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April 2012 – Hong Kong’s Ailing Health System
Hong Kong has one of the better public health systems in the world but the system is groaning under the challenge of an aging population, spiralling costs and rising expectations.
In this issue of Periscope we look at some of the problems facing the public health system:
Health Care in Trouble
Hongkongers are lucky to have one of the more equitable public health systems in the world. We enjoy relatively low-cost, high-quality care. Our hospitals employ some of the most advanced technology and our medical professionals are well-trained.
But health systems experts have long warned that Hong Kong’s reliance on hospital-based services is out of date and cannot meet the needs and growing expectations of a modern and aging society.
There are long queues at accident and emergency departments and many residents, especially the elderly, choose to use out-patient services at public hospitals rather than see private doctors.
In this issue’s Periscope, Varsity looks at some aspects of the problems facing the health system, including provision of health care services for the elderly and the shortage of doctors and nurses.
To encourage Hong Kong’s ever expanding number of old people to use private medical services, the government recently extended the Elderly Health Care Voucher Pilot Scheme for three more years to 2014. But so far, the scheme has not achieved the desired goals of relieving the burden on the public sector and increasing choice for elderly patients.
The pressure on the public system is exacerbated by manpower shortages. Reports of medical blunders frequently make the headlines, understaffing and overwork are often mentioned in these cases.
The rapid expansion of the private sector has led to an exodus of doctors and nurses attracted by the better pay and working conditions in private hospitals.
To alleviate the problem, the Hospital Authority (HA) has started to recruit overseas-qualified doctors to practise in public hospitals without first having to sit a licensing exam. But the move has met fierce opposition from local doctors.
As for the nursing shortage, the HA has also offered more training and promotion opportunities to nurses in order to retain them. However, it remains to be seen if these measures are effective.
Apart from leaving the public sector for the private one, nurses are also leaving the profession. Some nurses tell Varsity that their job is not well respected. Perhaps it is time to reflect on how nursing is perceived as a profession.
Apart from health, education is also a core issue that our society pays much attention to. In the Our Community section, Varsity looks at the associate degree and investigates whether the programmes offer students brighter prospects and value for money.
Gavin Li
Managing Editor
No Solution in Sight for Pensioners’ Plight
Reporter: Derek Li and Thee Lui
Dozens of elderly patients sit silently on benches in the lobby of Kwong Wah Hospital. The only sounds to be heard are the announcements calling for patients. Ms Lee, in her 70s, keeps an eye on the numbers flashing up on the screen and carefully checks them against the number on her chit. She knows she faces another hour of waiting.
Despite the frequent long waiting times in Hong Kong’s public hospitals, many elderly accept they have to wait since they are enjoying either free medical care or paying far lower fees than they would pay at private hospitals or clinics.
This is particularly true for those with chronic diseases like Lee. She has to go to the hospital for regular kidney check-ups every month and kidney dialysis costs her more than $10,000 every month.
Lee relies on a government subsidy of a few thousand dollars a month to pay for her medical expenses. Her son and daughter, who each have their own families to support, foot the rest of the bill.
Lee lives in a private elderly home which adds to their financial burden. She is waiting for a place in a government-subsidised elderly home that would cost $2,000 to $3,000 a month, a tenth of the cost of private elderly homes.
Like Lee, most of Hong Kong’s elderly population depend on government medical services. As highlighted in the latest Policy Address, Hong Kong’s aging population presents a huge challenge for its public health system. The number of people aged 65 or above is expected to rise from the current 0.9 million to 2.1 million in 2013, which represents a quarter of the total population.
The recurrent government expenditure on medical and health services in 2012 will be $45 billion, an increase of 8 per cent on the previous year and 17 per cent of total government expenditure.
In an attempt to relieve the increasing pressure on public medical services, the government introduced the Health Care Pilot Scheme in 2009 to encourage the elderly to use private health care services. Under the scheme, non-means tested medical vouchers were issued to people aged 70 or above. Each person was given five $50 vouchers, that is, a total of $250 to spend on private primary health care services.
Two years after it was launched, the Hospital Authority reviewed the scheme last year. Of just over 1,000 elderly people who were interviewed, only around a third said they used private primary care services more than they had before. The others did not change their behaviour and 26 per cent of these respondents said the reason was because they were used to seeing public doctors; a similar percentage said the subsidy amount was too small.
Although the total value of medical vouchers was increased from $250 to $500 following the review, many believe it is still far from satisfactory.
Tang Kam-ying, 79, visits clinics several times a month. He had already used three of his 10 vouchers for the year by February and thinks that even after the increase, the vouchers cannot meet the needs of the elderly.
Each time Tang visits a private clinic, it costs him two vouchers. So, when he chooses to see private doctors, he opts for those that charge the lowest fees.
Overseas Physicians Best Medicine for Doctors’s Shortage?
