Review Article

Open Access Journal of Review Article Biomedical Science ISSN: 2690-487X

The Portability of Health Care Services Between Guangdong and Macao

Chan Kin Sun1, Zhang Rui2*, Siu Yeung Fai3, Wei Hang4 1Programme Coordinator and Assistant Professor of master’s in public administration and Assistant Professor, Department of Government and Public Administration, Faculty of Social Sciences, University of Macau, Macao 2Student of Doctor of Philosophy in Public Administration, Department of Government and Public Administration, Faculty of Social Sciences, University of Macau, Macao 3Philip, Adjunct Associate Professor, Department of Government and Public Administration, Faculty of Social Sciences, University of Macau, Macao 4Supervisor, Global Exchange Office, City University of Macau, Macao

ABSTRACT

In the context of the development of a healthy city, the use of medical electronic vouchers, the remarkable results of smoking control haspolicy, to andcoordinate the relatively medical ideal resources preventive with medicine Guangdong and Provincethe control in ofthe COVID-19 future, in pandemic, order to enableMacao haslocal a residentssound healthcare to obtain system. more comprehensiveAccording to Macao’s and convenient micro-economy medical and services, newly i.e. introduction the portability of faculty of medical of medicine services. in Medical local university, doctor resources Macao SARare anGovernment important part of the medical service system and an important factor of the level of medical service. This study uses PEST as the analysis

researchframework results to summarize are also summarized the factors byfor PEST, the development including the ofrelated cross-city law amendments medical care (Politically); and multiple the location importance practice of the of equal doctors, status so as to conclude that the implementation of medical services in Macao can be. In the direction of portability of medical services, the

of patients for promoting the marketability of medical service in the Greater Bay Area (Economically); the establishment of an open KEYWORDScollaboration mechanism: (Socially); the establishment of a professional and patient unified management platform (Technically).

Guangdong-Hong Kong-Macao greater bay area; Portability; Cross-city medical care; Multiple location practice INTRODUCTION public institutions are to be coordinated. To realize this, several Regarding Medical Security, since Macao initiated in 2004 measures to facilitate convenient service are installed, in 2018, a “Health City” Scheme hosted by World Health Organization medical vouchers are issued in the form of electronic vouchers. And (WHO), Macao has become thereafter an exemplar of Healthy City a joint effort with Zhuhai has resulted in a promulgation of “trial points regarding Macao residents residing in Hengqin to be able Buildings, Tobacco and Health, and Healthy Lifestyle Movement to participate in Urban Resident Basic Medical Scheme of Zhuhai in its movement, specifically in School Health Promotion, Healthy [1]. These efforts have received recognition by WHO [2]. And residents”. This provision has enabled Macao residents living in the Health Bureau of Macao SAR Government has put forward a

under which activities related to hygiene matters in the private and Hengqin to apply for and benefit from identical medical insurance principle of “a sound healthcare system, putting prevention first”, benefits [3]. In 2019, Macao SAR Government has carried out more

Quick Response Code: Address for correspondence: Zhang Rui, Student of Doctor of Philosophy in Public Administration, Department of Government and Public Administration, Faculty of Social Sciences, University of Macau Received: August 21, 2020 Published: August 26, 2020

How to cite this article: Chan KS, Zhang R, Siu YF, Wei H. The Portability of Health Care Services Between Guangdong and Macao. 2020 - 2(5) OAJBS.ID.000210. DOI: 10.38125/OAJBS.000210

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proxy care, and branch service of medical institutions participating comprehensive smoking control policy according to tighter, overall to-point extension of medical institutions providing the service, by banning out-door standards [4] and this effort has been applied and Macao is different in that their medical system are not based Associationto electronic (Macao) cigarettes and Au shortly Hon Sam after Charity [5], exemplified Association by (Macao) effort in insurance schemes [13]. However, the situation in Hong Kong of collaboration between Smoking Abstention and Good Health the World greatly. Macao SAR Government actively tried to curb its upon low-cost, quality service [14], which may be in variation with in anti-smoking efforts [6]. In 2020, the COVID-19 outbreak affected arrangements in the Mainland of China. The “cross-city treatment right” in place is akin to the “cross-city patients’ rights” [15] under spread, making the territory with a low or zero rate of increase in the Guangdong-Hong Kong Macao cooperation scheme, which is cases. As of August, Macao has not had community outbreak of the canin contrast claim reimbursementto the across-the-board, of medical self-pay expenses regulation outside under of the peoplevirus, with infected. only 46There confirmed were nocases medical and 0 personnelcase of death. infected Of these [7], residing“Social Insurance place in special Law”. Thecircumstances, latter specifies including: that Chinese nationals 46 cases, 44 were people from outside and only 2 cases were local 1. The local medical institutions cannot provide the reflecting a high level of medical services in Macao. Macao Greater Bay Area, Macao implemented the “Outline get adequate treatment as a transfer patient Participating in the development of Guangdong-Hong Kong- necessary treatment, and upon their certification, the patient can 2. The cost covered by insurance for receiving medical care Area”, fostering areas of service for Macao residents in Guangdong in another institution other than the residing city is lower regardingDevelopment education, Plan for retirement,the Guangdong-Hong housing, transportation, Kong-Macao Greater and also, Bay

