On paper at least, Hong Kong’s got a great public health system. There’s a huge network of hospitals and clinics throughout the territory and if you’re carrying a Hong Kong ID card, costs are crazy low. However, my experiences with the system have been mostly very negative. It’s not the quality of the staff or the equipment; I believe it’s because they’re so incredibly over-worked that there is often no time to think properly or get things right. If you’ve ever wondered why a city with almost-free medical care also has a large network of expensive private doctors and hospitals, it could because those who can afford to do so prefer to pay and get taken care of properly rather than get shoddy care for free.
My girlfriend spent the day at Tseung Kwan O Hospital today. Tomorrow she’s getting minor surgery and they asked her to come in today for some preliminary tests. I dropped her off at the hospital at 8:30 this morning. ”Should I wait for you?” I asked. ”No, just go home, I’ll see you later.” By 6 PM tonight, all they’d done was take her blood pressure three times and then tell her to go home and come back the next day.
Three years ago I got really sick. I was running a fever that just wouldn’t go away and I had no appetite. I must have gone back and forth to the Tseung Kwan O Hospital at least 4 or 5 times. Each time I saw a different doctor, each time they took my blood pressure and temperature and told me I had the flu and gave me dozens of pills. And each time, I didn’t get better. Finally I said the hell with it and went to a private doctor who spent 15 minutes talking to me and looking at me before ordering some blood tests which showed that I had hepatitis. How many more times would I have had to go back to TKO before they would have sorted that out?
Actually my first bad encounter with a HK public hospital was back in 1995, my first year in HK. One of my regular hang-outs back then was a bar in Causeway Bay called China Jump. Located in a high floor in a shopping mall, this place would get really packed on weekend nights. They had a barber chair – you could sit back in that and have them pour booze straight down your throat or just lie on the bar and have the bartenders go at you.
One night, coming off the dance floor, I got pushed, my foot got stuck under a stair and my ankle got twisted. I could barely walk and tried to stumble my way back to our table. One of the bouncers spotted me – he didn’t offer help, he assumed I was completely wasted and tried to get me to leave the bar. ”I’m not drunk,” I shouted above the music, “I’m in pain. I just need to get back to my table and sit for awhile.”
I must have gone home around 1 or 2 AM that night. I woke up at 4 AM, completely in pain, my ankle swollen to more than twice its normal size. I tried to stand and couldn’t and realized there was nothing I could do except call for an ambulance. I dialed 999 and they came pretty quickly. They looked at my ankle and advised me to go to the hospital and I quite readily agreed. They strapped me to a stretcher – but the building I was living in had such a tiny elevator that they had to stick me in the elevator vertically, still strapped to the stretcher.
At the hospital, they looked at my ankle and pronounced it sprained but not broken. They told me to go home. I said to them, “Wait a minute, I can’t walk. Can I get a cane or a crutch or something?” Nope, sorry, that department doesn’t open until 9 AM, I’d have to come back. ”Can I get someone to bring me to a taxi in a wheelchair?” Nope, sorry. I had to hop for what seemed to be at least 100 yards to get out of the hospital and out to the street to try to get a taxi at 5:30 AM. At least the taxi could let me off in front of my building. Later, I had to hop back to the hospital again and got a pair of crutches and someone spent a minute with me showing me how to use them.
It wasn’t a matter of life or death, but it was extremely painful and just frustrating that this was their way of dealing with the situation. And it’s a memory that’s stayed with me – as has the memory of trying to walk around Causeway Bay on crutches – even in 1995 it was so busy there that people would bang into someone on crutches just because they were in a hurry and they’re important and you’re not (and it wasn’t like today when everyone walks into everyone else because everyone looks at their mobile phone when they’re walking now).
I still use the public hospitals from time to time. The doctors and nurses there are really nice. There’s always at least a 2 hour wait in the emergency room and the lone clinic in Sai Kung can get booked up days in advance. I just wonder why, in a city that has such massive reserves of cash, they can’t get the system to work a bit better.
