香港慢性病概況
Categories:Health Insurance, Healthcare, Hong Kong, Medical Insurance, News |Published on May 20, 2013
近年全球人口的平均壽命普遍越來越長，主要得力於先進的醫療服務，但壽命延長，不等如生活健康舒適。事實上，非傳染慢性疾病威脅，例如癡肥，抑鬱症，心臟病，哮喘，糖尿病或癌症等，一直嚴重威脅港人健康。近年已經不止老年人受慢性病威脅，因慢性病而死的人士有年輕化的趨勢，特別是心臟病、癌症和中風。研究顯示三分一因癌症而死的人士年齡介乎65歲或以下，因心臟病和中風而死的人士更有逾一成正值壯年，可見慢性病的影響力深遠。
慢性病患者劇增
自回歸後，香港的空氣污染日益嚴重，香港大學在今年初發表報告，以世衛新修訂的空氣污染指標“達理指數”，推算出在2007年至2011年間，5年內約有3200名港人因空氣污染死亡，因治療或死亡引致的經濟損失更高達400億港元，過去3年污染超標日分別為304、301、305日，遠低於世衛標準，情況屬“災難性”。
眾多本地研究已經顯示空氣污染與因呼吸系統及心血管疾病而入院或死亡的人數有顯著關連，而它對健康亦造成多方面的影響，急性病症包括急性呼吸道感染、支氣管炎、肺氣腫及氣喘，而患上哮喘等慢性呼吸系統疾病的患者其病情亦會惡化，甚至提早死亡。雖然不同人士受空氣污染影響的程度皆不同，但主要的病徵包括喉嚨痕癢、咳嗽和胸痛等，而兒童及長者的病情往往更嚴重。
除了空氣污染，不良的生活習慣亦是引起慢性病的原因，香港大學在二零一一年進行的調查顯示近九成受訪者每日沒有進食足五百克蔬果，而且七成人每周沒有進行中等強度運動，例如騎單車和打保齡球，達兩個半小時，三成受訪者的體重指數（BMI）更為廿五或以上，屬於肥胖，分別有兩成八至三成半受訪者患上高血壓或前期高血壓，幸好逾80%人屬非吸煙者或戒煙超過十年，近95%人無過量飲酒，可惜70%香港人每星期做少於2小時的體力運動，更有21％人表示沒有做任何運動，與國際標準的55％和18％相比，可見港人普遍缺乏運動。
香港人口持續老化亦造成越來越大比重的人口屬慢性病患者，根據香港統計處的估計，到2028年香港人口將超過800萬，到2041年更會有847萬，在30年間增加約140萬人，隨著出生率持續偏低，加上港人愈趨長壽，65歲或以上的長者急增，估計在2011年佔全港人口13%，到2041年佔30%。換言之，平均每3.3人中便有一人屬長者。眾所周知，年紀越大的人士會花越多錢在醫療方面，醫療費隨年齡增加，更進一步消耗長者的退休金，加上通貨膨脹的影響，可見老人家需要準備更多醫療預算。
無法預測何時結束治療
公眾一般也不了解慢性病患者的需要，當他們選購保險計劃時，往往側重在醫療保險，忽略了長期護理保險的重要性。醫療保險旨在向受保人收取一筆醫療保險金，從而建立醫療保險基金，無論受保人因意外受傷或不幸患病，醫療保險公司會為受保人補償因醫療費所造成的全數或部份經濟損失，醫療保險的保障範圍一般包括住院、門診、防疫注射、婦產科、新生嬰兒、牙科和已存在病症等，毫無疑問醫療保險有效防止受保人因高昂醫療費而負上沉重的經濟負擔，更確保受保人有能力向私營醫療機構求醫，確保受保人享有優質的醫療服務。
醫療保險的賠償往往屬於一次性給付，但慢性病患者卻需要短則數年、長則數十年的照護，而且無人可以有效預測何時該結束治療，因此而生的長期照顧費用可能相當龐大，一般醫療保險將難以應付，在這個時候，慢性病患者需要及早做好準備，按實際需要選擇按月給付的慢性病保險，縱使受保人因病完全喪失自理能力，保險公司仍可為他們提供每月所需的經濟支援，儘量令慢性病患者生活無憂。
世界衛生組織（WHO）指出全球眾多國家的人均壽命比起以往越來越長，他們的生活亦受惠於更優質的醫療服務，但科技再發達，人們仍然面對眾多健康問題，例如癡肥和慢性病。因此世衛建議成人每星期應該做150分鐘適量的帶氧活動，注意飲食，保持營養均衡，加上充足睡眠，就能減低患上各式各樣慢性病的機會。假如已購買醫療保險，生活更輕鬆自在。
南丫島海難 – 「珍惜眼前人」
Categories:Health Insurance, Healthcare, Hong Kong, Maternity, Medical Insurance, News |Published on May 20, 2013
