Healthcare

(English Version Only)

Doctors

The number of health care workers in Hong Kong has tripled in the past two decades. Statistically, there are about 1.6 doctors per 1,000 population. About half of the doctors work in the private sector, with 95% in solo practice. There are two medical schools in Hong Kong, at University of Hong Kong and Chinese University.

Unlike in North America, where medical degrees are graduate degrees, medical education in Hong Kong is modeled after the system in the United Kingdom, where the MBBS medical degree is granted after five years of undergraduate study. Hong Kong graduates are eligible for registration (license to practice) after one year of internship.

The level of physician competence in Hong Kong, like elsewhere in the world, is highly variable. In the public sector, junior doctors are theoretically under the supervision of more senior doctors and consultants. These junior doctors function in a similar way to interns and residents in the North American system, but with arguably less direct supervision or an organized curriculum.

A range of skill and qualification is also seen in the private sector. Some doctors choose not to further their medical education and start private practice as soon as they are licensed. Others remain in the public sector, or leave to begin private practice only after they have gained further experience and are qualified ‘consultants’.

There are many doctors in private practice who received their medical education outside Hong Kong. Some of these doctors have had minimal formal training; others have studied in the finest institutions in North America and Europe, with superior training and clinical experience.

Fees charged by private practitioners in Hong Kong vary, usually from $200 to $450 or more for a specialist consultation. In some cases, these fees include the cost of medicine, but separate charges are often made. Patients also have to pay extra for laboratory tests, X-ray examinations, etc. Separate charges are usually made for investigations and the cost of medicines.

Home visits are generally more expensive, but many doctors keep their clinics open after ordinary office hours to suit those who cannot attend during the day. If you have been recommended other than basic medical treatment, you should request, in writing, an itemized list of required consultations, tests and treatments, and their charges.

Medical Fees

Fees in public hospitals and clinics are heavily subsidized. Patients in general wards of public hospitals are charged HK$68 a day. This is an all inclusive fee, covering treatment, medicine, surgery, tests, accommodation and food. Some private beds are provided at major hospitals with higher maintenance and treatment charges.

A consultation at a general out patient clinic is charged at $45, while a specialist consultation is charged at $100 for first consultation and $60 per session. Attendance at geriatric or psychiatric day centers and home visits by community nurses are charged at $55 per session. Fees may be reduced or waived in cases of financial hardship.

Subsequent to the release of the Consultant Document on Health Care Reform in December 2000, a comprehensive review of the existing fees structure in the public health care sector was commissioned. Objectives of the review were to better target and prioritize public subsidies to areas of most needs, ie, lower income groups and services that pose major financial risks to patients.

While it would reduce the inappropriate and misuses of public medical services, the revamped fees structure will remain affordable to the general public and a safety net will be in place to ensure that the poor and needy will continue to receive adequate medical treatment. The first step has been to introduce a $100 minimum emergency room charge to discourage casual users and those who used the formerly free service to avoid consultation fees.

Hospitals

A complete roster of private and public hospitals may be found in the latest edition of The Medical and Dental Directory of Hong Kong, which is published by the Federation of Medical Societies of Hong Kong. The directory also describes the services available at each facility as well as referral and admission requirements. Transparency is not a local medical profession virtue. It is available only to doctors at $580.

Government hospitals are organized on a regional basis. Major government hospitals on Hong Kong island are Queen Mary Hospital (Pokfulam Rd, HK; Tel: 2855 4111) which is affiliated with University of Hong Kong, and Pamela Youde Eastern Nethersole Hospital (3 Lok Man Rd, Chai Wan, HK; Tel: 2595 6111); in Kowloon: Queen Elizabeth Hospital (Wylie Rd, Kln, Tel: 2710 2111); New Territories: Princess Margaret Hospital (6 Princess Margaret Hospital Rd, South Kwai Chung, NT; Tel: 2742 7111) and Prince of Wales Hospital (Ngan Shing St, Shatin, NT: Tel: 2636 2211). The Prince of Wales Hospital is affiliated with Chinese University of Hong Kong.

There are many private hospitals. Most popular among expatriates are Hong Kong Adventist, Matilda and War Memorial Hospital, and Canossa Hospital. Other private hospitals (eg Hong Kong Sanatorium, Central and St Paul’s on Hong Kong Island, and St Teresa’s Hospital, Tuen Mun Adventist Hospital and Baptist Hospital in Kowloon) cater mainly to local and Chinese-speaking patients.

