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1. Hong Kong’s health system is challenged by the severe shortage of doctors
                        Su cient healthcare manpower is fundamental in a well-functioning health system that provides timely and appropriate care to meet healthcare needs of the population. However,
                        i.
                        in the city’s first comprehensive healthcare manpower review by the Food and Health Bureau (2017), projections forecasted a shortfall of approximately 500 doctors by 2020
                        and 1,007 by 2030. Notably, these projections assumed the maintenance of the 2015 standard of health services provision (and various other assumptions that may not be
                        realistic), a standard characterised by chronically overloaded public hospital wards manned by chronically overworked doctors. As we work to move away from this standard of
                        care, the projected shortfalls are clearly underestimated.
                        ii.  In 2017, our population of close to 7.4 million people was served by 14,290 fully registered doctors, equating to having approximately 1.9 doctors for every 1,000 people in Hong
                        Kong. This number is well below the Organisation for Economic Cooperation and Development (OECD) average of 3.4 and we lag behind international peers including Singapore
                        (2.4). In other words, Hong Kong needs an addition of approximately 3,000 doctors to catch up with Singapore, and approximately 10,000 doctors to catch up with other
                        well-developed regions. This shortfall would continue to worsen if we do not increase the number of doctors in the public sector on a massive scale very quickly. In tackling a
                        shortage of doctors, reference could be made to Singapore- a place with fewer doctors per 1,000 population than Hong Kong in 2008 but subsequently increased the total
                        number of doctors by 70% to surpass Hong Kong in less than a decade.
                   2. The severe shortage of doctors is exacerbated by a rapidly ageing population and the growing burden of
                       chronic diseases
                        i. Hong Kong is home to a rapidly ageing population. The percentage of our population aged 65 years or above is expected to double from 15.9% in 2016 to 29.1% in 2036
                        (representing an increase of approximately 1.2 million people). This wave of ageing of the baby boomers cohort is just at the beginning phase and the speed of population ageing
                        in the next two decades is expected to increase.
                        ii. Ageing population and the more profound complexity of illnesses among the elderly correspond to a greater demand for health services, particularly in the public sector. This
                        can be exemplified by public hospital bed utilisation ratios where in 2016, every 1,000 people aged 65 years or above required 10.5 beds compared to 1.9 required by every 1,000
                        aged below 65 years. The ratio was 15.7 for every 1,000 aged 75 years or above. In other words, each of the abovementioned 1.2 million additional people aged 65 years or above
                        would require 5 times as much of medical resources than those aged below 65 years.
                        iii. Alongside ageing population is the rising prevalence of chronic diseases that adds to the burden of our already ailing health system. Thematic Household Survey data shows
                        that in 2017, the prevalence of reported chronic diseases increased in every age group compared to that observed in 2000. Notably, the prevalence increase in younger age groups
                        hints at an earlier onset of chronic conditions. Adding to the burden on our health system are those with multiple chronic diseases and more complex health conditions.

                        iv. Regardless of how we size the current shortage (not to mention the massive needs in the next decade), the current shortage of doctors is well above the number estimated by
                        the Government and is in the thousands, not the hundreds. As the health needs of our population are becoming increasingly di cult to meet, the number of doctors for every
                        1,000 people aged 65 years or above has dropped from 13.9 in 2000 to 11.8 in 2017.  Concurrently, the number of doctors for every 1,000 people with chronic diseases dropped
                        from 11.7 in 2000 to 7.2 in 2017. We estimate that Hong Kong will need an addition of at least 2,000 and 9,000 doctors, respectively, to bring the ratios back to the ones
                        observed in 2000.

                   3. Hanging on a rope stretched too thin — our public healthcare system is on the verge of collapse


                        i. Our public hospitals provide over 80% and over 90% of all inpatient bed days for the entire population and for those aged 65 years or above, respectively. They are, however,
                        sta ed with just close to 50% of active doctors in Hong Kong.

                        ii. Although the number of public hospital doctors increased by 24% between 2008 and 2017, the growth in the number of public hospital inpatient and day inpatient discharges and
                        deaths was 43% — nearly double. The growth rate of public hospital doctors did not match the upsurge in service demand and workload. As a result, each doctor has been
                        having to care for an increasing number of patients that add to their already heavy workload.

                        iii. The situation is likely to worsen. Based on current healthcare utilisation patterns and population projections, the number of public hospital inpatient bed days utilised by those
                        aged 65 years or above is projected to increase from the current 50% to more than 70% by 2036. Ageing clearly contributes to a substantially heavier burden on our already
                        overloaded public healthcare system.
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