十一國慶日本應是普天同慶的大日子，可惜南丫島海面卻發生香港有史以來最嚴重的海難，一艘載有124人的渡輪從南丫島出發欣賞維港煙火，不幸與一艘前往南丫島泊岸落客的港九小輪公司小輪相撞，導致38人死亡，近百人受傷。殘酷的海難既為國慶日蒙上陰影，同時告誡我們必需重視生命安全，珍惜眼前人，因為意外無時無刻都可能發生。到底在意外頻生的今天，香港人如何有效保障自己與家人的人身安全?
海難死亡人數升至38人
在2012年10月1日約晚上8時18分，港燈的「南丫四號」遊艇接載124人，包括船員，電燈職員與家屬參觀位於南丫島的港燈發電廠後，逕自駛往中環欣賞國慶煙花匯演，不幸在出發5分鐘後，於南丫島西北部對開海面，慘遭港九小輪海泰號攔腰撞擊，南丫四號船身在被撞擊後迅速入水，船尾重量急增，垂直向下沉，在數分鐘內直插海床，只剩船頭露出水面，船上所有人墜海。
至於港九小輪「海泰號」在發生意外時，船身劇烈搖晃，船頭隨即受損入水，船身向左邊傾側，乘客需要聚集在船的右側從而確保船身平衡，雖然有消息顯示乘客自發搜集救生衣打算拯救南丫四號乘客，但船員決定將海泰號駛回碼頭以策安全。
消防處接到求救請求後，馬上聯同海事處、水警和聖約翰救傷隊等機構，動員逾千人展開大規模救援行動，首先飛行服務隊出動直升機以射燈照亮漆黑的海面，協助搜索生還者，蛙人亦在沉船發生的位置與附近水域拯救生還者，水警輪和消防船亦不停地進出事後現場展開搜救。獲救的傷者先被送往海怡半島公眾碼頭或南丫島，再陸續轉送到各大醫院接受治療，包括律敦治醫院、瑪麗醫院、東區醫院與及伊利沙伯醫院。截至10月2日晚，事件已釀成38人死，四人重傷，共101人被拯救。
海難受害者索償額將逾億元
南丫島海難導致38人死亡，近百人受傷，鑑於這次海難牽涉的死傷人過百，據估計相關的醫療、人壽和意外保險索償額可能逾億元。根據香港法例，所有商用船最少要購買保額達500萬的第三者責任保險，所以海難的受害者最少會得到共1000萬元的賠償，由於餘額將由船公司一力承擔，部份人士擔心船公司可能無法繳付鉅額賠償而破產，乘客將得不到賠償費全數。無論如何，船公司已經與保險公司開始商討賠償事宜，它們將深入調查事件，再決定賠償費總數。
出事後，受害者其實可以透過保險提出索償，主要的保險計劃包括人壽保險，醫療保險和意外保險三類，這三種保險的性質與保障範圍各有不同，針對不同情況提供保障。
首先，人壽保險旨在減低因受保人去世而造成的經濟負擔，其中包括受保人的殮葬費，銀行借貸，失去受保人而失去家庭收入，還有受保人子女未來的教育與生活費等，避免受保人一家陷入財政困難，只要受保人不是因自殺而死，任何死因(例如自然去世，因病或意外去世)也可透過人壽保險入稟索償。
而人身意外保險則針對受保人因意外事故而傷殘或死亡時，為受保人或其親屬提供賠償，因此假如受保人自殘身體將不獲保障，否則，任何因意外造成的殘障或治療開支也將得到賠償，即使受保人不幸離世，只要死因庭裁定死因屬意外，受保人也可索償。換言之，在受保人自然死亡的情況下，只有人壽保險會作出賠償，但受保人因意外而死時，意外保險和人壽保險會同時作出賠償。
醫療保險目的在於減輕受保人因病或意外受傷時，負擔的醫藥費，並容許投保人有更大的自主權去選擇屬意的醫療機構和治療服務，因此醫療保險保障的服務包羅萬有，包括住院治療，門診治療、專科治療、手術費、婦產科服務、慢性病、康復治療和牙醫等。請注意，雖然意外保險同樣負擔受保人的醫療費，但它只會在受保人因意外接受治療的情況下，才會賠償，反之，無論病人因意外或危疾接受治療，醫療保險也會負責受保人所有的醫療開支，可見醫療保險雖然不會賠償受保人身故所造成的損失，卻可更全面地報銷各式各樣的醫藥費。總括而言，人壽、醫療和意外保險彼此相輔相成，假如受保人想為自己與摰愛的家人提供最全面的保障，三者缺一不可。
這次海難毫無疑問是一齣悲劇，眾多無辜者霎眼間消逝，再次提醒我們生命無常，一定要好好地關心家人和身邊的朋友，不然失去的時候必定後悔莫及，寄語大家「珍惜眼前人」。
工作假期保險保你輕鬆改變人生
Categories:Health Insurance, Healthcare, Medical Insurance, News |Published on May 20, 2013
常言道: 「讀萬卷書, 不如行萬里路」。
今天，越來越多香港年輕人了解「行萬里路」的重要性，他們前仆後繼往外地工作，欣賞各地的風光名勝，瞭解當地的人文風情，既增廣見聞，又培養卓越眼光，建立寬闊的胸襟，提高競爭力。為了方便年青人出國工作，香港政府自二零零一年推出「工作假期」計劃，大受本港年青人歡迎，計畫為18-30歲人士提供在德國，愛爾蘭，澳洲，新西蘭，日本，加拿大和韓國的工作簽證，使參加者可以一邊工作一邊體會當地的生活。
