Part II of the Hong Kong Healthcare Series: Opaque at Every Turn

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Hong Kong’s highly affordable and widely-used public healthcare system is hampered by long waiting times, leading some to choose the more expensive private sector that includes fees that are often opaque and does not always offer better quality.

Whopping prices for procedures

“Hong Kongers’ actual out-of-pocket expenditures on health are soaring. The figure more than quadrupled to over $43 billion between 1989/90 and 2013/14,” says health care group Bupa in its report Embracing Transparency – Harnessing the Power of Data in Hong Kong’s Private Healthcare System. The group expects expenditures to more than double to more than $94 billion by 2024/25.

Hong Kong’s private healthcare sector is charging patients more for common procedures than the private sector in other countries. For example, the average costs of colonoscopy and hip replacement are four times higher, and nearly double, respectively, compared to those in the U.S.

For the time being, there is no quality data to justify the higher costs. Many argue that paying high prices to an opaque system is unfair and changes are needed.

“The approach to monitoring quality, pricing and performance of health providers is inconsistent and consumers are left with inconsistent information and unstandardised pricing terminology,” says Bupa.

Hong Kong’s private sector suffers from a lack of transparency.

“Data transparency in healthcare is a well-established tool to improve quality and manage costs,” the healthcare insurer says.

Lack of financial transparency

There is no easy way for patients to compare services or the quality of one private hospital or another.

“In Hong Kong, it’s just word by month now to compare which private hospital offers better service,” says Dr Ho Chung-ping, president of the Hong Kong Medical Association.

What’s more, patients tapping into private health care services often do not know the final price until the bill arrives and more often than not they often find extra costs for medication, equipment, amenities and so on.

“When patients ask for a detailed list of fees, they may not anticipate that room amenities like cotton or soap will drive up the overall cost of their bill,” Bupa states in the report.

Meanwhile, hospitals do not provide price breakdowns for surgical procedures. Doctors’ fees, operating theatre costs, surgeon fees, anaesthetist fees and hospital fees are not always revealed by the hospitals – until the final bill comes.

In 2015, Hong Kong’s Consumer Council received 16 complaints about private hospitals overcharging, out of the 23 cases it received in total regarding hospital services.

Also, Bupa says that price variation for the same in-patient procedures is high for different “room class”, and there is no published quality data to support such variation.

For instance, cataract removal can cost private-room patients over 40 percent more than semi-private room patients, largely driven by higher surgical and doctor fees.

“The classification of ‘private’, ‘semi-private’, and ‘ward’ level actually vary from one hospital to the next,” says Bupa.

In Hong Kong, the same procedure to the same quality-standard costs 2 percent to 31 percent more depending on whether the patient stays in a ward or a semi-private room, and 5 percent to 43 percent more if the jump is from a semi-private to a private room.

Hospitals also convey prices using different terminology, with some citing the median price, the minimum price or the packaged price for procedures. It is difficult to compare prices due to non-standard pricing terminology and reporting.

Lack of quality transparency

Hong Kong’s dual-track healthcare system also translates into different approaches to transparency and quality outcomes. The public system is regulated by the Food and Health Bureau while the private sector is regulated by the Department of Health.

“The lack of a single regulator and the coexistence of two different sets of reporting requirements, creates stark differences in the practices and approaches to quality in hospitals in Hong Kong,” says Bupa.

According to Bupa, for the private sector, “the emphasis is on ensuring that private hospitals have policies and activities in place to support high-quality care”, while for the public sector, “the emphasis is on ensuring the actual result of the care being delivered is quantitatively measured and improved.”

Bupa further points out that while Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes is in place, there is a gap in transparency regarding outcome measures such as adverse events treated in hospital, healthcare associated infections and waiting times for elective surgery.

For example, hospitals only selectively report on key parameters of surgical procedures including price, length of stay and volume, rather than adhere to a common standard of reporting that may be more comprehensive and reveal data they doesn’t necessarily show the hospital in a flattering light.


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