All private hospitals require a referral from a doctor with staff privileges for admission. In addition, a deposit or a letter of guarantee from an accepted insurance company or an employer is necessary. Private hospitals also usually ask that bills be either settled every three to five days or as arranged prior to admission.

Charges for hospital fees vary from HK$640 a day for a bed in a general ward to $3,000 or more for a first-class ward. Patients have to pay for all services, such as medicines and dressings, besides the daily attendance fees of doctors.

Most doctors have admitting privileges to several private hospitals and their decision to admit patients to a given institution is based on a number of factors: convenience, patient preference, special facilities.

Routine Outpatient Care

While the health care delivery system is different than in other parts of the world, patients can get very good medical care in Hong Kong. For a number of reasons, expatriates would probably be more satisfied by seeking medical care in the private sector.

Establishing a good relationship with a primary care doctor is very important, because this physician should act as the patient’s advocate to secure the best possible medical care and to provide continuity. Knowing your doctor before an emergency arises is always most desirable. During routine visits, patients need to clarify with their primary care doctor the protocol that should be followed for afterhour problems or emergencies.

Patients should choose their primary care physician carefully and preferably on the basis of their qualifications. In the United States, American Board certification is an important indication of a high level of competence, gained only after a prescribed period of training and evaluation. Until recently, there was no analogous system in place in Hong Kong.

Amid some controversy, the Hong Kong Academy of Medicine was founded in part to accredit physicians and establish a specialist register. Choosing a physician with the qualification of ‘Fellow of the Hong Kong Academy of Medicine,’ may provide some assurance that the physician is properly trained and qualified. For

For elective surgeries, it is always a good idea to get a second opinion regarding treatment options and cost. One option to consider might be to have an elective procedure performed in the United States or home country. Another is to investigate international “health tourism” centers in Thailand, India and the Philippines that offer high standards of care at low costs. For specific recommendations and advice, consult your primary care physician.

Emergency Care

A little preparation helps a great deal during the frenzy of an emergency. Frustrations with language barriers heighten during a crisis. Non- Chinese speaking expatriates would be wise to keep a card with emergency instructions in English and Chinese (‘In case of emergency, please contact...’) and information about medications and allergies with the Hong Kong identity card.

Domestic helpers should be given explicit instructions on what to do for emergencies at home. Some private hospitals, such as the Hong Kong Adventist, and both YMCA/ YWCA and St John’s Ambulance Service offer First- Aid courses for domestic helpers. Practice drills are a good idea, especially for domestic helpers in charge of young children or whose English may not be fluent and who do not speak Chinese.

If the situation is urgent, but not life threatening, one should either report to a hospital emergency room or contact his or her primary care doctor. If in doubt, one should call or proceed to a hospital emergency room. Patients or their families may ask the resident medical officer to contact the primary care doctor.

For extreme emergencies, one should call 999 and the Government Ambulance Service will respond quickly. The ambulance may take the patient to the hospital of his or her choice or to the nearest regional public hospital which offers 24-hour emergency services.

Ambulance Service

There is no private ambulance service in Hong Kong, only the Government Ambulance Service and St John’s Ambulance Service (a subvented government organization). The Government Ambulance Service is part of the Hong Kong Fire Department. St John’s Ambulance Service can be summoned by calling their telephone number directly: Hong Kong: 2576 6555; Kowloon: 2713 5555; New Territories: 2639 2555. However, some of its ambulances have little equipment and crew members are not trained paramedics.

Only in recent years has a cardiologist in Hong Kong begun a program to train ambulance crews how to administer CPR. An internist who was with her patient, when an ambulance was summoned for a cardiac arrest at home, was horrified to find no intravenous fluids or emergency drugs to administer to her patient en route to the hospital.

Despite some difficulties and deficiencies, in an emergency it is wiser for a patient to call for an ambulance than to try to drive to the hospital himself, arrange private transport, or flag a taxi.

Dental Care

The level of dental care available in Hong Kong is very good. The University of Hong Kong has a school of dentistry. There are also many dentists with overseas experience and qualifications. Hong Kong Dental Association website: www.hkda.org provides a list of registered dentists in Hong Kong.

Optical Care

Hong Kong’s many opticians can grind lenses, provide soft and regular contact lenses, and have all varieties of glass and plastics for lenses, as well as frames from all over the world. The prices, especially for frames, are very reasonable. The quality of prescription lenses is highly variable. Be certain that lens boutique staff who test your eyesight are qualified to do so and not just retail clerks selling fancy frames.