參加澳紐等地工作假期計劃的人士將取得一年居留權，在當地從事短期工作，例如批發、零售業、酒店及飲食業工作，亦可能到農場或果園從事季節性工作。香港政府自二零零一年推出工作假期後，至今已吸引超過一萬二千人參加，參加者的足跡遍佈德國、愛爾蘭、澳洲、日本和韓國各地，名額亦一再放寬，今天前往新西蘭的名額有四百個，德國的名額亦達到一百五十個，甚至不再預設前往澳洲的上限，鼓勵越來越多年輕人投身工作假期。
很可惜不少年輕人尚未購買足額的保險，就貿然開始在外國生活，當他們在工作假期期間不幸遇上工傷、疾病或任何無法預計的意外後，往往要付上龐大的醫療費，早前已經有港人在外地遇上嚴重交通意外後，導致四肢癱瘓，由於醫療保險已過期，沒法支付每天近四萬港元的鉅額醫療費，致使不能回港就醫。事件反映港人在開始工作假期前一定要做好準備，得到一份足額的旅遊保險，醫療及意外保險，確保人身安全。
事實上，工作假期獨特的性質令參加者有必要同時取得足額的旅遊，醫療及意外保險。首先，全年旅遊保險往往為每次旅程設有最長受保期，約90天，而工作假期為期一年，投保人實不可能在當地逗留2至3個月後回港，之後再次前往海外。再者，旅遊保險並不保障工傷，假如參加者工作時發生嚴重意外，將付上沉重醫療費及回港費用。
而且國際醫療保險的保障範圍一般都不只限於本港，甚至包括全球主要國家及地區，例如澳門、台灣、日本、美國、加拿大及西歐等，投保人只需在購買前留意保障地區，只要受保人所在的海外國家或地區被納入保障範圍，無論遇上任何事故，皆可獲得醫療及意外保障，假如參加者長時間在國外逗留，即使旅遊保險已過期，只要有醫療及意外保險，就毋須擔心在海外求醫的費用。因此參加者在開展工作假期前，應該預先購買醫療及意外保險，特別是專保長期旅客的旅遊保險。
雖然醫療保險的保障範圍可以遍佈全球，但保單的保額主要以港幣計算，當受保人在國外發生意外或患病，保額未必足以支付當地的醫療費全數，因為海外國家往往向外籍人士收取昂貴的醫藥費，以歐美的醫院為例，在提供服務後，動輒會向外籍人士收取數千美元或歐元，旅遊保險特別提供在海外遇險時的保障，保額較高，更提供緊急支援服務，萬一投保人不幸受傷或身亡，保險公司會代為支付醫療及回港費用。可見旅遊保險比不一定包機送返的醫療保險較優勝。
本港的年輕人透過工作假期得到寶貴的生活及工作經驗，以加強自信心、適應力與人際溝通技巧，實在無可厚非，但要注意他們持工作假期簽證去外國工作時，身份實屬外籍人士，當他們遇上意外或患病時，需付上較當地人高昂的醫療費，嚴重者甚至需要緊急醫療支援，而足額的旅遊保險，醫療及意外保險正可保萬事無憂。
單非產婦當衝關孕婦，港爸爸遭殃罰十一萬
Categories:Health Insurance, Healthcare, Hong Kong, Maternity, Medical Insurance, News |Published on May 20, 2013
鑑於內地孕婦「衝關」在港分娩的情況日趨嚴重，醫管局早前下令「一刀切」，大副提高未經預約和不合乎資格分娩個案的收費，費用從此由4.8萬加至9萬。可惜新政策的成效尚未明朗，已經有中港家庭付上沉重代價。早前一名港人的內地妻子不幸患上致命的妊娠毒血症，雖然她已接受產前檢查並在私家醫院預約床位分娩，最終也被迫送院診治及分娩，期後公立醫院竟將其視作衝關個案處理，按規定向其徵收十一萬元，面對龐大的收費及初生嬰兒日後的生活開支，一家人的生活頓時陷入困境。
縱使周太 已經即時剖腹產子，她仍然因病情嚴重而入住深切治療部兩天，直至七月二十七日出院，期後醫院向周生周太徵收逾十一萬元的醫療費，其中包括一萬三千多元的深 切治療部費和九萬元的婦產科服務收費，院方直指周太身為內地孕婦，在入院前並未在公立醫院接受產前檢查及登記預約，形同「衝關」，所以要繳付「懲罰性」收 費。
事緣港人周先生與內地妻子已婚多年，期間周太一直持雙程證來往本港照顧其四歲女兒，直至今年初再度懷孕，她在港接受定期產前檢查後，於私家醫院預約在九月一日分娩並已繳交共五萬五千元「留位費」，可惜周太的身體在七月底出現嚴重水腫，甚至漫延至頭部，她即時向私家醫生求診，經診斷後證實患上罕見的妊娠毒血症，隨時會有生命危險，連累腹中嬰兒，因此周生在醫生建議下將周太送往伊利沙伯醫院急症室診治。
周先生曾經向醫院解釋，可惜院方以周太屬內地孕婦為由拒絕，最可惜的是周生沒有及時為周太購買任何孕婦保險或懷孕保險，事後他無法透過保險公司報銷醫療費，惟有自行繳付共十一萬醫療費，構成沉重的經濟負擔。
