Reasons behind long waiting hours of public hospitals in HK

The high cost of private clinics means that many can only opt for treatment at public hospitals. Reading about this case and feeling utterly heartbroken, we did not understand why the waiting hours could possibly be so long for a patient in urgent need to receive treatment in public hospitals.

Pamela Youde Nethersole Eastern Hospital is the only public hospital in the Eastern District, which consists of Tin Hau, Braemar Hill, North Point, Quarry Bay, Sai Wan Ho, Shau Kei Wan, Chai Wan and Siu Sai Wan. The population of the Eastern District as of 2022 is approximately 573700.

This case reflects the harsh consequences resulting from the uneven distribution of public hospitals in different districts which result in prolonged waiting hours. This in turn may take many innocent lives.

By comparing the distribution of public hospitals in Hong Kong and analysing it along with data like population by district and location convenience, we hope to raise the issue of the insufficient and unbalanced amount of hospitals in different districts to the public and government.

In Hong Kong, there are 43 public hospitals and institutions; From the map, we can see that in the New Territories, there is a sparse distribution of public hospitals, and most of them have accident and emergency rooms; There are relatively more hospitals in the Kowloon region while there are small clusters of public hospitals in each district of the Hong Kong region.

The population in Hong Kong is 7,413,070.

Below shows the population of the three main regions of Hong Kong and the corresponding number of hospitals in the region.

Islands District, Kwai Tsing District, North District, Sai Kung District, Sha Tin District, Tai Po District, Tsuen Wan District, Tuen Mun District, Yuen Long District

Kowloon City District, Yau Tsim Mong District, Wong Tai Sin District, Sham Shui Po District, Kwun Tong District

Central and Western District, Wan Chai District, Southern District, Eastern District

(as of 2021 Population Census)

Problem identified: Despite the huge difference in the number of population, the number of public hospitals in each district are similar. Accommodating more than half of the population in Hong Kong, the amount of public hospitals in the New Territories are insufficient.

Some of the public hospitals are in clusters, which causes traffic congestion. Although this may bring convenience to the patients who requires service from both hospitals, when all hospitals of the district are focused onto one street, the distribution of those hospitals will be more uneven, as Hong Kong already has insufficient public hospitals. Our proposed solution for this will be included later.

From the map, we can see that as of 2021, Kwun Tong has one of the highest population density and has a large elderly population, with 21.9% of the population being over 65 years old.

Older people generally have more complex problems requiring more hospital visits and care. Therefore, the rate of accidents and emergencies of the elderly is higher. Thus, having more elderly citizens in a district signifies a higher amount of hospitals is required.

From the map, Kwai Tsing, Wong Tai Sin, Eastern, Kwun Tong and the Southern District have a significant high percentage of elderly population. We will focus on the Eastern and Kwun Tong District because they have a relatively more severe issue as they only have one public hospital in the entire district.

Kwun Tong only has one public hospital - the United Christian Hospital, and its accident and emergency room waiting hour is over 8 hours. This unbelievably long waiting time may take lives. It is the only public hospital in the district, therefore it cannot accommodate this many patients.

The same phenomenon can be seen in the Eastern District, where the elderly population is extremely high, and has a high population density, yet only has one public hospital.

This issue of insufficient amount of public hospitals cannot be ignored, as it greatly decreases the efficiency and overall effort in helping patients as doctors rush to cure and rescue the overwhelming amount of patients.

A possible reason for less populated districts to have very long waiting times, such as Yuen Long and Tuen Mun, is the insufficient amount of hospital beds. This can be backed up by the data from the government; in 2021-2022, Tin Shui Wai Hospital's number of beds in their emergency rooms was only 300, and their waiting hours were up to 8 hours. Tuen Mun Hospital's emergency room is the only one in Tuen Mun. It has a population density of 5,908 persons/km2 as of 2021, yet only has 1935 beds in their emergency room.

