reform the council, the amendment to add four government-appointed lay members to the council has been met by strong opposition. Doctors were in particular worried that such move would jeopardise autonomy of the council, and the government may lower its licensing requirements for mainland doctors once they control the council.

A survey carried out by medical sector lawmaker Dr. Pierre Chan pointed out majority (>65%) of the general public were opposed to the idea of making it easier for overseas doctors to practice in Hong Kong and on the formation of a separate organisation to hear medical complaint cases.

“The results show clearly that citizens are with doctors. There is no question of doctors trying to defend the sector’s interest only,” Chan said. 

The crucial options removed from the Voluntary Health Insurance Scheme(VHIS)

The government released the Consultation Report on the VHIS this year. The public and healthcare professionals generally supported the idea of VHIS when it was introduced. However, several important items have been temporarily removed from the plan since its promotion due to resistance from insurers.

Secretary for Food and Health Dr Wing-Man Ko needs to water down VHIS coverage plan due to resistance from insurers. Photo credit: SCMP
Secretary for Food and Health Dr Wing-Man Ko needs to water down VHIS coverage plan due to resistance from insurers. Photo credit: SCMP

One of the most significant amendments is that insurers would not need to cover high-risk patients or guarantee to cover anyone, regardless of age or illness. While initially planned to promote private health insurance to the middle class, this controversial amendment made it more difficult and less attractive to many. Additionally, the scheme was then further modified to exclude the coverage of pre-existing conditions and the ability to transfer one’s insurance policy to another insurer without affecting the premium.

The recently completed Review on Mental Health

Coupling with its growing ageing population, Hong Kong is also reaching a critical point where its mental healthcare facilities and manpower are unable to cope with the rising demand.

Currently, there are only 330 psychiatrists employed in Hong Kong’s public hospitals, a number that is 400 short of WHO’s recommendation taking into account the population of the city. Moreover, the Hospital Authority (HA) has reported that the number of mental health patients is increasing at a rate of 2 – 4% every year with an especially notable rise among children. Yet, the number of mental health services of psychiatrist are not growing proportionately. Adding to that, support healthcare professionals such as psychiatric nurses and outreach staff are similarly lacking.

The government’s lack of support to mental health patients and healthcare professionals has occasionally come under fire in recent years. Nevertheless, the Review on Mental Health published in April this year might come as a rescue. The review states that implementation of recommendations by the Review Committee are now underway. Some of the measures include improving the ratio of case manager to patients, introducing PPP to shift the burden from public to private sector and increasing manpower to clear up the waiting list. MIMS

Read more:
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The ‘surplus’ of psychiatric nurses in Hong Kong
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