事實上周先生一家並不是全港首宗個案，社區組織協會病人權益幹事彭鴻昌表示過往已經有不少單非孕婦因為無法支付分娩費用而向他的組織求助，醫管院往往不會酌情處理她們的個案，使她們被迫繳付鉅額醫療費。根據統計處在今年年初進行的調查，只要丈夫是香港人，超過九成內地妻子在香港所生的嬰兒會在一歲後被帶返香港生活，因為超過七成單非家庭認為香港的教育制度優良，所以選擇將初生嬰兒留港居住。
面對龐大的經濟壓力，單非家庭實可透過保險將風險分散，首先孕婦可以考慮購買婦嬰保險，既可保障她們子女的健康，又可儲蓄一筆資金作未來子女教育之用，而且婦嬰險除了保障孕婦本身、更保障可能發生的妊娠期併發症、產子過程可能出現的風險和嬰兒可能有的先天性重大殘缺，同時為孕婦和嬰兒構成完善的保護網。
在周先生的個案中，周太作為全職媽媽照顧長女並打理家務，而周生任職文員，身為家庭的主要收入來源，憑著月薪一萬三千元金養妻活兒，為了有效分配資金，可考慮投保保費較便宜的一年期定期險，亦應該取得壽險保障，家庭醫療保險與意外險保障，防止家庭因失去經濟支柱而陷入困境。
Surgeries Commonly Carried Out in Hong Kong May Be Medically Unnecessary
Categories:Health Insurance, Healthcare, Hong Kong, News |Published on May 20, 2013
Hong Kong and its expatriate culture knows all about unnecessary spending. You only need to ask an expat family to compare their life here to the one they left behind at home, and they will no doubt reveal that they are leading a very different lifestyle now.
But surely this wanton disregard for money hasn’t spilled over into the healthcare sector of Hong Kong? If your doctor recommends you need a certain surgery, you are generally not going to argue with them – they are the ones that went to medical school after all. They are also supposed to be someone who you trust with your life and your health, especially if they are going to be performing surgery on you. So what happens if they may not be giving you completely honest advice?
The Hong Kong private medical scene is not as transparent as one would hope, and evaluative reports or figures from previous costs and surgeries are often very hard to come by. Normally, a patient may want to assess their doctor/hospital and their need for a surgery by analysing all the available information so they can make an informed and confident decision. However, with no such data currently available, patients do not have a benchmark to base their decisions on, and it would appear that many HK expatriates are resorting to other means to inform themselves or evaluate their doctor’s diagnosis.
