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Much has been said of late on the development of a workable public and private interface in the provision of health care service, hoping that it will be the ¡§be all or end all¡¨ for our ailing health care system. The need for redistribution of workload is not new. Similarly the reasons for such discrepancies are blatantly obvious. The latest health care Reform Consultation Paper of the HKSAR ¡§Lifelong Investment in Health¡¨, for example has identified 3 barriers. Unfortunately ways by which these walls could be dismantled and prudent means to bring the interface to fruition are still nebulous.
¡§It takes two to tango¡¨. Efforts must come from both sides if success is to be forthcoming. These efforts must be based on good will, open mindedness, full transparency and only for total good. Mudslinging is not only non productive but deleterious, fuelling the public¡¦s mistrust on our health care service. It is thus counter productive to accuse the Government of providing a service which is too good, too cheap and too extensive, after all such health care service must be the expectation of the general public. Similar it leads to no where to point an accussing finger at the private sector as ¡§overcharging¡¨ when these are only the ¡§crime¡¨ of a few black sheep.
Pivotal to the whole issue is for the Government to declare the role of heavily subsidized public health care service---whom it is for and what it is for. It is only through this that those who have the available resources and those who are of minor ailments will not be unnecessarily overloading the public service. They will have to pay the private sector rates irrespective of whether they seek private or public medical service. A genuine choice is this provided, private and public will be competing on equal grounds. It also open up a true incentive to take up medical insurance. Those who genuinely fall within the safely net of the public medical service could look forward to a more acceptable service with much shorter waiting time, as many in the queue would have sought private service because they will need to pay anyway. To implement this requires political determination and a strong, yet reasonable, Government, which hopefully the Chief Executive in his second term of office will demonstrate.
What can the private sector do, what can the private hospitals do to regain loss grounds? Admittedly there are no means for the private to compete with the public as there is no level playing field. Yet there, must be, and are, ways that the private sector could improve their attractiveness to win back some of the loss market.
Irrespective of the economic gloom, there will still be a reasonable size of the population that are willing to pay for private services where they can choose the provider and the time of service, if they are assured that a specific charge, or there about, as agreed will be the final charge. Regrettably often this was not to be the case. Whilst the patient may well be aware of the doctor¡¦s charge and the hospital room rates and that he/she is happy that such is within his/her budget and means, often times he/she has to leave hospital with paying much more, as often numerous hidden charges leave much to be desired uprooting whatever confidence, there is, if not respect, in the private service.
It is true that in private medical practice, it is often the patients who choose the doctors. The patient-doctor confidence and the doctor-patient relationship has in most cases never been in doubt. Yet in these days where patient demands ¡§transparency¡¨ and expects ¡§accountability¡¨, some forum of ¡§clinical audit¡¨ using ¡§peer assessment¡¨ is in dire need, not only to assure the patient of the high quality of care provided by the ¡§attending¡¨ doctors but also provides a good learning ground for the service providers. Regrettably whilst most public hospitals do have ¡§mortality and morbidity meetings¡¨ on a formal and regular basis, most private hospitals do not even have such rudimentary set ups. It may be argue that doctors who patronize a private hospital are not in that hospital¡¦s pay roll, curbing the hospital¡¦s rights and responsibilities on each ¡§attending¡¦s¡¨ performance. This is not entirely true---the strongest trump card of any private hospital lie in its power to grant to and remove admission and operation privileges from private practitioners. Well established ¡§clinical audit¡¨ is the best advertisement for any private hospital, that the hospital acts on behalf of the patients to ensure that those doctors who are given the privilege of using that hospital are performing to those standards required by the hospital! The Director of Health as the comptroller and registrar of private hospitals should ensure that such ¡§audit¡¨ system be available and implemented as a criteria for issuing of the necessary hospital licence. The Academy of Medicine as a body set up by law to determine and monitor doctors standard is in the best position, and together with the Academy Colleges, to advise and assist private hospitals in setting up and run these systems.
It is a fact that patients with major catastrophic illnesses commonly patronize public hospitals. This trend is moving upwards. The obvious reason must be an economic one. The cost of long term stay in private hospitals together with the need for multiple treatment procedures and continuous close monitoring in vital signs, could be phenomenal that many find it ill afford. Yet there could well be a hidden reason---the apparent lack of a proper team approach in the private settings. As a patient and the relatives, irrespective of the highest trust that they placed on his/her chosen doctor, they know that doctor could not be available all the time---Who will be responsible for any unforeseen essential resuscitation in that doctors absence, when time measured in minutes and seconds are never on the patients¡¦ side.
Private hospitals should well consider setting up teams of different disciplines amongst the peers who patronize the hospitals. These doctors could go on rotation, be in the hospital premise when they are ¡§on duty¡¨ to deal at hand with all the necessary life saving activities until the ¡§doctor in charge¡¨ arrive and take over. This is far from being a publicity stint, it is an essential service for patient good, for the provider¡¦s peace of mind, and for the relatives of the patient, a value added comfort.
All these, and many others, will not reverse the wheel of private and public imbalance in workload overnight. Given time, some effects will surely surface. More importantly it demonstrate the commitment of the medical profession, as one body, to standards, and our pledge of accountability to the patient and the community we serve.
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C.H. Leong
President