7-1: the numbers game
Blown away

The doctor will see you now

Having lived in Britain for many years, I was thoroughly indoctrinated with the line that the National Health Service (NHS) is the best healthcare system in the world, and when I went on holidays overseas I worried that if I fell ill I might have a very expensive brush with a local system that imposed charges. In the UK you don't have to pay to see the doctor (though many people do have medical insurance so that they can see a specialist more quickly and be treated in a private hospital).

Now I have lived in Hong Kong for several years I am quite accustomed to the idea that if you want to visit a family doctor (GP) you have to pay. Many people can them claim the cost back from their employers, but if you don't have that benefit and can't afford to pay out of your own pocket then there are public clinics (I think they do now charge, but much less than private doctors).

In Hong Kong you can visit any GP you wish, and you pay for each consultation, but the UK system is much less flexible. Patients using the NHS (which is 99% of the population) have to register with a local GP. The doctor is then paid by the government based on the number of patients on his or her books (without taking account of how many times a year the doctor sees the patient). Except in an emergency you cannot visit another GP, and if you move house you have to transfer to another doctor near where you live. However, you may find that the GP you prefer already has the maximum number of patients and cannot accept you, though you may be able to choose another doctor in the same practice.

That's another difference - most doctors work in a group practice, sharing the cost of the building, and the admin and nursing staff, and on any given day only some of the doctors will be available for appointments. Ah, yes, appointments - in the UK you probably have to book up to see the doctor a day or two in advance, whereas the few Hong Kong doctors who operate such a scheme will usually offer you an appointment within an hour or two of when you call. Mostly you just turn up and wait, which is how it once was in the UK.

Plus, in Hong Kong you can see a doctor at more convenient times. Saturday afternoon? No problem. Sunday morning? The doctor is there waiting to see you. Not like the UK, where doctors usually have a morning and early evening surgery, and if you want an urgent appointment you have to convince the receptionist that it's vitally important. However, the doctor also has to provide 24 hour emergency service, but they often sub-contract this service or else a group of doctors will share the responsibility.

Frankly, I don't know how Hong Kong GPs cope with the hours they work, especially as most of them operate independently rather than in group practices.

The biggest problem with Hong Kong's system is that many doctors seem to operate an assembly line system for dispensing pills and potions, as explained by Hong Kong GP Brian Walker (in Spike):

Now, everybody knows that if you want to cut costs of medical care, all you need to do is visit a local GP who implements a three-minute-visit/five-bags-of-pills policy. This is an excellent local approach to healthcare, combining, as it does, elements of economic stimulation for the pharmaceutical industry together with population control by means of culling weaker individuals.

There's no doubt in my mind that most doctors in Hong Kong prescribe too many medicines and don't spend enough time listening to their patients to find out what is really wrong. Until quite recently this often included giving antibiotics for the common cold and other viral infections, with the very unfortunate effect that some bugs have developed resistance to many antibiotics and are much more difficult to treat. Fortunately this particular aspect of prescribing does seem to have been changed, but they still give out too many medicines.

My feeling is that this happens mainly because patients demand it. They feel dissatisfied if they leave without several bags of pills, and the mark of a "good" doctor is that they give good medicine to their patients. Brian Walker's point about cutting costs is also relevant - doctors can't afford to spend more time with each patient without increasing their charges, and if they did that they would probably lose business.

One interesting difference compared to the UK is that here you normally get your medicine direct from the doctor, and are usually only given a few days supply. In the UK, the doctor would give you a prescription to take to a nearby pharmacy, where you (normally) have to pay the 'prescription charge' before you can pick up your medicine. The charge is fixed by the government, and doesn't take account of the cost of the medicine - you pay the same amount regardless of what you have been prescribed. Certain groups such as children and the elderly don't have to pay at all, and if you need regular medication you can buy a 'season ticket' to cover all your prescriptions, which limits the cost.

In Hong Kong, doctors can give you a prescription to take to the pharmacy, but you then have to pay for the medicine. Interestingly, the prices vary considerably (whereas in the UK I think they still have resale price maintenance), so it's worth shopping around to find the lowest prices. Or if you like paying high prices, I can recommend Watsons and Mannings.

In the UK, the current hot topic with regard to the NHS is choice, and there's no doubt that we have much more of that here in Hong Kong - as long as you (or your employer) can pay. However, I am not convinced that having a choice is much of an advantage. Most people don't really want to choose their doctor, and don't have the specialist knowledge to make an informed decision. What they do want is to be able to see a doctor when they need to, and to receive the best possible care. In Hong Kong most people can see a doctor almost whenever they want, no matter how trivial the problem, but I am not convinced that they get the best possible care.

Comments

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John Doe

Doctors either have a financial incentive to over-treat, or a financial incentive to under-treat; pick your poison.

Here is a thought: whichever system produces the most rapid improvements in medical technology is really the best, since technology ultimately dwarfs all other determinants of health care quality.

Chris

I'm not sure I totally agree. Most visits to the doctor are for minor illnesses, and in many cases these do not require expensive medicines or any medical technology, just common sense.

Tom

I,m trying to find a web address for either Watson,s pharmacy or Manning,s pharmacy for international delivery. Does anyone have these?

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