Online social forums, such as Asia Expat, are a hot bed for discussion, and many peer-rated reviews on hospitals and doctors can be found on these sites. It is understandable then, that with no real data to go on, decisions may be formed purely based on how highly a doctor is recommended. As a result, patients may be subjecting themselves to unnecessary surgery mainly because of word of mouth, leading them to put all their trust in a highly recommended doctor and their professional opinion.
If this can happen in a place like Hong Kong, then other countries elsewhere in Asia (where similarly priced private healthcare sectors exist) could also fall victim to the same issue.
But what does all this mean for Hong Kong’s local and expatriate residents? This tendency to over-prescribe and regularly perform unnecessary surgeries among HK doctors could spell trouble for both you and your insurance provider.
Private medical procedures in Hong Kong do not come cheap and its private healthcare sector actually ranks as the second most expensive in the world so if insurance providers are having to cover claims increasing in frequency and in cost, general premium rates are likely to follow suit and increase as well. This is all the more concerning if you discover you may not have actually needed your surgery in the first place, and have just unnecessarily made your body, and your insurance premium, suffer as a result.
Hong Kong Health Insurance (HKHI) chose to investigate this issue further and the data acquired on behalf of HKHI suggests that; the most common surgeries and treatments which are being performed in Hong Kong are not always medically justifiable, and private doctors could actually be recommending and performing these unnecessary procedures purely to generate a higher income.
