“After decades of hope and technological advancements, patients nowadays have more options to battle cancer,” said Dr Wing-Kin Sze, a clinical oncologist who has devoted 30 years to patients in the public sector and has recently switched to private practice. “Whether it’s target therapy or immunotherapy, these newly developed treatment approaches have prolonged patients’ survival. Yet, it undoubtedly goes without saying that they also come at higher costs.”

In this exclusive interview, MIMS sits down with Sze to uncover the causes of escalating costs in cancer care and, more importantly, how healthcare professionals, patients and insurance companies can collaborate to drive the costs down.

Hong Kong middle class finding it difficult to afford private care

The healthcare system of Hong Kong runs on a dual-track basis, which encompasses both public and private sectors. The underprivileged are entitled to subsidized treatment in public hospitals. The better-off middle class supposedly have the freedom of paying for better-quality medical services in the private care sector. However, this is rarely the case.

“Middle-class patients might be able to afford one-time treatment in the private sector. But, for treatment that requires longer hospital stay, it’s much harder for them,” Sze said. “They are not the poorest in the society, but the cost is still a big drain on their finances in the long run.”

Sze recalled the case of a female patient in her 40s. “The woman was from a typical middle-class family. Both she and her husband were working hard for their family with a 4-year-old child. It was a lovely family until her husband suffered a devastating stroke 4 years ago, leaving one side of his body paralyzed,” shared Sze.

The nightmare did not end there. Shouldering the mounting stress of taking care of her husband and child alone, the woman was later diagnosed with breast cancer. “She was holding back her tears, telling me she didn’t want to die yet because of her husband and child,” Sze recalled.

Sze advised the woman to receive treatment in the private sector as it was more likely for her to access quicker and better-quality care. “My goal was to effectively minimize adverse reactions from treatment as well as her chance of relapse. I understood that medical expenses was an issue to her, given her situation, but I told her not to worry about it since I would charge as low as I could. No doctor would ever intend to earn money from her after listening to her story,” he said.

Enhancing transparency in the private sector

Unsettling stories like this are happening every day in Hong Kong. More often than not, middle-class patients have to resort to public healthcare when they run out of pocket for life-saving treatment. Eventually, this results in overcrowding in the public sector.

“More than one patient has told me that meeting doctors who spend time to chat with them and care about them is like winning the lottery,” shared Sze. “This sounds ironic, but this is exactly the inconvenient truth our public healthcare system is facing right now. Patients have to wait for hours in public hospitals for consultation with doctors that lasts only a few minutes. How can cancer patients put their faith on doctors or this healthcare system if there isn’t even the time to communicate?”

Sze occasionally receives gifts from grateful patients.
Sze occasionally receives gifts from grateful patients.

To relieve the pressure on the public sector, Sze said patients need to be diverted to the private sector. However, there is a front-and-centre issue that hinders the flow: transparency in the private sector.

“There isn’t a reasonable market price of treatment for patients to take reference from. Patients are like walking in a dark tunnel with uncertainties lying ahead. They don’t even know how long it takes for them to reach the destination,” Sze described.

“If we can advise them on the expected cost and duration of treatment, then they can plan the budget ahead. It would be easier for them to decide where to receive treatment based on their budget and preferences.”

Ensuring medical insurance is well spent

With healthcare costs ever increasing, Sze supports the idea of purchasing insurance products to cover unexpected medical expenses. However, he emphasized that having insurance coverage does not mean patients do not need to manage their medical expenses well.

“Similar to auto insurance, drivers still have to be responsible for their behaviour on the road even though any damages to their insured vehicles are covered by their insurance plans,” elaborated Sze.

“There was a young patient in his 20s who requested to undergo colonoscopy. He didn’t experience any symptoms of colon cancer. He requested the procedure simply because it would be covered by his insurance plan,” recalled Sze.

“Think about the scenario where people consume as much food as possible in an ‘all-you-can-eat’ buffet – until they cannot take in anymore. This may sound funny, but when you put this into the context of health care, such behaviour would drive up overall health insurance costs, and patients would be the ultimate victims who suffer,” he warned.

In view of this, Sze suggested consumers to consider insurance plans with deductibles, meaning lower premiums given that consumers pay a small portion of medical expenses themselves. “Whether this small portion is paid by consumers themselves or covered by their employer-sponsored medical insurance plans, it symbolizes the need to be responsible for their spending,” he noted.

“Patients should not simply regard insurance companies as automated teller machines that pay them whenever they claim medical expenses. Instead, treat them as your partner to plan your medical expenses ahead. Ask to be explained clearly what the plan covers. Understand the details of the plan fully before making the decision to purchase,” Sze added.

Sze said his dream is to establish a social enterprise.
Sze said his dream is to establish a social enterprise.

As Sze concluded, he said his dream is to establish a social enterprise to benefit more patients. “As with any other healthcare professionals, I believe profit making is not the reason why we are so deeply committed to taking care of our patients. Even if patients are capable of paying for the expenses, it doesn’t mean we have to take them all,” opined Sze. “Hopefully, this social enterprise can enhance transparency in the private sector, creating a ripple effect for other practitioners to follow suit.” MIMS

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