Local doctors oppose scheme to make it easier to recruit overseas doctors
Reporters: Sabrina Poh & Viola Yeh
She starts her work day at 9 a.m., spending the morning checking up on and chit-chatting with patients on her ward rounds. Then she has a working lunch or talks to her supervisor at noon. In the afternoon, she has to rush to fit in more patients. Technically, she finishes work at 5 p.m., but she rarely gets to wrap up her work before 7 p.m. When she is assigned to be on-call, which usually happens one to two times per week, she needs to stick around until 1 a.m. the next day. By the time she gets home, she is exhausted; she eats, talks a little to her family and goes to bed.
Dr Vinci Ma, who is in her early 30s, studied and practised medicine in the United Kingdom (UK). She returned to Hong Kong to be with her family. As a result, she has had to adapt to the long working hours and frenetic pace of Hong Kong’s public hospitals. Here, she works 60 to 70 hours per week, compared to 48 hours in the UK.
Ma has been working in the Queen Elizabeth Hospital since 2009. Like other doctors who qualified outside of Hong Kong, she had to sit a re-qualification exam and jump through other hurdles to be granted a partial licence. “We can only practise under limited registration, which means we are restricted to working in public hospitals, in a specific department under a contract,” Ma explains.
Ma earned her medical degree from the University of Nottingham and worked in the UK as a pediatrician for three years before coming back to Hong Kong.
She spent half a year to prepare for the licensing exam set by the Medical Council of Hong Kong (MCHK). “There aren’t any [sample] exam materials. There is a syllabus but it is not very helpful,” she recalls. As a result, Ma had to go through all the materials she studied while at medical school.
She passed the examinations, which have long been criticised as difficult by other overseas-qualified doctors, on her first try. However, she still had to repeat half of her basic training before she could practise.
Nurses Flee Public System
Hospital Authority’s efforts to retain nurses fail to stem exodus
Reporters: Ian Cheng and Vivian Ng
Dozens of patients were resting in a big hospital ward. One of them wanted to get out of bed to go to the toilet, so he pushed a red button beside his bed to call for a nurse. Help did not come. After a long wait, the patient pulled himself out of bed. He fell onto the floor.
Incidents like the one above happen all the time, according to an experienced nurse in a public hospital who spoke to Varsity on the condition of anonymity.
Nurses in public hospitals work one of three eight-hour shifts, the morning, afternoon or night shift. That may not sound very long, but each shift is gruelling. They often do not get breaks and even if they do have breaks, they are too busy to take them.
On a typical shift, a nurse might start their day distributing medication, then take patients’ blood pressures and pulse rates. They may feed their patients, change dressings and even help with bathing. They have to listen to advice from doctors and act on their instructions immediately. Getting anything wrong could lead to grave consequences.
The hectic day ends only for another to begin. Sometimes a night shift may be followed by an afternoon shift, so the body does not have time to adjust to the different rhythms and sleep patterns.
The overworked nurses in Hong Kong’s public hospitals are a symptom of staff shortages. There are about 40,000 nurses registered or enrolled under the Nursing Council of Hong Kong (HKNC) but below 80 per cent of them are currently working as nurses. In July last year, the Hospital Authority (HA) said it was still short of 1,000 nurses, despite an expensive recruitment drive.
Susan, not her real name, is a registered nurse in a public hospital. She says the nurse-to-patient ratio at her hospital is around 1:13 during the day but can rise up to 1:40 or even more during the night. The international standard is 1:4 to 1:6.
She says nurses who work on medical wards are so busy that they do not even have time to go to the washroom during the night shift. They dare not drink too much water.
Susan finds the demands of her work very stressful. She finds it hard to fall asleep after work and often spends time trying to remember if there was anything she forgot to do on duty.
The pressure does not just come from the work itself, but also from patients’ families.
Susan cites the case of a patient whose relative claimed to be a policeman. The man suspected the nurses of stealing from the patient and wanted to search them. The nurses felt they could not just ignore the accusations.
“When you retorted, he would say your attitude was bad,” says Susan, adding that it is useless for nurses to argue with patients’ irrational family members.
Wong Kam-man, a nursing officer working in a public hospital in Kowloon, says it is also common for nurses to be sworn at by family members of patients. Although such verbal violence upsets her, she feels helpless to do anything.
“There is no reason why I have to be scolded by you when I go to work,” says Wong. “You can just speak if you have something to say.”
Wong recounted an incident where a colleague was attacked by a visitor who dashed into the ward during non-visiting hours. Wong says the nurse was scared to go to work after the incident and had to seek medical help for psychological trauma afterwards.
Alternative Paths to Universities
Does society recognise associate degrees?