Caesarean births are a very controversial topic in Hong Kong and the number carried out here per year is steadily increasing. However, the driving factor behind the higher demand for this particular delivery method may be less about a patient’s personal preference and more about the fattening of your doctor’s wallet.
Yes, it can be said that the local Hong Kong culture is all for C-section births, with a firm belief in astrological and auspicious dates playing an important role for elective C-sections. However, these cultural beliefs do not transfer over into the expatriate population and yet 50% of the C-section births that occurred in the private sector (public hospitals do not allow medically unjustifiable C-sections) are believed to have been performed unnecessarily.
Caesarian section rates may actually be a reliable indicator of whether a health system suffers from over-operating. Typically, it is good practice for a country’s Caesarian section birth rate to total a conservative figure that reflects the percentage of medically justifiable Caesarian section births. However, Hong Kong’s Caesarian section rate is twice that of the UK’s, Australia’s and the US. So, based on this, if one uses Caesarian section rates as an indication of whether a health system is over-operating, would it be far-fetched to extrapolate higher surgical rates in other areas of medicine as well?
This over-prescription of caesarean births is all the more baffling when the risks of a birth by C-section are compared to those that may occur during a natural vaginal delivery. Infections, excessive blood loss, anaesthesia complications, blood clots and possible injury to surrounding organs all pose very real threats, not to mention the dangers that face the unborn baby.
Then of course, you have the fact that you will need to spend more time (and money) in hospital, you’ll have a longer recovery period and may need more post-natal check ups than you would need for a natural delivery.
Furthermore, how a first delivery occurs basically dictates the risks for all subsequent births and so women with a history of a caesarean birth are more prone to risks if their second birth is a natural delivery. In other words, for a young woman’s first birth, natural delivery should always be encouraged unless a C-section can be medically justified.
However, rates for hospitalisation and obstetric care typically fall between USD $15,000-20,000 for a normal vaginal delivery (for a standard shared room) but can cost an extra USD $5000-10,000 for a basic (without complication) C-section procedure. Take this, and the fact that doctors can actually book C-section births – meaning more flexibility, more procedures and ultimately more money, and you may have an idea as to why a doctor may encourage a woman to have a C-section, rather than talk her out of it.
Meniscal tear surgeries are another interesting one to consider. On the one hand, you may wonder how the repair of cartilage in your knee could be deemed unnecessary, but on the other, the basic cost of a meniscal tear surgery in a private hospital can total USD $7000 (for 2 days in a standard room) so there is a lot of money to be made here.
The medical justification of meniscal tear surgeries is very dependent on the personal circumstances of the patient in question and an individual’s need for surgical repair can differ depending on the location and type of tear present.
For example, as meniscal tissue is non-regenerative, it has very few mechanisms for repairing itself and meniscal tears are therefore generally more likely to occur as we age. A degenerative tear can simply be the result of the wear and tear inflicted over the years and typically, these types of tears may not require surgery as an individual can still maintain an active and healthy lifestyle for the majority of the time (symptoms may worsen in certain conditions such as the cooler months of the year).
Acute tears and flap tears on the other hand, tend to be more symptomatic and can be very painful so a surgery would often be required in this case to relieve the individual of painful symptoms and try and save as much of the meniscus as possible.
Obviously each patient leads a different lifestyle and a perfectly functioning knee may be more necessary to some than to others (depending on a patients state of health, age etc). For less symptomatic tears, there are alternatives to surgery and a comprehensive physical therapy plan can help to strengthen the surrounding muscles in the knee, allowing a patient to avoid surgery whilst maintaining a reasonably active lifestyle.
A meniscal tear surgery does not guarantee a full recovery and there is a chance that the knee will not return to its original functioning state. Yet doctors may not be as keen to suggest physiotherapy, particularly to a patient on an expatriate package, as they would be to suggest surgery, and up to 70% of the meniscal tear surgeries performed in Hong Kong might have actually been carried out unnecessarily.
