The private medical sector can help address patients’ woes amid COVID -19 pandemic

As the coronavirus pandemic stretches Hong Kong’s healthcare system, private sector medical resources could provide crucial reinforcement to divert non-emergency service and help meet the expected explosion in demand for COVID-19 testing when cross-boundary travel resumes, medical experts said.

Front-line workers in the private and public medical sectors agreed that seamless collaboration could change the landscape of the deepseated imbalance between the two, where public hospitals serve most of the city’s patients with fewer than half the doctors.

To reduce cross-infection and alleviate pressure, public hospitals have reduced non-emergency medical services for over nine months and suspended most scheduled surgeries and medical checks. In February, about 40 to 50 percent of in-patient services were postponed. As of late September, services have returned to 60 to 70 percent capacity.

Since the beginning of the outbreak, the Hospital Authority launched seven new projects to allow patients to seek medical treatment at private institutions for the same price as in public hospitals. By midSeptember, nine pregnant women, 121 infants, 23 breast cancer patients, 60 orthopedic patients, 68 cancer patients, 313 patients with urologic symptoms and 597 patients in need of gastroscopies were transferred to receive treatment under the seven projects according to the Authority.

The long wait for outpatient specialist services has been heightened during the pandemic, with the need for social distancing and medical resources being shifted to battle the coronavirus. The authority’s latest data showed that, by the end of June, various outpatient specialist services had been extended for weeks during the pandemic, with the most serious one extended for 16 weeks. By the end of June, the waiting time for ophthalmic specialty services has reached as long as 3.3 years, and medicine and ear, nose and throat service had reached as long as 3 years and 2.7 years respectively.

Despite the government’s endeavor to beef up public-private medical institution collaboration, these current projects have produced limited results, Samuel Kwok Po-yin, a surgeon and president of the Association of Private Medical Specialists of Hong Kong, told China Daily.

Bear the pain

Kwok said the prolonged waiting time is a heavy blow to public hospital patients, most of whom are grass-root residents suffering from the protracted waiting time of public service. They had to bear the pain and wait, without knowing a definite time of service resumption. Some had no choice but to resort to private service and the cost worsened their livelihood woes during the pandemic.

Gynaecologist Chen Siu-wai from the private sector said the prolonged waiting time could also put patients at risk. She said four of her patients, who had delayed cancer screenings out of fear of being infected at public hospitals, were found to have cancer. Chen said that if they could have been tested earlier, the cancer may have been caught sooner.

In stark contrast to the strained public hospitals and eagerly awaiting patients, some private sector doctors have seen a significant drop in patient visits. Chen said her workload during the pandemic has reached the lowest in the past two decades, with February seeing 50 to 60 percent fewer patients than usual. But Chen said she is willing to volunteer in public hospitals to help the battered sector. In September, Chen provided her expertise, together with 6,000 local medical professionals and about 600 medical experts from the Chinese mainland, during the city’s first mass testing program, in which almost 1.8 million people were tested for the coronavirus. The pandemic has clearly exposed the long-existing imbalance between public and private medical systems, noted Kwok, who is also the former head of United Christian Hospital’s surgical department and has more than 20 years of experience serving public hospitals.

With the approximate number of doctors, public hospitals serve over 90 percent of the inpatient patients. Kwok said he believes private institutions have the capacity and the willingness to undertake more, especially during this time of crisis.

And given the mounting pressure on public institutions brought by the risk of future pandemic outbreaks and the city’s aging population, deeper private-public collaboration is definitely a must, he said.

Kelvin Wong Kiu-fung, a surgeon at North District Hospital, agreed with Kwok that the private sector resources could alleviate pressure on the overstretched public hospitals in both the short and long term.

To achieve that goal, he and Kwok suggested public hospitals should establish a centralized management system to accelerate the transfer of overdue cases that failed to meet public hospitals’ criteria for immediate treatment.

They also pointed out that under the current projects, only part of the treatment process, such as non-emergency medical checks and surgeries, are outsourced; patients still need to return to public hospitals for further treatment. This has impaired the effectiveness of the projects, they said.

Consider outsourcing

They advised public hospitals to consider outsourcing a patient’s complete treatment process to private institutions, since the private institutions are well-qualified to provide full service, and the city has a wellestablished regulatory mechanism for services by private institutions.

Also to benefit more patients, obstetrician Chen held that more medical checks, which are easy to conduct, with much demand at relatively low cost, should be included in the collaboration projects, such as ultrasonic examinations, a much-needed service for gynaecological patients.

The doctors said private institutions could also contribute more to COVID-19 testing after cross-boundary travel resumes.

To completely open cross-boundary crossings with the mainland and set up travel bubbles with overseas areas, they reckoned that more large-scale community tests are to be expected. After that, regular individual tests to get exemption certificates or health codes are expected to see a sharp rise, which public institutions may not be able to handle alone.

Private medical workers, who have accumulated experience in the Universal Community Testing Programme, could be better mobilized to undertake sample collection work, they noted.

Overcome the crisis

Kwok and Chen suggested the government make plans in advance and negotiate with suitable private institutions. Amid the challenge brought by the pandemic, Kwok said private institutions have made efforts to overcome the crisis, noting that major private hospitals have offered discounts to attract more patients.

Yet from a long-term perspective, the initiative is not sustainable and still can’t help much with grass-root patients, Kwok said. Chen added that private doctors can’t openly offer discounts like hospitals, as such behavior is often regarded as unprofessional by the Medical Council of Hong Kong. That put them in a quite passive situation amid the crisis, she said.

Thus better coordination at the government level in triaging public institution patients seems to be the most feasible way to balance privatepublic resources, they held.

In Wong’s opinion, the authorities have the resolve to promote privatepublic medical collaboration. In 2016, the Hospital Authority set up a HK$10 billion fund to boost collaboration. He hopes the medical authorities can better utilize the fund to tackle the problems of the privatepublic partnership highlighted amid the current crisis.