Doctors are worried about the difficulty of screening and follow-up. Industry: Public-private partnership referral guidelines must be clear. Follow up with the community as much as possible to reduce the burden on public hospitals.
Figure – The picture shows Sham Shui Po District Health Centre. The “Policy Address” proposes a new plan to fund hepatitis B screening… (photo by Liao Kailin)
[Ming Pao News] The “Policy Address” proposes to implement a new plan within this year to subsidize the screening of hepatitis B carriers to prevent and treat liver cancer. It is expected that screening will be carried out at district health centers, and carriers will be followed up by family doctors on a co-payment model. A review of data from the Department of Health estimated that approximately 410,000 people in Hong Kong are suffering from hepatitis B. Chan Pui-yin, a gastroenterologist and liver specialist and vice-president of the Hong Kong Medical Association, is worried that hundreds of thousands of carriers will be screened in a short period of time, which may increase the number of public hospital consultations. ; He pointed out that the treatment and follow-up of hepatitis B are different from those of hypertension and diabetes. He paid attention to the follow-up arrangements for screening and emphasized that it should avoid increasing the burden on public hospitals. Legislator Lin Zhexuan of the medical and health sector suggested clearly setting the conditions for referral to public hospitals so that most cases can truly be followed up by the community.
Ming Pao reporter Yang Chen
This newspaper asked the Health Bureau to inquire about the target audience of the new plan, the number of carriers expected to be screened, and the pressure that identifying more carriers will put on the public medical system. The Health Bureau responded that the new plan will be implemented through district health centers. Collaborate with family doctors to provide risk-based hepatitis B screening and ongoing management through a co-payment model, allowing suitable patients to receive ongoing care services in the community, adding another way to manage hepatitis B. The Bureau is formulating planned service models and procedures, strengthening training for medical professionals, and will announce details in due course.
Specialist: Different treatments for diabetes and hypertension
Difficulty comparing referral follow-up
Looking at the 2020-22 Population Health Survey Report of the Department of Health, nearly 40% of people with chronic hepatitis B virus infection did not report themselves as patients in the survey, and about 70% did not seek relevant medical services, indicating that there is a considerable proportion of chronic hepatitis B in Hong Kong. People infected with the virus do not know their infection status. The Department of Health also estimates based on the results that about 5.6% of the entire population in Hong Kong is suffering from hepatitis B, which is about 410,000 people. The Department of Health recommends that people infected with hepatitis B should take into account factors such as age and family history, and undergo “blood alpha-fetoprotein test (AFP)” and ultrasound examination every 6 to 12 months to monitor the risk of liver cancer (see separate article).
The new plan is expected to refer to the chronic disease co-treatment plan, with screening conducted by regional health centers and family doctors following up on carriers. Chen Peiran has a “neutral” attitude towards the new plan and believes that it is difficult to evaluate the effectiveness at present. However, he said that hepatitis B patients need to be followed up two or three times a year. “Even if 400,000 people are not screened, 200,000 people are suddenly screened out.” It may be Hundreds of thousands to millions of new medical consultations will increase the workload of frontline medical care and even increase the burden on public hospitals. The number of patients and treatment methods for hepatitis B, hypertension and diabetes are different, making it difficult to compare the referrals of the two plans to public hospitals. The number of specialist cases depends on the status of the screened carriers.
Lin Zhexuan: If the condition is stable, it should be followed up by a family doctor
Lin Zhexuan believes that the new plan can screen out hepatitis B carriers as early as possible and follow up, “rather than waiting for liver cancer to be admitted to the hospital first.” He believes that it can save public medical burden in the long run. He added that family doctors have the ability to be responsible for routine follow-up and timely referral to specialists. Once the patient becomes stable, the family doctor can continue to follow up, which is expected to not increase the burden on the public hospital.
Lin suggested that the government should improve the public hospital referral system. “Family doctors are fully capable of treating (diseases), and (public hospitals) will not accept them.” The government should allow citizens to obtain most medical services in the community. He also suggested that the government refer to other countries to formulate clear guidelines, including referrals to specialists, frequency of consultations, etc.; it also needs to purchase sufficient private medical services, including laboratories and family doctors, to provide one-stop services as much as possible.
Lin Yonghe, a family doctor who participates in the chronic disease co-treatment program, said that hepatitis B is “invisible” and carriers usually have no symptoms and often seek medical treatment only when they develop cirrhosis and liver cancer. He believes that early screening is necessary and he expects the target population of the program to be They are high-risk groups such as family members of hepatitis B carriers, people who have not received the hepatitis B vaccine, new immigrants, and foreign domestic helpers. Lin suggested that public hospital specialists, family doctors and other stakeholders should work closely together. In addition to identifying hepatitis B carriers during the screening stage, liver enzyme testing, such as “alanine aminotransferase (ALT)”, “aspartate aminotransferase (APT)”, etc., can be added. Those in need should be promptly referred to specialists, and other stable cases should be followed up by family doctors. In addition to liver cancer monitoring, liver function tests should also be included in follow-up follow-up.
Original URL: https://news.mingpao.com/pns/%E6%B8%AF%E8%81%9E/article/20250102/s00002/1735752818236