A knee arthroscopy is the typical procedure for carrying out a meniscal tear surgery but it can also be performed for diagnostic purposes.
However, while it may be a common, low risk surgery, there are still small risks present and other, less invasive ways available to observe the knee. But if you consider the fact that a typical MRI scan at a private hospital will cost around USD $700 whereas a knee arthroscopy will set you back USD $3500, that could explain why up to 80% of knee arthroscopies may have been performed unnecessarily in Hong Kong.
A cholecystectomy refers to the surgical removal of the gall bladder via an open surgery or a more common (and less painful) laparoscopy, and in Hong Kong at least 30% of gall bladder removals were believed to be unnecessary. While this may not be a particularly shocking figure in itself, if you consider that the risks with this kind of surgery involve possible blood clots, infection, damage to surrounding organs, pancreatitis and bile leakage, you might wonder why a doctor may choose to suggest this surgery if there is no urgent need for it.
The most common cause behind cholecystectomies is gall stones, however, many experts disagree as to whether a cholecystectomy actually needs to take place if gallstones are present but symptoms are non-existent.
If symptoms do become apparent, typical advice from a medical expert may be to wait and see if symptoms go away on their own (known as watchful waiting). This is especially recommended if a patient is experiencing gall stones for the first time, if the pain is mild and if they are not at risk of future complications or planning on having children. However, considering it is a relatively straight-forward procedure and the cost of a basic cholecystectomy with one day in a standard room can cost a minimum of USD $700 (not including doctors fees), its easy money for your surgeon, and an unnecessary cholecystectomy for you.
Unnecessary treatments are worrisome enough when they only affect you for the short term, but imagine if you found out you underwent a life changing operation when you could have survived without it.
Hysterectomies are typically the suggested treatment when a female patient is suffering from uterine fibroids, endometriosis, heavy menstrual bleeding, chronic pelvic pain and cancer (of the cervix, uterus or ovaries) and typically involve the surgical removal of the uterus and in some cases, the ovaries.
Uterine fibroids are noncancerous growths that develop in or around the uterus and are usually the most common reason for a hysterectomy. However, many women rarely experience symptoms and if they do, they can be mild and manageable without such drastic action.
Of course, symptoms vary depending on how many fibroids are present, their location and their size, but a hysterectomy should still be considered as a last resort, or if a woman does not plan on having children and has considered all her options first.
In fact, non-symptom causing fibroids typically do not become cancerous and unless they are causing pain or heavy bleeding, procedures to remove them would not normally be contemplated “just in case”. However, it is believed that up to 50% of the hysterectomies carried out in Hong Kong could have been medically unnecessary, leaving women with an irreversible and permanent alteration to their body.
Fibroid growth is stimulated by oestrogen, a hormone which naturally dwindles as a woman approaches menopause, by which time a fibroid could naturally shrink by itself without the assistance of a surgeon’s knife. Consequently, other procedures are becoming more popular alternatives to a full removal of the uterus. However, with a bare minimum cost of USD $900 (1 day in a private hospital standard shared room, doctors fees not included), it would appear HK surgeons are tempted to opt for more drastic methods rather than partake in watchful waiting.
Staying on the subject of women’s health, ovarian cystectomies are another controversial topic amongst healthcare professionals.
Like fibroids, ovarian cysts are often affected by a woman’s hormone levels and are actually a very common occurrence among women, particularly those in their child bearing years.
In fact, during a woman’s menstrual cycle, when an egg is released from a fluid filled follicle in the ovaries, it is very common for this a follicle to take on more fluid and grow into what is termed a ‘functional cyst’. These are typically around 3 centimetres big, they rarely become larger than 6 centimetres and while they may cause some mild discomfort during menstruation, surgery is not normally the optimal solution. In fact, 90% of simple cysts occur in this form and will simply go away on their own after about 5 weeks.
