Hong Kong’s public healthcare system is facing a number of growing challenges which remain among the most hotly debated social issues by people from all walks of life who reside here. To find out exactly what these burning issues are, and how they came to be, we talk to the experts at healthcare initiative The CIS Free Clinic, which aims to provide free healthcare for the underprivileged population of Hong Kong.
You wake up one morning and feel a sudden stab of pain on your back as you get out of bed. Frustrated, you try and walk it off, but soon realise that the pain worsens with every step you take. So you call your boss to tell them about your situation, and get ready to visit your nearest public hospital.
The public hospital is bustling with patients. There are elderly people lying in beds in the middle of hallways, infants crying in every corner, and stressed nurses navigating through a maze of people. Uncertain of what to do with yourself, you head over to the registration counter to get an appointment in the emergency unit.
Once registered and dismissed by the nurse at the counter, you head over to the waiting area with your number card, and it takes you ten minutes to finally get a seat. And so there you are, sitting among frustrated adults, crying children, and wheezing elderly people, all waiting their turn. Next thing you know, it takes four hours for your number to be called and for you to see the doctor …
Severely Understaffed Hospitals
Under all the glitz and glamour of Hong Kong, public hospitals are often overcrowded, underfunded, and lacking in resources. These hospitals are funded by the Government, however the majority of them are understaffed and hence struggle to cater for the large number of patients every day.
Part of the appeal of public hospitals in Hong Kong is their provision of medical care at a very low cost, and therefore 90 percent of Hong Kong citizens turn to them for treatment. However, public hospitals only employ 40 percent of Hong Kong’s doctors, as many doctors prefer to work in the more lucrative sector of private healthcare. It is predicted that the elderly population (aged 65 and above) will double to over 2 million by 2029. The elderly tend to visit medical facilities more often (in fact, 4.7 times more often) than younger patients, and they make up 42% of all inpatients in public hospitals. With these numbers expected to increase and the underallocation of resources, public healthcare in Hong Kong is, and will continue to be, a growing issue.
According to the Hospital Authority, public hospitals still operate on days when they have a shortage of 700 nurses and 250 doctors. The pressure of attending to hundreds of patients each day then falls to the few workers who remain in public hospitals, who are often stretched to their limits. As stated by the Association of Hong Kong Nursing Staff, the average ratio of nurses to patients in public hospitals is 1 to 11, while the international standard is 1 to 6.
Not only does this lower the quality of care, it also creates extremely long waiting times which the “regular” patients have to go through. The Hong Kong healthcare system classifies patients into 3 categories, Priority 1, Priority 2, and Regular – each with lower priority than the last, and in turn longer waiting times. However, this insufficient routine can easily be disrupted by the absence of a staff member or the rise of an emergency. The former will place more pressure on the already burdened hospital staff, and the latter will interfere with planned schedules and the organisation of staff members.
Read more! Check out our comprehensive Guide to Healthcare in Hong Kong
Negative Attitudes towards Public Healthcare
For fear of the long waiting times, individuals with seemingly minor problems are often unwilling to seek medical attention. They allow their symptoms to exacerbate to the point where medical attention is unavoidable, and consequently overwhelm the hospital staff with a need for critical care. Cases like these are frequent, and many patients rarely have the protection of full medical insurance, and are therefore unable to receive medical attention on a regular basis.
Lack of experience with medical procedures can also cause patients to fear medical equipment when they are undergoing a medical, therefore making them unable to go through with them. The lack of understanding of medical procedures also leads to the stigmatisation of the treatment.
Chloe Martin, a representative of the Justice Center Hong Kong, says that public hospital staff are not typically trained to communicate with diverse clientele, and this lack of preparation results in the inefficient provision of healthcare services for the integrated community. Martin’s clients would often try to seek medical attention from the Accident and Emergency Department (A&E) because of the miscommunication between staff and patients, and are consequently subject to less than ideal treatment because of such a mistake.
These individuals may have entered the A&E because of their incomprehension about the waiting time, or because they are desperate for medical attention after being told that they are “not entitled to free treatment” because the staff didn’t know how to address or process their foreign identification papers. That’s where organisations such as ourselves come in, where we aim to offer a helping hand by providing free and cost-effective essential healthcare for those who need it.
Limited Access to Patients with Special Needs or Different Backgrounds
As refugees and asylum seekers only have limited rights in Hong Kong, they are often overlooked when it comes to healthcare or their welfare in general. Before 2005, refugees were able to gain access to public healthcare if they had a letter of referral proving their status as refugees or asylum seekers. However, after 2005, hospitals instead asked for passports or immigration papers, which asylum seekers would not have, thus limiting the amount of care they were able to receive. In some cases they even ended up being arrested, which lead to many refugees and asylum seekers being put off seeking medical care.
Patients that are not provided for under the local healthcare system are only entitled to two emergency treatments. Refugees do not receive dental care, ophthalmic care, or psychiatric care, unless they pose an imminent danger to society. Additionally, local doctors are prohibited to provide medication to asylum seekers. Martin informs us that these are just some of the components that make up the stumbling blocks refugees face when attempting to seek medical attention.
Also, asylum seekers without a Hong Kong Identity Card are categorised as “non entitled persons” and must pay fees that are similar to that of private hospitals, which hugely neglects any consideration about their financial capabilities alongside their needs. Of course, the issue of translation in languages beyond English, Cantonese, or Mandarin is yet another reason why the ethnic minorities in Hong Kong are overlooked in the city’s health sector.
Unaffordable Medical Care
For many people in Hong Kong, changing to private healthcare is not a viable option. A study published in 2014 for The Chinese University of Hong Kong (CUHK) indicated that one tenth of Hong Kong citizens do not seek medical care simply because they cannot afford it, and this tends to alter their attitude towards seeking it. The mentality implemented within the older generation is passed on to their children, creating a cycle whereby individuals do not seek healthcare for chronic issues that may or may not be serious and life threatening.
As per the 2013 government statistics, nearly 1.4 million people in Hong Kong are living with chronic diseases, which accounts for nearly 20% of the population! A staggering 72% of those chronically ill are economically inactive, which makes it near impossible for them to seek help. The issue then becomes cyclical; public healthcare is time consuming and people can’t afford private healthcare, therefore they resort to not seeking help at all.
There is an undeniable relationship between poverty and a person’s demand for healthcare, and the Government needs to allocate resources to help educate the public on the importance of healthcare. Even if patients could spare some money to pay for consultation fees, there are still a lot of critical medical services that are not subsidized by the Government, such as angioplasty (“通波仔”, which costs between $20,000 and $30,000). Alongside the high price of medical services, constricted mobility for people with a low income also becomes a frustration, as skipping a day of work is often not an option as it may result in an even tighter financial strain for them.
At The CIS Free Clinic we are not aiming to replace the public healthcare system, but we do see a genuine need in healthcare for many people in Hong Kong, and we are merely trying to fulfil that. As a school, we work closely with many non-profit organisations to provide a solution to the problems the public healthcare system presents to many individuals in Hong Kong.
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