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Hong Kong and U.K. - “A Tale of Two Health Systems”

Dr Chan TC Howard

Medical Officer, PWH A&E

"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”- Charles Dickens, A Tale of Two Cities

It has been several years that I started working as a doctor in Hong Kong. After obtaining my medical degree in the United Kingdom, I underwent my postgraduate training in varies parts of the country, with the exposure to the field of emergency medicine. I was once offered a post by the Hospital Authority (HA) of Hong Kong, which was working as a doctor in the Accident and Emergency Department at the Prince of Wales Hospital. The post was originally created as part of the programme for manpower relieve in the public healthcare sector. As a result I was appointed to work as a doctor in PWH under limited registration with the Medical Council of Hong Kong.

The healthcare system in Hong Kong is somehow similar but yet different from the system in U.K., despite Hong Kong was under British administration. The healthcare system in the U.K. is within the National Health Service (NHS), which is mostly funded by the U.K Government. Consultation payment in any emergency department within the NHS is usually not required, but payment might be necessary for certain non-emergency prescriptions. Healthcare service in Hong Kong is provided by public as well as private systems. The public healthcare system is partially funded by the Hong Kong Government, and patients attending any emergency department in the government hospitals are required to pay for the service. However, this amount of payment has covered all investigations and prescribed medications within the emergency department.

The working system in Hong Kong shares certain similarity in the U.K. as all patients are initially assessed in the triage station. They will then be categorised accordingly depending on the seriousness of their clinical presentations. Most of the patients attending emergency department in Hong Kong will be seen by doctors after their initial triage assessments. However, the practice is not the same in the U.K. as not every patient is acquired to be seen by a doctor. The decision of providing appropriate treatment in the emergency department in U.K. is based on initial clinical assessment and national guidelines. If a patient presents with non-critical condition and does not require to be treated by a doctor, the patient can then be seen and treated solely by an advance nurse practitioner. Advance nurse practitioners in U.K. can provide independent consultation and treatment, such as writing up prescriptions and issuing medical certificates for sick leave. Also the nursing staff at the triage station can turn away any patient presents with non-urgent medical condition, which should be managed in the setting of primary care. Hence the workload at the emergency department can be reduced and patients can be treated more efficiently.

The improvement in primary healthcare system in U.K. for the past 20 years has established a robust relationship between patients and their family physicians. It is common for patients to visit their family physicians for consultation instead of attending emergency department, unless their health conditions cannot be managed in primary care setting. If a patient is required to be seen by a hospital specialist, the patient would be referred to that specialty directly to the allocated hospital. The patient is seen in the emergency department only if the patient’s medical condition deteriorates and becomes critical. This process can avoid any unnecessary intervention and time delay.

The practice of emergency medicine in Hong Kong and U.K. shares some similarities, and yet there are certain variations. This can be related to the differences in healthcare system, primary care management and culture of population. The healthcare systems in Hong Kong and U.K. have their merits as well as their shortfalls. Unfortunately a perfect healthcare system for both patients and medical professions is simply non-existent.

“So tell me what are the differences between the two healthcare systems and which one is better?” Well, perhaps you ought to spend some time (the best and worst of times!) to work and live in both places, only then you will truly have the answer.

P.S. A very special thanks to Dr S Ong; a bona fide gentleman, mentor and inspiration.

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