Reporters: Yannie Mak & Matthew Leung
Every year starting in late March, Hong Kong’s secondary schools become battlefields for tens of thousands of anxious students taking their A-level Examination. This year, they are joined by students taking the new Hong Kong Diploma of Secondary Education Examination. This means there will be more than 110,000 students sitting their school-leaving exams this spring.
Many of them will hope to gain the grades needed to secure entrance to a University Grants Council (UGC) funded undergraduate programme. But only around 15,700 will make it due to the limited number of places. Most students are bound to consider alternative paths if they wish to pursue their studies.
The associate degree was introduced by the government in 2000 to boost the number of students in tertiary education. Various institutions providing associate degree programmes have since positioned themselves as stepping-stones to entering degree courses and over the years, their programmes have attracted a fair number of students.
According to the Information Portal for Accredited Post-secondary Programmes (iPass), the number of enrollments to full-time associate degree programmes reached 27,500 in academic year 2010-11, seven times the number in 2000.
Yet the qualification seems to get a bad rap from society at large. With a certain amount of stigma attached to it and uncertainties about future prospects, deciding whether studying for an associate degree is a justified or risky move depends on individual expectations.
Kong Ka-sin, a first-year associate degree student in psychology at the College of International Education, chose the associate degree path as she thought it would give her a better chance of getting onto degree programmes than a vocational school would.
However, she thought twice before making the decision. “I held a negative view towards associate degrees when I was in Form Five,” says Kong. “Is it really corresponding to degree programmes? Is it really recognised [by employers]?”
She now realises the courses have helped her discover where her interests lie and encouraged her to strive for better career prospects. Kong believes this knowledge benefits students whether they eventually continue their studies in university or join the workplace.
After seeing the possibilities of further study from the experience of her seniors, Kong now feels more comfortable about her choice.
What concerns her now is how much her tuition costs. According to the Education Bureau (EDB), more than half of the local self-financed institutions providing associate degree programmes plan to raise their tuition in the coming academic year by five to 10 per cent on average.
Shirley Heung Shuk-yi, a second-year associate degree student in health studies at the Hong Kong Community College pays around $50,000 a year in tuition fees. She is unhappy about what she gets in return. Heung complains that most of the time a dozen students have to share one life-sized anatomical mannequin for practicals.
Heung attributes this phenomenon to a sharp increase in student intake. Heung says there were fewer than 100 students in her programme the year before she was admitted, but that number has now more than tripled.
According to figures from the EDB, only six per cent of the 30,000 students enrolled in associate degree programmes in 2011-12 will be able to further their studies on UGC-funded degree programmes. The rest may have to consider self-funded degree programmes offered by local universities, which charge $20,000 to $40,000 more per year than the UGC-funded degree programmes.
Rocky Tam Lok-kei, a second-year student in associate of social science programme at the Community College of City University, explains that graduates from self-funded degree programmes are usually welcomed by employers as they tend to have more practical knowledge and their courses are designed with industry needs in mind.
This makes self-funded programmes a good option for those who do not get onto UGC-funded degree programmes. But just as some doors open up for associate degree graduates, others close.
The City University of Hong Kong recently announced it would slash admissions for self-funded degree programmes from 652 this year to 90 in 2014-15. The university says the move is to ensure quality teaching. But Tam, who is a representative of The Group in Concern of the Cutting of Self Financing Top-up Degree Programmes of the City University, accuses the university of neglecting associate degree students’ expectations.
This development may just be the latest twist in the fluctuating fortunes of the associate degree in Hong Kong. Its reception has been mixed in the 12 years since it was introduced.
Sensing Cinema
Making cinemas and films accessible to the deaf and blind
Reporters: Astina Ng and Lindy Wong
“Actor Nick Cheung Ka-fai embraces a little girl and rushes into the building which is a clinic. Once inside [the clinic], Cheung lowers the girl onto a surgery bed,” the narrator, local DJ and voice artist Jacqueline Pang Ching pauses and pants. “A doctor there… takes out… a… knife. What will happen next?”
Little sweat beads roll down the forehead of a member of the audience in the hall. He freezes and grasps the arms of his chair tightly. Suspense hangs in the air, a sudden yelp from the audience further heightens the intensity.
Pang is providing a vivid narration of a local thriller, The Beast Stalker, for the audience of blind and visually-impaired people and she certainly knows how to captivate them.
First off, she thinks good narrators must be deeply emotionally engaged. Pang also puts a lot of focus on the mood and the atmosphere. Her passion and charisma infects everyone in the room.
Pang has been volunteering as a narrator for movies for the blind for around three years now and describes this work as a win-win arrangement. The visually impaired are entertained by her performance and she gains satisfaction from using her talents.
She recalls how an audience member was in tears when he thanked her for allowing him to enjoy movies again after many years. She was so touched, she also teared up. “What I did is just simply depict what I see, I had never imagined this little task could bring so much happiness to them.”
