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Editorial Hong Kong needs more hospitals
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【明報專訊】HONG KONGS population is growing and ageing. To meet demand, it needs to build hospitals and ensure that there will be sufficient doctors and nurses. This is most straightforward. However, it is many years ago since the government had plans to build big public hospitals, and there has long been a shortage of doctors in the territory. Things are such that Franklin Lam, an Executive Council member, describes Hong Kongs health care system as on the verge of collapsing. Furthermore, Secretary for Food and Health Ko Wing-man believes Hong Kong will see a shortfall of over 2,000 hospital beds in the next decade.

A study by HKGolden50 (which Franklin Lam has set up) shows that, in the past decade, the number of inpatients grew 8%, but that of hospital beds was about 35,000 and grew only 1%. As its population is growing and ageing, Hong Kong is expected to need nearly 40,000 hospital beds in ten years. According to the study, there are about 12,000 doctors in the territory, and the shortfall is about 5%. It is projected to rise to nearly 20% (3,140 doctors) in seven years. Furthermore, 40% of the practising doctors will retire in twenty years. Our universities now train up 420 doctors a year, but they will not become specialists until mid-2020 at the earliest. To meet its urgent need, Singapore has brought in doctors from other places. However, Hong Kongs medical profession is "protectionist". Between 2006 and 2010, on average only nine non-local doctors managed to practise here a year. When a city lacks doctors, its health care services suffer. Conceivably, that is a reason why Hong Kong has seen frequent medical blunders in recent years.

Hong Kong is badly short of doctors and health care facilities because the Donald Tsang administration formulated no population policy and made no long-term plans. Hong Kongs fiscal reserves now stand at $650 billion. Controlling such ample resources, the government will let citizens down if it grudges them public hospitals.

Ko Wing-man agrees that Hong Kong needs more doctors and hospital beds. We hope the Leung Chun-ying administration will carry out long-term planning and do what will remedy the situation. For example, it should see that there will be more hospitals and more doctors and nurses, for it is clear from available data that it will not meet Hong Kongs long-term need to admit 420 medical students a year. Hong Kong has to bring in doctors from other places to meet its urgent need. We hope the medical profession will have regard to the SARs overall interests and refrain from making things difficult. The government should let citizens see that it is responsible. It should consider taking back the Medical Councils power to approve non-local doctors applications if it cares only about the professions own interests.

As the health care financing plan may turn out to be one of voluntary medical insurance, the Donald Tsang administrations idea of increasing the private sectors share in Hong Kongs health care services does not seem likely to work. A practicable option is to increase health care spending. Unless the government does so, Hong Kongs health care system will collapse sooner or later. However, public hospital charges are now unsustainably low. The government should consider gradually raising them so that users of public health care services will bear a suitable share of the cost of providing them. Public hospitals should set a certain percentage of their beds apart for middle-class patients who would obtain health care services at cost. As private hospitals have raised their charges so much that they seem bent on reaping exorbitant profits, such beds would appeal greatly to middle-class patients. The idea is well worth the governments consideration.

明報社評 2012.09.27﹕規劃增建醫院增加醫生 應付老年社會需求

本港人口增加、人口老化,故需要興建醫院和有足夠醫護人手應付需求,道理淺顯易明,但是,過去多年香港並無規劃興建大型公立醫院,而醫生人手持續緊絀。行政會議成員林奮強形容香港醫療體系瀕臨崩潰。食物及衛生局長高永文也認同未來10年,本港短缺2000多張病牀。

林奮強成立的「香港黃金50」研究數據顯示,過去十年,住院病人升8%,但本港病牀數目一直維持約3.5萬張,僅增長1%。隨着人口增長及老化,預測10年後病牀需求升至近4萬張。另外,研究發現本港現有約1.2萬名醫生,已短缺近5%,估計7年後,醫生短缺將增至近20%即3140人,還有40%醫生將於未來20年退休,目前大學每年培訓醫生數目已增至420名,但最快要2020年中才能成為專科醫生。星洲招聘外地醫生應急,本港醫學界則實行「保護主義」。2006年至2010年間,平均每年只有9名外地醫生成功來港執業。醫生不足會影響醫療質素。近年本港醫療事故頻仍,相信與此有關。

本港公營醫療設施和醫生嚴重不足,直接與曾蔭權政府沒有人口政策、沒有長遠規劃有關,以現時港府坐擁約6500億元財政儲備,以這樣豐沛的資源,卻吝於興建醫院,這是對不起香港市民。

高永文認同病牀短缺、醫生不足。我們期望梁振英政府開展長遠規劃,對症下藥,包括增建醫院、增加培訓醫護人員。因為從數據而言,現時每年420名醫科生並未能滿足長遠需求。至於招聘外地醫生應急,期望醫學界從市民整體利益出發,勿再諸多留難。政府則要對市民展示負責任的做法,若醫學界只顧及業界利益,便要考慮收回醫務委員會就招聘外地醫生的審批權。

另一方面,隨着醫療融資最終可能只做到自願醫保,看來曾蔭權政府擴大私人醫療在整體醫療所佔份額的算盤難打響。政府回過頭來,加大對公營醫療的投入,是較可行的選擇,否則醫療體系遲早爆煲。但是,現在公營醫療收費極低,不可能持續,政府應該研議逐步增加收費,要使用者負擔適當比例的成本;公營醫院也應增加一定比例的病牀,供中產人士使用,以成本收費,這類病牀,在私家醫院收費飈升形同牟取暴利下,對中產人士極具吸引力,值得政府考慮。

Glossary

shortfall﹕If there is a shortfall in something, there is less of it than you need or expect.

grudge﹕to do or give something unwillingly

bent on﹕If you are bent on doing something (usually undesirable), you are determined to do it.

明報

2012年9月28日


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