Given the controversy over maternity beds in Hong Kong hospitals for mainland women, it's ironic that the traffic actually flows both ways. Many Hong Kong residents are crossing the border to the mainland to avoid long lines for medical services here. Andrea Deng reports.

Leung Kai-chung's son is in good health today - luckily. Four years ago, when the boy was 16, he complained of discomfort in his sinuses. His mother took him to a general practitioner. He got a quick examination and a referral through the public medical link to a specialist - whose appointment calendar happened to be booked up for the next 10 months.

So, they waited. The boy started feeling unbearable pain in his nose and ears. His mother made up her mind the boy couldn't wait months to see the specialist. "Let's go to a mainland hospital," Leung suggested. It was an easy choice from his point of view.

Leung's a collector of antiques from after the fall of the Qing Dynasty to before the founding of the PRC. Shenzhen is a good place for finding antiques. He goes there often and he has connections. It would have been easy to have one of his friends make an appointment for the boy at a mainland public hospital. Matters never got that far. Leung's wife wouldn't go for it.

His wife, without even telling Leung what she was going to do, made an appointment for the boy at a private clinic.

"My wife always had a prejudice against everything on the mainland. She's not confident about the quality of medical care there," Leung said.

It was a good thing she took things in hand. She took their son to the doctor and got the bad news. The boy was in urgent need of an operation and if he didn't have it he would go deaf. The cost of the operation - HK$80,000.

"Of course it was expensive for us. You think HK$80,000 is easy?" said Leung. He was a civil servant in those days. His wife once owned a beauty shop but that was long ago. It folded during the 1997 Asian financial crisis, leaving Leung as the family's sole breadwinner. When the couple got the bad news about their son, and the need for an operation, they were still paying a mortgage.

Leung is aware of the absurdity of the situation here in "affluent" Hong Kong, where one has to wait forever to see a specialist at a public outpatient clinic. Leung has his own horror story. He went to a clinic about a skin problem a couple of weeks ago and that led to his getting an appointment to see a a dermatologist - in August 2015. The skin problem is nothing urgent, as it happens, fortunately.

"It's ludicrous," said Leung. "I thought I would just have to wait no more than a year. Turns out I have to wait two years," He's one of the lucky ones because his condition is minor.

"There was an elderly old gentleman there," Leung related. "The skin on the man's legs had festered and I heard him say, 'My skin would have been completely festered in two years,'" Leung said.

Public health in Hong Kong uses a sort of triage system. If you're not going to be dead in the next five minutes, you have to take the pain anyway. There are no quick remedies for suffering - not physically, not mentally. There's always a delay unless the need is urgent.

Tim Pang Hung-cheong, a community organizer for the Society for Community Organization (SoCO) which has looked deep into Hong Kong's public medical system, said it has become commonplace for patient not under urgent necessity to wait for one year, maybe even two, before seeing a medical specialist in some public clusters.

Pang recently became a member of the steering committee doing an overall review of the Hospital Authority (HA). He considers the queue of people waiting for medical specialists one of the most serious problems for the health system and one of the first the authority should be looking at. Pang says the longest waiting time nowadays is at public gynecology outpatient clinics in East New Territories - 120 weeks.

The situation is getting better. Public attention has forced the HA to act. The HA has allocated more resources, meaning surgeons, nurses, anesthetists and even cleaning ladies are working more overtime to try to catch up with the waiting list of patients, says Kenneth Fu Kam-fung, president of the Hong Kong Public Doctors' Association.

"Five or six years ago, patients who cannot pee and need catheterization would wait a year in some clusters before they get further treatment. Now, in Queen Mary Hospital at least, they only have to wait between six and eight weeks and they don't need to be on the needle for the entire year," said Fu.

"Generally, it leaves average Hong Kong people no choice but to wait," Pang told China Daily. Or, they may pay much higher fees for private medical services, which are available immediately to the wealthy or even the middle class, said Fu.

Many observers, including former medical sector lawmaker Leung Ka-lau, pointed to the HA's uneven allocation of resources to different clusters as the root of the problem. It's not a general lack of medical professionals that creates the long queues in some clusters.

Fu said the HA must carefully evaluate the allocation of resources. Some clusters have shorter queues. That could be because there are better doctors in that cluster, or more efficient ones, or the administration works better. Some lines are longer. That could be because the doctors spend more time in enquiry and diagnosis. Cases of fever are an example. Some doctors may check to see if there's any inflammation, others might prescribe an antipyretic right away, Fu said.

The alternative

For people like Leung Kai-chung, there's little alternative other than to go to public hospitals on the mainland. The incentives, he said, include no long waiting times, lower fees than what private clinics charge in Hong Kong and really - the medical care isn't that far behind what Hong Kong has to offer, especially when in Hong Kong, you can't even see a specialist here to get a quick diagnosis, he says.

He trusts the quality of medical care on the mainland after his heart examination experience in Guangzhou back in 2006. He went to a Hong Kong emergency ward at first - took an electrocardiogram. The doctor told him he was fine and insisted it was not necessary for him to see a specialist.

"I doubted his judgment. My chest was in pain and I was worried that it could be something bad," said Leung. "There's nothing you could do if the (community) doctor declined to write you a reference letter. But heck, even if he did I would have to wait at least half a year to see a specialist."

A friend of his suggested he see a heat specialist in Guangzhou. He underwent an examination for an hour. He walked and ran at different speeds on a treadmill while the doctor monitored his heart. The doctor asked him a lot of questions, noted a lot of details - the kind of thing they do at private clinics in Hong Kong. The doctor told him that he had high blood lipid and had to change his diet. "I was relieved when the doctor told me that it was not coronary heart disease," he said.

The bill came to under 1,000 yuan. It would have cost only a few hundred Hong Kong dollars to see a specialist at a public facility here. But for immediate medical examination and diagnosis, fees on the mainland are much cheaper than what private clinics in Hong Kong charge. Leung went back again this year. It cost him less than 2,000 yuan, and it's the best he can get.

About 600 Hong Kong residents were admitted to Shenzhen People's Hospital in 2012, Shenzhen Economic Daily reported. The hospital's Department of Thoracic Surgery performed surgeries on more than 40 Hong Kong people - half of whom suffered lung cancer. The Daily also quoted the orthopedics department at the hospital as saying 10 percent of its patients came from Hong Kong - many of them couldn't stand the wait for medical service in Hong Kong.

Analysis showed one Hong Kong resident with blood in his urine. A Hong Kong clinic gave him antibiotics and he was referred to a specialist for closer examination - seven months later. He opted for Shenzhen No 2 People's Hospital, and had surgery within a week.

Fu, who is a urologist at Queen Mary Hospital, said the waiting time is about four to eight weeks for specialist outpatient services for patients with cancer symptoms at general clinics. If the patient has kidney stones or minor kidney problems, he might have to wait a year in some clusters.

Pang, of SoCO, said the lack of knowledge and experience with mainland hospital care has deterred many Hong Kong people from traveling across the border for medical service.

"They don't know which hospital has better reputation and which one to go to. They're not familiar with the medical system there. They're also concerned about the service quality and the medical care quality," Pang said.

Contact the writer at andrea@chinadailyhk.com

(HK Edition 10/04/2013 page1)