醫護人手捉襟見肘 保護主義礙解困局

<轉載自2017年6月20日 明報 社評>

本周起公立醫院急症室收費正式調高，盼令部分病人轉往私家診所或普通科門診求醫，紓緩急症室壓力，成效如何仍待觀察。當前本港醫療系統一大死結，是醫護人手不足，無論是急症室、普通科門診乃至專科服務，市民輪候時間都愈來愈長。上周政府發表報告，推算2030年全港多個醫療專業將鬧人手荒，莫說提升服務質素，連維持目前水平也有困難。當局有責任加緊培訓醫護人才，更有效率地調撥人手資源，不過醫生業界亦應承認人手不足的事實，勿因自我保護心態，反對引入更多合資格海外醫生以應付中短期需要。

急症室加價難治本 增加醫護釜底抽薪

醫管局總裁梁栢賢稱，公立醫院星期日實施新收費後，急症室整體求診率比過去兩星期的周日少了7%，惟伊利沙伯醫院和威爾斯親王醫院的急症室輪候時間仍然一度超過8小時。食衛局長高永文表示，加價是否可以收到預期效果，令非緊急病人減少到急症室求診，還需更多時間觀察。本港公立醫院人手不足，急症室、內科、兒科及婦科是「重災區」，當局採取需求管理措施，希望將非急症病人引導往普通科門診等部門，做法可以理解，然而目前普通科門診服務同樣面對人手不足的問題，門診預約經常爆滿；私家門診收費相對昂貴，對基層市民來說負擔沉重。隨着人口老化，市民對醫療服務需求與日俱增，當局要釜底抽薪，長遠來說必須大幅增加醫護人手。

上周政府發表《醫護人力規劃和專業發展策略檢討》研究報告，假設現有服務模式不變，到了2030年，13個醫療專業將有10個面臨人手短缺，全港公私營醫療系統的醫生短缺將逾千人，普通科護士和物理治療師也分別短缺1669人和933人，鑑於全港九成住院服務和三成基層醫療服務是由公營醫療系統提供，當局應優先解決醫管局人手短缺情况。綜觀各界對報告的反應，雖然不乏批評之聲，但是大多數持份者認同本港醫護人手嚴重不足，必須改善。例如物理治療師組織認為，報告仍然嚴重低估了人手短缺，又無制訂病人與物理治療師的比例，擔心影響服務質素；護理業界亦指出，公立醫院的護士病人比例為1：10至1﹕12，遠低於國際水平的1：4至1﹕6，報告並未真確反映人力需求，有關人手不足的估算，仍然遠低於病人的實際需要。

然而醫生業界代表卻大唱反調，揚言報告「誇大」了醫生人手短缺問題，未有「對症下藥」，云云。他們堅稱，現時醫生人手問題是「不患寡而患不均」，當局調配人力資源無方，導致公立醫院一些部門人手緊張，此外報告亦低估私營市場承受能力，建議將部分公營醫療系統病人分流予私家醫生跟進。善用現有醫療資源發揮更高效率，當然不會有人反對，可是本港醫護人手不足，乃是鐵一般的事實。今年初天水圍醫院正式啟用，惟因人手不足，初期只能提供3個專科門診，直到3月中急症室才開始提供8小時有限服務，何時能夠實現24小時服務，仍是未知之數。當局坦言沒有足夠人手，現在勉強增加服務時間，並非最好安排。巧婦難為無米之炊，醫生人手嚴重短缺，就算人手調配再靈活，也沒可能解決十個茶煲七個蓋的問題。

批評政府誇大短缺 醫生代表罔顧事實

兩個多月前立法會財委會舉行會議，多位議員都關注醫生人手不足，令服務輪候時間不斷延長。港大醫學院院長梁卓偉表示，就算如何不同意今次研究報告的解讀，都不能說香港有充裕的醫生人手。梁卓偉的說法無疑是一記當頭棒喝，提醒醫生業界人士不能罔顧事實、不顧曲直。近年政府一邊投入更多資源興建醫院，一邊增加醫科學額，惟報告顯示新血仍不足夠，况且醫科生由入讀本地大學至完成專科培訓需時13年，就算即時大增學額，遠水亦難救近火。當局為了紓緩中短期人手壓力，除了挽留退休醫生，確應積極考慮增加引入合資格海外醫生。

不少國家如新加坡、加拿大、英國和澳洲等為了應付醫生不足，都向海外醫生招手，然而本港卻面對相當大的保護主義阻力。一些業界代表極度抗拒外國畢業醫科生來港執業，就連負笈海外的港人子弟也未能倖免。近年醫委會雖然將海外畢業醫生來港執業的考試，由每年一次增加至兩次，然而次數仍嫌太少，有必要顯著增加。有業界人士渲染，倘若大開中門增聘外來醫生，可能存在良莠不齊問題。然而增聘海外醫生並不等於要降低來港執業門檻，優先容讓負笈海外的港人醫科畢業生回港執業，更是合情合理。香港回歸前，英聯邦國家醫生毋須通過考試便可在香港執業，社會輿論並沒有懷疑他們的質素。業界組織不應出於自我保護心態，妨礙解決醫生人手不足的問題。

Protectionism — an obstacle to solving the shortage problem in hospitals

AT the beginning of this week, the government raised charges for emergency room services officially in the hope that some patients will turn to private clinics or general out-patient clinics for medical care and thus ease the strain on emergency rooms. The outcome of the measure, however, remains to be seen.