institutions being included in insurance schemes. the cross-border prospects for cross-city social insurance [8]. Later 3. Agreements by municipal government on outside medical on, in March of 2019, Macao participated in the “Joint Meeting of To realize the above, further actions need to be made in respect Municipal Departments of Guangdong-Hong Kong-Macao Cities” of medical service contracts, standardized contract samples to stipulate details of rights and duties of the signatories. Also, efforts ofand the became Greater signatory Bay Area”,to the “Frameworkenabling platform Agreement for oncooperation, Deepening mechanismGuangdong-Hong for effective Kong-Macao cooperation, Cooperation cooperation in the projects, Development civic medical record, so as to ensure legal protection and procedures in affairs and social welfare maters surrounding elderly service, living to enhance concepts of evidence, like proofs of registration and security, charity affairs, social organizations, social rescue and medical cooperation. According to the stipulation of the “Legal Aidlawsuits Regulations and trials. of theLegal PRC”, aid legalservice aid is is another the responsibility area of cross-city of the pandemic of coronavirus, Macao initiated a “Macao Health Code”, Government. To ensure the rights of the patients, legal aid helps in andexchange its use and in cooperation cooperation with matters its counterpart, [9]. In 2020, “Guangdong in confronting Health the disputes and can remove restrictions on the rights of the patients Code”. The interface of the two schemes was installed on May 10 due to their resident identities. from the Mainland need not undergo isolation and the returning For the Greater Bay Area residents, rights of medical care Macao[10] and visitors became to in Guangdong service for would the public be exempt on July from15. All quarantine residents [11]. The above provisions of health schemes and quarantine can be a reference. For example, payment of medical care in another exemptions witness a “smart” development of medical and health localityshould beshould extended be made equally. by Inthe this government regard, the of laws the incity place in whichin EU coordination between the parties, as directed by the state as an the patient lives. Actually, this cooperation has been in practice in important arrangement [12].

transfer service between Hong Kong and Macao: Health Bureau of Macao SAR Government and Hospital Authority of Hong Kong From the above background, this study summarizes the of medical practitioners” from a PEST (Political, Economic, Social has signed a cooperation agreement for 5 years (2018-2023) [16], prospects for “cross-city medical care” and “multiple-cities practices strengtheningStrengthening cross-city Cross-city medical treatmentControl to and Counter its development. Problems brought about by Asymmetrical Information (E) and Cross-cityTechnological) Medical analytical Care framework. The most important problem of medical reform comes from As professionalization in medical service is part and parcel asymmetrical information [17]. This results in the medical quality of social service development in Macao, its regularization has become necessary. However, as most Macao medical professionals control are discernible: are trained either in Mainland China or from Taiwan, and a lot of and makes its control an imminent issue. At present, three areas of Macao residents get medical treatment in neighboring areas. As 1. Mutual management and cooperation in accounting and clearance of medical insurance; establishing different levels of by people geographically, the mobility of medical practitioners evaluation implementation; and rational distribution of medical hasprofessional become very medical important. care requires The provision refinement of this in service accessibility is an resources in the Greater Bay Area [18].

Bay Area Strategic Planning. The following uses PEST as an 2. The possibility of control within the trade using important direction in the Guangdong-Hong Kong-Macao Greater organizations and associations therein to regulate internally and to improve on management and professional ethics. analyticalThe Right framework of Cross-city to delineate Medical the issue Treatment at stake. (P) grievances and complaints, providing communication channels Greater Bay Area, that is, based on the relevant regulations, certain 3. To unify on mechanisms intended for management of patientsConsideration can enjoy treatment made of in cross-city medical institutions medical treatment external to in his/ the her city, including medical costs incurred. This provision has already between the cure and the patients. In addition, perhaps the last area is to improve on systems of whistleblowing, trust, and anti- fraud using information technologies [19]. been made in respect of other areas of medical care, such as point- C 2020 Open Access Journal of Biomedical Science 553 Open Acc J Bio Sci. August - 2(5): 552-556 Review Article Review Article Zhang Rui

