25 Apr 2013


One year ago, a girl described her aspiration to serve the poor at our admission interview. I asked, “In the current public hospital system, patients have to line up for investigations and treatment. For example, a cancer patient may have to wait several weeks before surgery can be performed. Now, if she agrees to pay for the service as a private case, the surgery can be done on the next day. Do you find this acceptable?”

“No,” the girl replied promptly, “all people should have equal access to medical care. Allowing rich people to jump the queue is unfair and is a discrimination against poor people.”

“Are you against private medical service in general? If the same patient enjoys immediate surgery at a luxurious private hospital, is it unfair?” I pursued. The girl appeared less confident. “I still feel it not right.”

After the interview, my co-interviewer exclaimed, “Communism!”

I did not have any standpoint when I asked the question. Some are proud to be the doctors of the richest men in town, while others take pride in serving the public. I thought it was just a matter of choice. It was not until the hospital raised the private consultation fees that I gave the matter another thought.

Our administrators would tell you that the private service at public hospitals serves a noble mission – to earn money to support other public services. Besides, the two systems are separate and would not interfere with each other. Both arguments are flawed. First, the purpose of public hospitals is to provide affordable medical service to the public, not earning money. If resource is at stake, we should seek support from the government and cut unnecessary wastages. At the same time, patients who can afford private service may be encouraged to do so. We do not need to provide private service ourselves.

Second, we are the same doctors. When we are seeing private patients, we cannot be seeing public patients at the same time. Whenever some of us perform endoscopies for private patients, we occupy the rooms and our colleagues can just stay idly in the waiting area. It is difficult to conceive how public service would not be affected.

Of course, our applicant did not know the inside story. Her argument therefore centered on equality. Is equality a sound argument against private medical practice?

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