According to Leung Pak-yin, Chief Executive of the Hospital Authority, the overall visiting rate of emergency rooms last Sunday, when the new charging scheme was implemented in public hospitals, fell by seven per cent compared with the two previous Sundays. Still, at Queen Elizabeth Hospital and Prince of Wales Hospital, the waiting time for emergency room services was once over eight hours. Ko Wing-man, the Secretary for Food and Health, said that it took more time to ascertain whether the fee hike can produce the expected result, i.e. dissuading patients with a non-urgent condition from using emergency room services.

According to a report named Healthcare Manpower Planning and Professional Development published by the government last week, if the existing service mode remains unchanged, 10 out of the 13 medical professions will be faced with manpower shortages by the year 2030. The overall public and private healthcare system will be short of more than 1,000 doctors, 1,669 general out-patient nurses and 933 physical therapists. According to the report, since 90 per cent of in-patient care and 30 per cent of basic healthcare are provided by the public healthcare system, the government should give priority to solving the manpower shortage problem within the Hospital Authority. In view of the responses from different sectors to the report in spite of some of the criticism of it, we can conclude that most stakeholders agree that Hong Kong's healthcare system is seriously understaffed. A physical therapists' association, for example, argues that the report still massively underestimates the shortage problem in the profession and fails to formulate a proper ratio of patients to therapists, worrying that that will affect service quality. The nursing profession, meanwhile, has pointed out that the nurse-patient ratio at public hospitals is 1:10 to 1:12, which is significantly lower than the international standard, which is 1:4 to 1:6. The profession has criticised the report for failing to reflect the demand for manpower accurately and underestimating the shortage problem by failing to take into account patients' real needs.

Representatives of doctors, however, take a completely opposite stand, claiming that the report has "exaggerated" the shortage of doctors and has failed to "find the right medicine for the problem". They stress that the primary problem is not the lack of manpower, but the government's failure to deploy human resources in a fair way, which they think has made some departments at public hospitals understaffed. They also claim that the report has underestimated the private market's ability to withstand pressure, and have suggested that some patients in the public healthcare system be diverted to private doctors for follow-up treatment. Without a shadow of a doubt, no one is against making good use of existing healthcare resources to achieve higher efficiency. But it is an indisputable fact that there is a lack of healthcare workers in Hong Kong. Tin Shui Wai Hospital, which came into operation early this year, had only three specialist clinics at the beginning due to manpower shortages, and it was not until mid-March that it started providing 8-hour limited emergency room services. It is still uncertain when a 24-hour service will be ready. The government has stated plainly that, given the lack of healthcare workers, it is not the best arrangement to increase service hours when the hospital is not ready.

Before Hong Kong's handover, doctors from member states of the Commonwealth of Nations were not required to sit an examination in order to practise in Hong Kong. Back then, there were not any doubts about their standards raised by society. Associations of medical professions should not try to prevent the shortage problem from being solved out of protectionism.

醫護人手捉襟見肘 保護主義礙解困局

本周起公立醫院急症室收費正式調高，盼令部分病人轉往私家診所或普通科門診求醫，紓緩急症室壓力，成效如何仍待觀察。

醫管局總裁梁栢賢稱，公立醫院星期日實施新收費後，急症室整體求診率比過去兩星期的周日少了7%，惟伊利沙伯醫院和威爾斯親王醫院的急症室輪候時間仍然一度超過8小時。食衛局長高永文表示，加價是否可以收到預期效果，令非緊急病人減少到急症室求診，還需更多時間觀察。

上周政府發表《醫護人力規劃和專業發展策略檢討》研究報告，假設現有服務模式不變，到了2030年，13個醫療專業將有10個面臨人手短缺，全港公私營醫療系統的醫生短缺將逾千人，普通科護士和物理治療師也分別短缺1669人和933人，鑑於全港九成住院服務和三成基層醫療服務是由公營醫療系統提供，當局應優先解決醫管局人手短缺情况。綜觀各界對報告的反應，雖然不乏批評之聲，但是大多數持份者認同本港醫護人手嚴重不足，必須改善。例如物理治療師組織認為，報告仍然嚴重低估了人手短缺，又無制訂病人與物理治療師的比例，擔心影響服務質素；護理業界亦指出，公立醫院的護士病人比例為1：10至1﹕12，遠低於國際水平的1：4至1﹕6，報告並未真確反映人力需求，有關人手不足的估算，仍然遠低於病人的實際需要。

然而醫生業界代表卻大唱反調，揚言報告「誇大」了醫生人手短缺問題，未有「對症下藥」，云云。他們堅稱，現時醫生人手問題是「不患寡而患不均」，當局調配人力資源無方，導致公立醫院一些部門人手緊張，此外報告亦低估私營市場承受能力，建議將部分公營醫療系統病人分流予私家醫生跟進。善用現有醫療資源發揮更高效率，當然不會有人反對，可是本港醫護人手不足，乃是鐵一般的事實。今年初天水圍醫院正式啟用，惟因人手不足，初期只能提供3個專科門診，直到3月中急症室才開始提供8小時有限服務，何時能夠實現24小時服務，仍是未知之數。當局坦言沒有足夠人手，現在勉強增加服務時間，並非最好安排。

香港回歸前，英聯邦國家醫生毋須通過考試便可在香港執業，社會輿論並沒有懷疑他們的質素。業界組織不應出於自我保護心態，妨礙解決醫生人手不足的問題。