While Pang’s experience in radio drama makes her a good movie narrator, she says there are differences between a radio drama and movie narration. For instance, a movie narrator has to deal with the unpredictability of shot changes in a film. Pang jokes that narrating the action sequences in the martial arts biopic Ip Man was like commentating on a horse race.
Not all volunteers are professionals from the entertainment industry. Paul Wong Chun-yui, an accountant, is a scriptwriter for descriptive movies for the blind. To prepare for a two-hour movie screening, Wong had to watch a film seven times and spent his Christmas writing. His biggest challenge was striking a balance between writing descriptions and creating atmosphere.
Barter Hunting
Cash is not king as people swap unwanted items.
Reporter: Natalie Cheng
Inside an office space in an unremarkable industrial building in Kwun Tong, soft music and laughter fills the room. People are talking and walking between racks of clothes and shelves full of books, browsing for something they might like.
This is neither a warehouse nor a stockroom. It is a place where people can share and exchange their unwanted items with others. No money changes hands here. The age-old practice of barter is the order of the day.
JupYeah held its first Pop-up Swap event on Boxing Day last year. People exchanged used clothes, old books or electronics in a small unit inside an industrial building.
JupYeah, Cantonese for “taking stuff” was set up by six young people. It was Ren Wan, a freelance journalist and core organiser of JupYeah who came up with the idea. “Initially it was three people swapping clothes in private. Then we decided to have a public event. Slowly JupYeah came into being,” she says.
Barter is the exchange of goods and services without using money. For JupYeah, anything that is unwanted but is clean and usable, whether it is brand new or used, is still tradable.
JupYeah is different from other barter trades, it is not one-to-one trading. Instead, people can come to either just leave their stuff for others or take anything away without offering anything in exchange.
One complaint Wan often receives is that people may take items of higher retail price away without giving anything. Wan does not think this is a problem. “When something is useless to you, it loses its value immediately. Its value does not depend on its retail price.”
For Wan, the most important thing is whether the unwanted items can still be used rather than be thrown away or recycled. This is the main reason for setting up JupYeah.
“In fact, we can exchange unwanted items. This is an alternative. We should not throw all the unwanted items away but encourage the barter cycle to extend their lifespan,” says Wan. “Consumption is too high in Hong Kong. In fact, do we need to buy everything we need?”
Wan says barter can be an alternative way to gain “new” stuff and encourages teenagers and young adults, especially those with deep pockets, to join barter events.
To Yu-hin joined JupYeah’s Boxing Day Pop-up Swap and enjoyed it thoroughly. It left him with a good impression of this method of “acquisition”. To brought an old film camera to the event, a stranger showed an interest in it and they started talking and became friends.
To likes Pop-up Swap because it is held informally, like a casual party where participants share the same values about consumption and materialism. He can make new friends at the events. At the same time, he also treats the barter activity as a treasure hunt. “[I] do not know whether I will find something I like,” he says.
The Feng Shui Hobbyists
Ancient Chinese practice wins new enthusiasts
Reporter: Kris Lee
In a coffee shop in Central, a stylish young woman sits engrossed in what she is reading. Unlike most of the customers, she is not reading a fashion magazine or a gossip magazine, she is reading a feng shui book.
Winifred Woo is a 20-year-old medical science student at the University of Sydney. She has known about feng shui for most of her life, having heard about it from her parents. But it was only after Woo left home to study abroad that she really started to learn about the ancient Chinese practice.
Leaving home and starting a new life alone in a foreign country is not an easy task. Woo encountered lots of difficulties and often felt depressed. “Sometimes there are things that humans can’t control, I hope feng shui can help when I encounter setbacks,” Woo told Varsity when she returned home for Chinese New Year in February.
As a student, Woo wants feng shui to assist her in school work and relationships with others in school. Following the instructions in a feng shui book, she put a Wenchang (see glossary) tower on her desk and lucky bamboo plants in the Wenchang position in the east of her room. She also placed a goldfish bowl in the south-east position of her room, which is the direction of the Taisui (see glossary) Lord this year.
“These things are easy to do, are cheap and have no negative effects, so why not?” To demonstrate how convenient it is to practise feng shui nowadays, Woo whipped out her smartphone and enthusiastically showed off a Luopan (see glossary) application.
After putting all the feng shui decorations in her room, Woo has become more confident about studying. “I am not sure whether there is a placebo effect, because I feel there is a power assisting me,” she says.
Woo may be a student of medical science, but she does not think there is a need to pursue scientific proof for everything, including feng shui. “It is not like taking medicine and getting cured right after that.”
Woo believes in feng shui because she says it is part of China’s cultural heritage. She says that if it did not have its merits, it would not have such a long history or be passed down from generation to generation.
However, while Woo likes feng shui, she stresses she will not invest too much in it because she only sees it as a hobby, not a way to make a living. As a beginner, she is content to get information from online forums, television programmes and books.
