The healthcare system in Hong Kong has coped poorly with the increasing demands driven by an aging population. COVID-19 was the last straw. Despite only a minority of medical workers joining anti-China protests and staging a strike last year, dissatisfaction among employees of the Hospital Authority, the biggest employer of Hong Kong’s healthcare sector, has been simmering for years.
Churning of doctors and nurses needs to be balanced by the intake of new graduates to maintain the basic functions of the HA. An aging population and heightened health-consciousness of Hong Kong residents fueled the expansion of services the HA must provide and the construction of new hospitals. Open discussion of HA reform is crucial, not only because it is the last gatekeeper of the health of Hong Kong residents, but also because social stability hinges on maintaining that service.
While HA Chairman Henry Fan Hung-ling correctly pointed out that the churn rate of doctors and nurses in the organization has increased by 0.9 percent in 2021 compared with 2020, he attributed it mostly to emigration — alluding to political reasons, rather than taking responsibility for his own mismanagement of the HA. That Fan had to second-guess the reasons for continuously high rates of decampment shows even the chairman himself is not well-informed despite the HA collecting reams of data from employees. That Fan chooses to conveniently divert the public’s attention to the recent political turmoil shows he is unwilling to reform an ossified healthcare system during his tenure. His lenient treatment of lackadaisical doctors and nurses who staged an unjustified strike to avoid caring for highly contagious patients is hard evidence of torpid leadership.
Open discussion of HA reform is crucial, not only because it is the last gatekeeper of the health of Hong Kong residents, but also because social stability hinges on maintaining that service
Emigration cannot fully explain the brain drain. Indeed, even though the salaries of doctors in Hong Kong — on average HK$150,000 ($19,290) a month — are at least double that of Britain and Singapore, morale remains low. The poor geographical mobility of doctors is already known, as each country has its own licensing examination followed by different training systems that take another few years to complete. Most doctors who rear children may also find it inconvenient to leave Hong Kong without planning their career progression in lockstep with their children’s educational milestones.
What, then, are the plausible explanations for the churn? Data cannot tell if it goes unrecorded. For starters, residency matching remains grossly opaque with minimal improvement over the years. Department chiefs are free to choose residents with neither equitable justification nor a standardized assessment — medical interns’ lore has long told that being an attractive female is a deal breaker to get into the training programs of highly competitive specialties such as ophthalmology and radiology. No territorywide criteria such as those in the Chinese mainland, Britain and the US are implemented, despite struggling with a fragmented healthcare system and thinly spread hospital networks.
At the other end of the career, hoary specialists retain their professional titles by clinging onto outdated medical practices. Word-of-mouth seems sufficient to justify their rent-seeking behavior in the absence of hard evidence corroborated by data (the complication rates of surgeons remain unknown). Continuous medical education points are earned flimsily to maintain specialty titles: Doctors can attend Continuing Medical Education lectures remotely related to their specialties; some sign the attendance register and leave after a brief visit; many fall asleep during the lectures; and none need to go through a test to gauge their knowledge gained from the CME event.
In the HA, hospital administrators are a self-serving bunch of senior doctors who loath clinical duties. After a lifetime of never-ending patient care work, they sense a long-awaited opportunity to step away from the long grinding hours of clinical work. Transition to an administrator requires nothing more than a personal referral, and few bother to pick up new skills as a quinquagenarian. There in a secluded office, they find solace without having to pick up nurses’ calls. They enjoy the freedom to stifle creativity with the authority bestowed by their doctoral title, lest innovation disrupts not the bureaucratic healthcare system but their own careers when projects go south.
In a business utopia, an unregulated market entrenches the rent-seeking behavior of large incumbents as they strive to exploit employee and consumer benefits in the name of protecting shareholder value. In healthcare, such a framework defies the purpose by exposing the people we ought to protect to the machinations of those who profiteer from an ossified system. Often, administrators in the HA care less about the welfare of residents and employees than an uneventful denouement of their career — a sacred mission they uphold until retirement. Currently, healthcare administrators are allowed to walk free from their own incompetence — but such a moral hazard cripples the stability of Hong Kong’s society.
The author is a licensed medical doctor in Hong Kong and holds a master of public health degree from Johns Hopkins University.
The views do not necessarily reflect those of China Daily.