Some hospitals are located on higher grounds, such as hills or elevated grounds or slopes, this may cause inconvenience for emergencies. Especially for some cases where patients consulting hospitals on their own instead of taking an ambulance.

From the map, we know that Cheshire Home Shatin, Bradbury Hospice and Shatin Hospital are all located on Turret Hill, elevation of 399m. In order to reach Cheshire Home Shatin, it takes a 34-minute walk from the nearest MTR station, Shek Mun. Alternatively, you can take a bus from the MTR station, which takes a 7-minute walk and a 20-minute bus ride. The situation occurs similarly for the other 2 hospitals.

Also, Pok Fu Lam is an elevated ground, elevation of 102 m; Queen Mary Hospital, Maclehose Medical Rehabilitation centre, Tung Wah Group of Hospitals Fung Yiu King Hospital and The Duchess of Kent Children’s Hospital at Sandy Bay are all located on Pok Fu Lam. The nearest MTR station is Kennedy Town station, which takes a 28 minute walk to reach Queen Mary Hospital. Otherwise, you can reach the hospital by bus, it takes a 7-minute bus ride and a 4-minute walk. 

These examples show that hospitals on elevated grounds are rather inconvenient for patients to reach.

Besides from these examples, we can also see that nearly all of the hospitals are elevated. One example is Queen Elizabeth’s Hospital, you will need to walk up the hill and stairs to reach the hospital's main building. It is not a gentle or easy walk for patients to go up to these elevated hospitals.

For some hospitals, there are some minibuses or other transportation services from MTR stations. However, it will not be a pleasurable experience for patients to interchange so many times when travelling to the hospital. Therefore, hospitals located on higher grounds are inconvenient and troublesome.

The government is building the Kai Tak Hospital to ease the load of the public hospital in the Kwun Tong District.

The population of the Kowloon region is projected to increase by about 5% from 3 752 200 in 2019 to 3 923 600 in 2028; whereas the elderly population aged 65 or above will rise by about 50% from 664 300 in 2019 to 995 200 in 2028. To meet the long-term rising demand for healthcare services and facilities in Kowloon arising from the growing and ageing population, the Government has reserved sites in the KTDA for hospital development.

Kowloon East which includes the Sai Kung and Kwun Tong District currently has a population of around 1.2 million. Kwun Tong especially, has high population density and elderly population (click on the district name to see the details), but there are only 3 public hospitals in these two districts, offering only 2600 hospital beds, and only one hospital with an emergency room.

Now, the government is building the Kai Tak Hospital to ease the load of the public hospital in the Kwun Tong District. The location is marked with the yellow pin. However, it will only be completed earliest by 2025.

Limited transportation options and high costs of transportation further exacerbates the problem of the accessibility of hospitals. Issues of needing to take a taxi to a public hospital every time and how there are no MTR exits near public hospitals were raised in our survey responses.

We are proposing the following solution for public hospitals with limited accessibility and in relative high demand.

At the nearest MTR Station of the public hospital, a coach bus route will be set up from the MTR Station to the corresponding hospital.

The public hospitals listed below have the most needs for the routes as the walking distance from the nearest MTR station is around 20-28 mins.

The walking time from MTR Station to corresponding hospital

• NGAU TAU KOK STATION -> UNITED CHRISTIAN HOSPITAL - 20 min

• KENNEDY TOWN STATION -> QUEEN MARY HOSPITAL - 28 min 

• TIN SHUI WAI STATION -> TIN SHUI WAI HOSPITAL - 25 min

• TUEN MUN STATION -> TUEN MUN HOSPITAL - 20 min

These 4 hospitals have a wait time averaging from 4 to 8 hours; They also take around half an hour to walk from the nearest MTR stations. This is very inconvenient as the patient, who most likely is sickly, has to walk such a long distance - or take a taxi which causes financial burden for the patient and is not environmentally friendly.