Of course, there are cysts that are not functional and can continue to grow in size but 98% of these cysts in young women are normally benign and pose no cancerous threats. In younger women in particular, cysts are highly dependent on a woman’s hormonal balance, so simple changes such as taking birth control pills, or adjusting diet and lifestyle, can dramatically affect a patients prognosis. This is especially the case if a patient is only suffering from mild symptoms and a watchful eye is kept on the cyst to monitor growth.
Considering that surgery can bring about significant risks and offers no guarantee that cysts will not return, it is somewhat surprising that surgeries appear to be so frequently resorted to for ovarian cysts in Hong Kong. Although, when the total cost for an ovarian cystectomy and a night in a standard (shared) room can reach USD $1800, maybe it’s not so surprising that up to 60% of these procedures may have been performed without solid medical justification.
Unnecessary surgeries seem to occur in other areas too, but when it comes to surgery on your spine, you would definitely want your doctor to consider all other options first. In Hong Kong however, this may not always be the case and as many as 70% of spine-related surgeries carried out here could have been performed unnecessarily.
With a condition such as spinal stenosis, depending on the severity of a patient’s case, it is quite likely that only mild or moderate symptoms will be present, so it is often manageable for a patient to wait and try other non-surgical treatments first. Most medical experts will in fact recommend other options above surgery and even then, surgery should be as non-invasive as possible.
Obviously, when operating on something as delicate as the spine, open surgery makes the procedure a high risk one and therefore more expensive (around USD $8300 including doctors fees and standard accommodation). Unfortunately, some doctors may suggest an open surgery for this very reason and seeking a second or third opinion is highly recommended for sufferers of spinal conditions, especially when you consider some of the potential risks involved (infection, blood clots, nerve and tissue damage, to name a few).
So, where insurance is concerned, what could all this mean for you as a policyholder and a possible ‘unnecessary’ patient?
Firstly, if you have purchased a local Hong Kong insurance plan, your procedure in a private healthcare facility will most likely be covered. However, as many plans include sub-limits on benefits such as surgical or anaesthetist’s fees, unnecessary procedures may eat into these benefits and could leave you paying out of pocket for unplanned or emergency medical treatment. What’s more, given that local Hong Kong health insurance plans are typically experience rated; unnecessary surgeries are likely to greatly affect your premiums when it comes to renewing your plan.
International health plans play more of an important role in Hong Kong as typically, most expatriates will be part of an international plan when receiving coverage in Hong Kong. Where premiums are concerned, unnecessary treatments have more of an indirect impact on international health insurance.
Since international plan premiums are community rated, the effects of unnecessary treatments are not immediately seen in premium rises at renewal.
However, if doctors are insisting on carrying out medically unnecessary surgeries left right and centre, more claims (which tend to be quite expensive for surgeries) will be paid out and premiums will see a steady increase overall. Furthermore, as many of the surgeries mentioned tend to be performed on younger patients, especially procedures such as cystectomies, C-sections and knee operations, it could mean that even if you fall under a younger ‘low risk’ age group; your premiums could rise dramatically in the near future if this trend continues.
As previously mentioned, private healthcare in Hong Kong is the second most expensive in the world after the United States of America, and the overuse of medically unnecessary surgeries will not help resolve this issue.
Another unhelpful factor which appears to be adding fuel to the fire, is that of the transparency (or rather lack of it) problem. Hong Kong’s private healthcare sector could definitely benefit from being at least a bit more open with their evaluative data. If an online system were to be made available whereby patients could have an insight into a surgeon’s previous rates in order to, for example, compare how often they performed C-sections over normal deliveries, doctors could gain more trust and loyalty from their patients and still not miss out on making money. And loyalty is the key to maintaining a reputation in the expat community where, as previously noted, word of mouth is so very much relied on and if a doctor comes highly recommended, they will be highly sought after.
If this trend continues however, insurance plans and premiums will undoubtedly suffer the biggest impact and so the important thing to take away from this is that second opinions matter. At the end of the day, it is your body that is going under the knife so don’t hesitate to find out just how necessary your surgery might be – you (and your insurance policy) won’t regret it.