HongKongEcho: One hospital, two systems

Combine the best of Hong Kong and mainland China to create a model hospital. Across the border in Shenzhen, Professor Chung-Mau Lo is at the helm of a project trying to do just that.


 

“On most days, you can easily see Hong Kong from here,” remarks Professor Chung-Mau Lo as we take in the view from his seventh-floor office at the University of Hong Kong-Shenzhen Hospital.

A swift 15-minute drive from the Lok Ma Chau border crossing in Shenzhen, this state-of-the art public hospital which opened in 2012 is – in fact – managed by the University of Hong Kong (HKU).

The peculiarity doesn’t escape Lo, who is one of Hong Kong’s most prominent surgeons and Chief Executive of the hospital. “My friends keep asking me what on earth I’m doing here,” he says with a slight grin.

The answer, he explains, lies in an opportunity. Impact the quality of healthcare for over a billion people and expand Hong Kong’s own already-significant training, research and teaching capabilities.

Professor Chung-Mau Lo, Executive Director of the University of Hong Kong-Shenzhen Hospital

Seeing red

“Our idea was to bring the quality of Hong Kong’s system, through our management, as a way of creating a model for other public hospitals in Shenzhen to follow,” says Lo.

Corruption, patient-on-doctor violence, rampant over-prescription of drugs; the existing problems of China’s public hospital system are clear.

Taking a stroll through the hospital’s mammoth central atrium, a quiet, plant-filled space that feels almost mall-like with its maze of escalators, it’s hard to imagine that a trip to a public hospital in mainland China can often be a chaotic affair.

Typically it means waking up at the crack of dawn to queue with dozens – if not hundreds – of others to get a handful of (not-so-private) minutes with a doctor.

As a fix, Lo and his team implemented a booking system, but patients simply wouldn’t come. “Even those who made appointments would come early and try to get in first,” he laughs. “We took the time to educate people and I’m glad to say now it works well – the Shenzhen government has rolled it out across all hospitals in the city.”

Likewise, the hospital faced similar resistance from patients in stamping out red packet payments.

In mainland China, a doctor’s fixed salary may make up only 30% of their income in some hospitals, according to Lo. Red packets and incentives for prescribing drugs may make up the rest. “We cut out these incentives and instead raised the fixed salary of doctors to discourage these temptations,” he says.

Patients are spread across an enormous total floor area of 367,000 sqm making for a quieter experience
than your average public hospital.

Endemic violence has also plagued the sector. With no official avenues for complaints and little in the way of credible insurance, it’s not unusual for patients to take matters into their own hands and seek retribution from doctors directly.

“We introduced a patient relations office right in the middle of the hospital to create a constructive dialogue with patients,” he says. Medical indemnity insurance also means there can be compensation following complications.

“The point is you can’t simply outlaw these things without improving the context of why they occur in the first place.”

 

The cost of change

It’s lunchtime when our tour takes us to the hospital’s pharmacy. Rising above the quiet is the crisp buzz of the pharmacy’s robotics system which distributes medications to pharmacists through barcode recognition. “Here, speed is everything,” says General Manager of the Pharmacy Department, Bill Leung, a Hong Kong local with decades of experience practicing in the UK and Hong Kong.

Treating some 7,000 daily outpatients means efficiency is a priority. “We’ve cut down the distribution time for medications to around 10 minutes,” he says.

German robotics technology in the hospital’s pharmacy helps to automate the distribution of medications.

Such advances, of course, cost money. “Balancing the budget is a headache,” admits Lo in between one of his lengthy strides. HKU simply operates the facility, he emphasises, and the hospital itself doesn’t receive additional funding compared to Shenzhen’s other public hospitals.

“We’ve introduced a ‘packaging’ model for pricing,” he says. Other public hospitals currently charge a basic 10 RMB fee for a consultation which is set by the government. “It’s ridiculously low. Hospitals can’t be profitable so doctors overprescribe or run a plethora of unnecessary tests at extra cost.” IV drips for common colds, for example, have been eradicated with the Guangdong Health Bureau following the hospital’s lead in 2016 by issuing a directive for all hospitals to stop the practice.

Lo and his team have instead introduced consulting and inpatient packages which cover the most common services as way of creating a price ceiling. “Again, in the beginning nobody came because they thought we were so expensive. Over time they see that, actually, you don’t end up paying all the additional costs.”

Similar packages are offered for common surgeries, which also often incur hidden costs. “For our own budget, all these changes make us more efficient – there’s far less wastage.”

Meanwhile the plush private wing – we noticed a soon-to-be-opened Starbucks at its entrance – adds a complementary revenue stream (about 12% of total income) for those looking for a higher level of service, most notably Shenzhen’s rising expatriate population.

Block V: A plush private wing of the public hospital which accounts for 12% of income.

A unique opportunity

These are admirable advances, but Hong Kong is in the midst of its own shortage in public sector doctors and questions have been raised about why HKU is putting so much effort into a Shenzhen-based project.

“It comes down to HKU’s mission to bring impact through innovation, internationalisation and an interdisciplinary approach,” says Lo who remains employed as a professor and continues to practice part time in Hong Kong. It’s the same case for the other 200-plus Hong Kong doctors who are shuttled back-and-forth between the cities.

Over 2,000 HKU students have visited the hospital for training since 2017, he adds. “The variety and severity of cases we come across at this hospital is far more beneficial from a teaching and research standpoint.” Certain rare diseases which may only account for a handful of cases every year in Hong Kong can be found in the hundreds in Shenzhen.

“It’s not just a unique opportunity for Hong Kong to advance its medical expertise. The changes we’ve been driving are beginning to take hold – they’re no longer that unusual. For us, that’s a huge opportunity to impact even more people in a positive way.”

Useful links

HealthCare and Insurance HongKongEcho: The new insurance paradigm HongKongEcho: A new vision for research in Hong Kong