This is overall a more efficient and beneficial solution for both the environment and those going to the hospitals; it is significantly more environmentally friendly than each individual taking a taxi which will worsen the air pollution in Hong Kong, and also reduces the financial burden of the patient.

The last solution we are proposing for this issue is for the government to build more hospitals. The government can consider reserving lands to build hospitals when planning to build large residential estates on them.

A large percentage of land in Hong Kong is used for public housing estates and deeply correlates to the population density of a district. The government can consider to decentralise Hong Kong's population by building public housing estates in the New Territories such as the North District or Tai Po District, or the Sai Kung District, because the number of hospitals in more populated areas such as the Central Kowloon region cannot accommodate the number of residents, resulting in prolonged waiting hours of accident and emergency rooms.

Moreover, more hospitals should be built instead of adding even more pressure to the hospitals in populated areas. For example, the neon pins are some of the suitable locations for new hospitals to be built. The pin in the Eastern District is planned to be used to build a public housing estate with an unexpected population growth. Therefore, we think it may need to include plans for building another hospital because

• it is near a big cluster of public housing estates -> convenience of residents.
• it can relieve the overwhelming amount of patients for the only public hospital, at the moment, in the Eastern District.

The pin in the Yuen Long District is also land which is going to have a public housing estate built on it, and we think it is a suitable location as the waiting hours of the other hospitals in the district on average are 6.5 hours which is quite long. If a hospital is to be built on part of the land instead, it will relieve the waiting hours.

All in all, it would be favourable for citizens' convenience if more hospitals were built near residential areas.

Furthermore, many hospitals are clustered on the same street as mentioned in the first map. Though it is more accessible for patients who need different types of services, it will cause inconvenience for those who live far from the hospital clusters. Therefore, more hospitals should be scattered in different parts of a district for the convenience of residents of the district.

The amount of public hospitals in Hong Kong is insufficient: the number of physicians per 1000 population is 2. Although comparing with some other countries or cities, it is considered as a moderate amount, but there can still be some improvements towards the problem.

After analysing Fig. 7, we have selected 3 countries: Russia, 4.31; Kazakhstan, 4.10; Ukraine, 3.25. These 3 countries have the most number of physicians per 1000 population. These results show that Hong Kong still has some room for improvement to do towards a sufficient amount of hospitals.

We have also selected another country: Cambodia, 0.23; Cambodia has a very low number of physicians. Some of the main problems in Cambodia that causes the health care to be poor are: inconvenient transport; lack of physicians, as the standard is unprofessional; insufficient amount of hospitals, there are only 34 public hospitals and 54 private hospitals, which is not enough for the entire 16.59 million population. Many citizens decide to travel to neighbouring countries for better medical treatment.

From the example of Cambodia, we can interpret that the main problems of Cambodia’s health care are similar to Hong Kong, including inconvenient transport, lack of physicians, and insufficient amount of hospitals.

When Hong Kong reaches a sufficient amount of hospitals and physicians, they will be able to efficiently serve the population of Hong Kong, which in turn will reduce the waiting time of hospitals.

Behind the problem of the insufficient amount of public hospitals in Hong Kong lies many issues. From Fig. 6. above, a huge problem is there are not enough medical workers in Hong Kong for public hospitals. Tackling this issue is never easy, and changes may take years - but change must be made. As the public hospitals require more medical workers, the government should provide more benefits to medical workers and provide more educational support for students studying medicine. The government should be willing to put more money into the education of students studying medicine and citizens' health to slowly build up a more stable medical system.

We hope that through our findings and suggestions, the government can build more hospitals to ease the load of the already insufficient amount of medical workers in public hospitals. Furthermore, we hope the government can consider the convenience of public hospitals for citizens by setting up more hospitals and transportation according to our suggestions. By improving these issues, lives can be saved more effectively and efficiently, and both the doctors and patients can have a more ideal experience at public hospitals. Therefore, through making improvement in these areas suggested, the resilience, sustainability and diversity of the city can be elevated.

Thank you!