UPDATE: So she stayed in the hospital from 8:30 AM to 6:30 PM and they checked her blood pressure 3 times and did a urine test once. When she finally asked what was going on, she was told that they were keeping her in the hospital over night. ”But the doctor yesterday said I didn’t need to stay over night.” ”Oh, it’s a different doctor today, we don’t know anything about what the other doctor said.” So they had to call him and check. So their systems are so poor that they can’t provide any continuity in treatment from one day to the next? Or was it just that yesterday’s doctor couldn’t be arsed to get everything into the system? We’ll never know.
If the healthcare system was good more people would want to (& enjoy) using it.
Obvious – treat ‘em like shit & they won’t come back (for one reason or another).
Nothing about hospitals but pictures you might like:
http://www.spiegel.de/fotostrecke/lumix-festival-fuer-jungen-fotojournalismus-fotostrecke-83592.html
“Why doesn’t this almost free, universal, cradle to grave comprehensive healthcare system work the way I want”? \\sorry to be sarcastic but this looks a little like a ‘first world problem’ you have here.
In your first example you use primary care at a hospital – it’s not really set up for that and there’s a huge network of local, relatively cheap ($200- $500) private doctors everywhere in HK for that. The Hospital Authority is more for A&E and more complicated engagements. We have been referred back to the public system for some things and the service has been nothing but exemplary. In 17 years in HK I have used both sectors for my family and myself and I honestly, hand on heart, would choose the public system for its resources, staff and care.
Both of my kids were born a la local in public wards and the first one was an emergency c-section with complications – that would have run me 200-500k if we had gone private – it was $1600 for mother and child after a week or so in baby intensive care. And the staff – busy, overworked and crowded (at that time) with mainland mums were, even to this hard bitten atheist cynic only describable as ‘angels’.
As you point out we are lucky in HK to have a plethora of choice for healthcare in HK. Not everyone can afford private care (or is insured as such) and so putting up with a delay here and there isn’t too much of a hardship. The systems the doctors use I know (because of my job) are the best in the world for their scale. I suspect there is an element of truth to the comment above about reducing demand as doctors are expensive resources – but it is NEVER at the cost of patient wellbeing as far as I can tell.
No it isn’t perfect but in the world of healthcare compared to say, the US or the NHS in the UK, it’s a beacon of hope for what can be achieved. One’s health and the ensuing stress when it’s not good is horrendous anyway and I am thankful I have the choice and that the ‘public’ choice is probably the best in the world.
I wish you all health.//rant over.
M, I get your point but I have to disagree. “Why doesn’t this almost free, universal, cradle to grave comprehensive healthcare system work the way I want” – I don’t think that’s an unreasonable question considering that I was misdiagnosed and suffering. This wasn’t an inconvenience or a long wait in a waiting room, this wasn’t an incompetent doctor. This was a series of overworked medical staff trying to dispense with each case as quickly as possible because that’s the way the system functions. I will happily admit that with all its faults it is superior to what takes place in the US. That doesn’t mean it can’t be further improved.
Got to agree with M above. We are no longer in Hong Kong but have some experience of the healthcare system in Europe and Middle/Far East. We had an almost identical situation as described by M a few years back and the staff and facilities (and cost) of the Queen Mary were exemplary. Yes it was a little rough and ready (and the wife had to get used to the congee and canto soap operas) but in terms of care and cost this particular part of the HK healthcare system was terrific. No doubt there is room for improvement as with all government sponsored healthcare regimes throughout the World but in terms of organisation and value for money HK is close to as good as you are likely to get.
I seem to remember one of your commentators (not me) on here telling you it was probably Hepp before you were diagnosed. You wrote a few posts about it.
Re, the usa. I read recently about patients getting accessed by debt collectors before they even get in the hospital. Any outstanding medical bills means no treatment. What a backward country in this respect. Drunk of capitalism.
Anyway hope the GF is ok.
Yes I understand what you mean – everything can be improved, of course and we should always strive for that. I think HA has improved – my first time paying in a hospital took hours – last time 10 minutes, and I think it will continue to improve across the board.
