Why Macau spends millions to send its patients to Hong Kong – some by air

Macau resident Mrs Chan visits Hong Kong at least four times a year, for appointments with a dentist, gynaecologist, dermatologist or other medical professional. The public relations officer consults doctors in her hometown only for minor ailments, such as a cold, she says. That’s because medical professionals she encounters in Macau speak Cantonese with a mainland Chinese accent, and that worries her.

“I might see a specialist in Macau, but for a second opinion I always go to Hong Kong. A Kiang Wu gynaecologist told me I needed to get a fibroid removed,” Chan says, referring to the former Portuguese enclave’s largest private hospital. “After getting a second opinion from a doctor in Hong Kong, I had surgery performed there.”

Chan (who does not want to reveal her full name) is typical of many Macau residents, who distrust the city’s hospitals and seek specialist treatment in Hong Kong. The majority of doctors working in Macau’s hospitals are graduates from medical schools in mainland China.

She doesn’t trust them, Chan says, because of bad experiences friends have had in hospitals in China and Macau. Additionally, most people in the city grew up watching Hong Kong soap operas that projected an image of Hong Kong doctors as professional and highly skilled.

Macau has three major hospitals, Kiang Wu Hospital, publicly funded Centro Hospitalar Conde de São Januário, and the University Hospital at Macau University of Science and Technology.

Kiang Wu employs more than 340 doctors, a third of whom are graduates of Zhongshan School of Medicine, while another third trained at Jinan University’s school of medicine; both schools are in Guangzhou. The remainder qualified at other universities in China or Taiwan. Its more than 800 nursing staff earned their certificates in nursing schools at Kiang Wu Hospital, Macao Polytechnic Institute or in China.

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Lei Chin-Ion, director of Macau’s Health Bureau, and Guo Chang-yu, his deputy and president of Centro Hospitalar, are also Jinan University graduates.

Ultimately the problem for Macau is that it simply does not have the infrastructure to cater to the spectrum of residents’ health care needs. It has very few specialists and not a single training school for Western medicine.

Fong Chi-keong, a Macau legislator and president of the board of directors of Kiang Wu Hospital Charitable Association, says the city is too small to warrant dedicated places for training specialists. A government-commissioned study on the feasibility of doing so by University of Macau reached the same conclusion.

“The Macau government says we don’t need to have everything in such a small place, and we can use Chinese and Hong Kong resources. The patients that Macau hospitals can’t handle are sent to Queen Mary Hospital [in Hong Kong],” Fong says.

“There are only half a million residents in Macau and 180,000 of them are migrant labourers who go back to Zhuhai [in Guangdong province] and neighbouring areas at night. And the cost of setting up a medical training school is high.”

Nevertheless, Macau is paying the price, and the cost is rising. The government spent HK$5 billion on public health care in 2014, with the figure jumping to HK$7 billion in 2015.

In 2014, Centro Hospitalar sent 2,000 public patients to Hong Kong for treatment, the most serious cases arriving by helicopter. Such trips overall cost the Macau about HK$200 million a year.

Hong Kong’s Hospital Authority does not keep a record of the number of Macau residents treated at its facilities, a spokesman says. They are classified merely as non-local patients, all of whom pay HK$4,680 per day for a hospital stay, compared with the HK$100 a day paid by Hongkongers.

Fong, who says he has heart disease which he has treated privately in Hong Kong, is full of praise for the city’s professionalism.

“Hong Kong doctors regularly brush up on their knowledge by learning about the latest medical breakthroughs and getting overseas training and exams,” the lawmaker says. “Macau is not like that.”

According to Chan, she and her family would rather put up with the hassle of ferry trips to and from Hong Kong for even basic treatment such as a dental scale and polish.

“Before the handover, we couldn’t communicate with the Portuguese doctors. After the handover, we don’t trust the mainland [Chinese] ones. Hong Kong dentists are more professional,” she says. She has family members who receive cancer treatment in the city.

Chan says Macau’s government’s puts more focus on preventive medicine. “There are public health clinics near where I live that provide free medical check-ups, such basics as blood pressure and cholesterol level. They also teach us how to maintain a proper diet to ward off diseases such as diabetes.”

All Macau residents have access to free health services, including diagnosis and drug prescription, in public clinics across the city. Those who can afford more personalised care can turn to Kiang Wu Hospital or a number of private clinics. However, top-notch specialists are hard to retain.

Liu Bolong, a professor in the department of government and public administration at the University of Macau, says: “A major flaw of the Macau health system is relatively backward treatment for major illnesses and low quality of specialist medical care. We suggest the University of Macau set up a medical school and recruit academics, professors from mainland [China] and around the world, allow them to teach in Macau and serve as consultant specialists at Centro Hospitalar Conde de São Januário.”

Ma Hok-cheung, director of Kiang Wu since 2014, is the first doctor from Hong Kong to head the private hospital. The University of Hong Kong graduate is a former chief executive of Ruttonjee and Tang Shiu Kin Hospitals in Wan Chai, and of Caritas Medical Centre.

Since patients with serious diseases are sent to Hong Kong for treatment, specialists in Macau experience few such cases, he says. “For example, we may only see a case of leukaemia once every five years.”

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Ma hopes his background will help Kiang Wu introduce best practices from Hong Kong.

“There’s a lack of a uniform government accreditation system for specialists in Macau. We just randomly call our doctors specialists in heart or other disciplines. In Hong Kong, there are specialist colleges such as the College of Radiologists. You have to pass certain exams before you can call yourself a specialist,” Ma says.

Kiang Wu sends its doctors to Hong Kong, China and Taiwan for internship training, he says. “At Kiang Wu, every doctor who receives specialist training must also spend a year training outside Macau. If they are master’s or PhD graduates from mainland [China}, they’re only required to do such outside training for six months. Clinical PhD graduates can be exempted.”

Specialists recruited by Kiang Wu from mainland [China} already have an established reputation, Ma says. “For colleagues who apply for promotion, we invite mainland [Chinese] experts to sit on the adjudication board. The adjudication process is rigorous and fulfils international standards.”

In an e-mailed reply to queries, the Macau Health Bureau said it had signed collaborative doctor training agreements with authorities in Hong Kong, Beijing and Guangzhou. The bureau defended its approach to health care.

“Jinan University in Guangzhou has trained many medical graduates for Macau each year, making a great contribution to the development of Macau’s health service. The World Health Organisation ... has praised Macau’s medical system for its wide coverage and high quality, and for serving as an important reference and inspiration to other cities .... The average life expectancy of Macau residents is among the highest in the western Pacific region.”

If Macau residents are cautious about consulting doctors from China, visiting Hong Kong medics may not be the solution in the future. Their fears are beginning to have echoes in Hong Kong.

In February, the government submitted the Medical Registration (Amendment) Bill 2016, proposing the introduction of more lay members to the Medical Council of Hong Kong – which monitors the professional conduct of doctors – without increasing the number of members from the medical sector. Critics worry the government is trying to make it easier for non-local doctors, including those from China, to practise in Hong Kong.

Passage of the bill was delayed in the Legislative Council earlier this year, through filibustering and the lack of a quorum. The measure is due to be debated in the next legislative session.