Empire

There is an ever-increasing urge, mostly from the press and our honorable council members, for the government to put more resource on health care. “Money is not a problem.”

(Of course. Money is always not a problem; no money is the problem.)

OK, money is not a problem now. Can we do whatever we want ? Let’s take screening of colon cancer by endoscopy as the example. The unit price is merely HK$5000. If we do it for everyone over 60 year of age in Hong Kong every 5 years– assuming there are around one million eligible subjects – it costs HK$1000M each year. (If you know the expense of our Monetary Authority and what it doses, you would fully agree with me that HK$1000M is a negligible addition - to waste.) Maybe we can find some Mr. Li to donate !

But the story doesn’t end here. Who is going to do the endoscopy ? Gastroenterologist of course. How many of them do we need ? Let’s assume one fully trained gastroenterologist can do 10 colonoscopies each half-day session (an all too optimistic estimation), it will be 80 per week (5-day-week as ordered by some Mr. Tsang, one working day needed for clerical work, education, and breathing) and 3600 per year (45 weeks per year, allowing for leave and public holiday). Since we need 200,000 endoscopy each year, we need 56 gastroenterologists dedicated for a program of this kind – essentially doubling the number of existing manpower under government hospital.

(This is, no doubt, a highly unprofessional demonstration of health economics calculation. We have not considered the need for additional investigations for any abnormality detected, nor the manpower for pathologist and the all too important nurses.)

I am sure those aiming to build big empire would argue – more than ever - for a program of this kind after looking at this estimation. Or they may have think of it well ahead of us.

(PS. Don’t be mistaken and I have nothing against infra-diaphragmatic colleagues. If we do virtual colonoscopy for screening, we end up with the same numbers, but all those budding gastroenterologists become radiologists.)