My point really is what are you striving for? It’s already the best in the world. Public healthcare is fiendishly complicated – too good and no private sector (and tax payers pay innefficiently for it), too bad and, well, we know what happens there.
Maybe Singapore has a better system? I don’t know. I do know this one and while it has its imperfections, I can think of loads of better uses for my tax dollars than improving something, that frankly, is already world beating. Especially when there are other options. But then no ones fucked up my diagnosis yet and I bet that makes a difference in perspective.
PS: Keep the film reviews coming. V good. I always mean to comment on them but by the time I’ve also seen the film the moment has gone.
Dude, that’s hyperbole worthy of James Tien. First it’s the best in the world and then you ask if maybe Singapore is better but you don’t know. There’s cleaner ways to make your point.
I’ll gladly cop to it being ONE of the best in the world but it’s not THE best and given the reports that show up regularly in the papers about people getting transfusions with the wrong blood type (just two days ago a report of a patient receiving a transfusion with improperly stored blood – and there should have been an alarm going off when the refrigerator malfunctioned except the alarm had “not been connected properly”) or getting the wrong kidney removed or pulling a squid out of a foxy archaeologist (oops, wrong thread) there is plenty of room for improvement and there’s so many billions in surplus that it wouldn’t take raising taxes to do it.
BTW, perhaps our paths have crossed in the past? I did a bit of IT consulting at HA back around ’95 or ’96.
Hyperbole: guilty as charged. Should read ‘one of the best IMHO’. As for the HK press….I’m sure they stick the boot in and I honestly don’t know if HK is worse or better than anywhere else for fuck ups. My favourite was when they attached some poor dialasys patient to an air con and killed him. Mistakes happen – would be interesting to find out actually if there’s a league table of that sort of thing.
But if I’m spending the tex dollars – a whole new conversation – environment, social welfare, attracting more businesses to invest, housing, elderly care (over and above a social welfare safety net), education….they would all be way above on my list.
We shall agree to disagree – and I wasn’t at HA, just an external party impressed by what I saw there 2005-6 ish.
Yep, agree to disagree.
And just to be fair – for anyone who looks at the comments and such – my gf spent the entire day in the hospital. Had a procedure (not going into details on it), general anesthetic, a day in the ward recovering, bags of antibiotics and painkillers, and the whole shebang cost HK$150 (that’s about US$22.50).
I suppose that while I have this dislike of HK hospitals, by comparison the US medical system has its head up its butt. When the system works here, it really works. When it works in the U.S. – wait a minute, does it ever work there?
Most of the Honkie doctors are useless. The nurses are excellent.
Hmmm… where to start… I have generally nothing but praise for HK’s Public Hospitals, or to be more precise PMH in Lai King. I have had recurring Cellulitis on my right leg for a few years and was only properly diagnosed there after many visits to private doctors came up with all manner of shite from DVT to Gout.
Anyway when I was admitted for this in May ’07, there were a whole array of tests done and they found out I was anaemic in a bad way. “Too bad for a (then) 39 yo male”. So I was invited back for an Endoscopy, which is one of the most uncomfortable procedures you can have whilst awake. 2 of these were negative so they asked me back for a Colonoscopy. That’s when they found I had Colon Cancer.
All of this was done been May and August, which was pretty good going for anywhere on the planet, especially in comparison to the NHS in the UK, which would have been a year or more wait for the 1st procedure.
Between finding out I had cancer and a successful operation was 10 days!!! That is fairly good going by most standards. And then 30 weeks of intravenous Chemo followed from November ’07 onwards.
I was out of pocket for all of this to the tune of approx. HK$5000, or US$640 – again a very fair price for all the procedures, including major invasive surgery. Work insurance paid me back for all of it.
So maybe these things balance themselves out over the territory. For every poor experience, there’s a good one?
Niall – that’s great that they caught this in time and that it was successfully treated. Congratulations!!! Of course I don’t believe my experience was anything more than my experience.