2 August 1997

Long term health financing policy
the only solution for doctor oversupply problem

(Keywords:- manpower needs, unemployed, student intake)

          This week sees the town and gown factions of the medical fraternity at loggerheads with one another over the issue of manpower needs in Hong Kong now and into the future.

          The town, represented by the Hong Kong Medical Association, maintains that Government projection of having 13,000 doctors by the year 2010 indicates an oversupply. In a rare show of solidarity, the two local medical schools rebut and claim that there is still an under-supply, citing the long queues of ¡§awaiting to be treated¡¨ patients.

          To the public the wrangle is obvious: private practitioners are worried of ever increasing competition; the two medical schools are concerned with budget cut should there be a reduction of medical students!

          The root of the matter surfaced when some 88 medical graduates were unable to secure permanent jobs with the public medical service upon completion of their internship this summer. Needless to say, the problem is far from being ad hoc for if the current health care system remains status quo, it will haunt this community in the years to come.

          The pragmatics will say ¡§tough luck¡¨, no country can guarantee jobs for all its graduates; not for engineers, not for accountants and similarly not for doctors. Yet, it takes $3.5 million to ¡§create¡¨ a doctor through medical school. If that professional is not contributing back to the society with his/her gained knowledge, it amounts to discarding taxpayers¡¦ money down the drain!

          It is thus on this basis that the Hong Kong Medical Association suggests that there should be reduction of medical student intake to ensure that future graduates will be able to engage his/her time with the job that he/she is destined to perform.

          The irony, of course, is that whilst doctors remained unemployed, patients are waiting in long queues for treatment at public medical institutes. Yet is increasing doctors in public institutes the be all and end all solution? Increasing the number of doctors will definitely speed up the turnover. Regrettably the benefit will only be short lived. For with the irresistible attraction of public medical services ($68 per day inclusive of all treatment), the queue will double and triple in no time. It may be argued that Government should be asked to spend more on health care. Yet, unless the public is willing to shoulder infinite tax rise for health care, there has to be a limit of how much of the total public coffer should be invested in health care, balancing the needs of other areas of government spending. The insatiable appetite of the public in public health care under the current system could never be fulfilled.

          Whilst the need to further increase our public health facilities should be considered in the face of our booming economy, the way to decrease the long waiting list in public hospitals is by a workable health policy and health charging policy. Government must have a political will to determine the extent of the provision of heavily subsidized medical services; over and above which health care becomes services for which payment is required and for which those who could afford must pay more. This should be considered in line with introduction of a territory-wide compulsory medical insurance scheme. It is only through such a reviewed system that those who could afford will be channel back to the private sector, shortening the never ending queue for the real needy. Government has procrastinated long enough. It is time to act.

          As a short term measure, student intake by the two medical schools should be reduced to balance the manpower demand. There is no reason why the budget originally allocated for a full quota of medical students could not be redeployed for post-graduate training or research, in the same way of our Dental School which had to cut its student  intake in 1990. Such a reduction must, of course, be done with flexibility. Basing on societal needs, the actual number of student intake could therefore be regularly adjusted.

(Hongkong Standard)

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