realities of the time. Laws, such as “Medical Practitioners Law” and organizations and associations in order to enhance development “Temporary Methods on Registration of Medical Practitioners”, of theIn medical this regard, industry Hong [20], Kong a prospective is exemplary facilitator of using of raising trade should be amended to ascertain the role and duties of the medical medical service in the entire Area. professionals. This will clarify a number of problems relating the medical professionals to the public, the institutions, the society, and Establishing Open-style Cooperation Mechanism (S) To coordinate policy implementation in the Area, the experience Hygienealso the relevantDepartment” government has some entities contradictions [22]. In addition, with the the “Medical current reference. The need to respect individual local policy and the “Notifications on Multiple-location of Medical Practitioners by of the EU in cross-city medical management can serve as a good Practitioners Law”, making the legality of the latter a standing issue requirement to implement cross-city provisions is reminiscent of [23]. the “One-Country, Two-Systems” situation. The realities call for an Medical Practitioners Practice”, “Temporary Method of Registration coordination mechanism can be realized by a Central Government If multiple-city practice is to happen, ambiguities in “Details on open-style, effective coordination mode of operation. An open-style localities of practice. The situation is less confronting in Macao, asof Medicala lot of medicalPractitioners” professionals should arebe clarified,graduates especially of Mainland regarding China committeedirected “Guangdong-Hongfrom the top. The Committee Kong-Macao serves Greater as the core Bay of Area the Medical Security Joint Committee”, something like an EU initiated Professional School and the Macao University of Science and oversight, coordination and supervision of discussion/ expert Medical schools. This will make graduates of the Macao Medical groupsmechanism, established and is responsiblethereunder. for The policy expert making, groups implementation, gather experts from respective localities. sponsoredTechnology hospitals (since 2019) and theless more susceptible binding to CEPA problems (Closer arising Economic from Unified Medical Management Platform (T) the ambiguities of the laws hitherto discussed. In fact, with jointly Greater Bay Area Development Plan Outline”, Macao has found Emphasis is on information interface and sharing. Through improvementsPartnership Agreement) in legal provisions and the helpful “Guangdong-Hong and instrumental. Kong-Macao standardization of medical management in the Greater Bay Area, Expediting Reform on Management System of Public Hospitals (P2) mechanism,management interfaceefficiency informationcan be enhanced advantage, and cost input of management by greater can be lowered. Reference can be made to EU’s information flow Multiple location for medical practitioners is an important issue. establishing an overall Greater Bay Area medical record and government public finance and social innovation research, based, reforms in areas pertaining to the profession must be However, as public hospitals are human resources management- data bank, facilitating prompt and speedy medical service. This profession, salary system, quality and safety management, post, and doing business, tourism, studies, or for other reasons. A system considered. Key areas of concern mechanism of management of the service will be particularly useful for short-term stay people

schoolsmotivation and system. is expanding Reference its experience can be drawn into fromShenzhen, Hong whichKong andhas platformpremised may upon include something services like EU’sother E111than filingdata of form patients. will make For witnessedMacao, especially in 2012 Hong a hospital Kong, operatedwhich has by well-established the University ofmedical Hong example,easier insurance it may enable clearing. standardization In addition, of the medical medical institutions management and professionalization of medical personnel, resulting in accreditation may open a medical school there also. Kong [24]. It is a possibility that Chinese University of Hong Kong management and protection of privacy of data should be enforced. Support on Group-led, Multiple-location Practitioner and standardization. Of course, in doing so, network security Mode (E) and Macao patients, through electronic platform can enable record The case of Guangdong province is illustrative of how Hong Kong According to established policy, there are three types of practitioners, including on Government directives ones, practice accessibility and faster payment, a prelude to e-medical care in cooperating hospitals, and the practitioner’s own initiative to practice in two or more medical institutions. The three can be Government.and e-voucher [21]. The latter prospects are a near possibility, with e-payment and featured finance promoted by Macao SAR Multiple Location Practice of Medical Doctors thesedifferentiated three types into of practice. directive-based Currently, or however, self-initiative-based. attention has been The discussion on the center of multi-location of practitioners around The fact that Hong Kong and Macao have higher economic law amendments and innovation in public sector medical service. paid to a group-led, multiple-location mode of practice. The attempt development is due to their market mechanism, which allows for the professional to be more in line with New Public Management This aspect enables multiple locations for medical doctors to is to allow the market force to play a more prominent role, enabling provide their service and to facilitate professionalization. Five areas medical institutions, reference can be made to “4+1” model used of improvements can facilitate medical policy reform, including and free market force. Regarding self-initiated multiple-location

medical doctors, the structure of revenue of medical institutions, in foreign countries, that is, out of five working days, only 4 days legal provision, public hospital reform, mode of certification of practiced in another hospital or clinics at local level. Another model and the training of medical professionals. Further details of these should be working in the hospital and the remaining 1 day can be

analysis done before. is “4+2”, which is, out of six working days, only 4 days are hospital realities can be delineated again through a framework of PEST medical care places. This possibility gives the medical practitioners Amendments to Laws and Regulations pertaining to work, the remaining 2 days can be at other hospitals or at local level Multiple-location Practice of Medical Doctors (P1) all, it affords choice by the medical practitioners [25] to provide more autonomy and efficient instrumentalities. Most important of The laws governing the medical profession, especially the “Medical Practitioners Laws” is imperfect, not corresponding to professional, high-quality, and safe medical practice. It also enables more insurance-support services.

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Improvements on Income from Medical Revenue and Re-making of Values of Medical Practitioners (S) for medical security, and a task force/ group comprising experts to As the current revenue structure of the medical sector is from Awork social on security coordination card along and communication the lines of form tasks. E of Technologically, the EU can be medicine and medical instruments, the service payment accruing a unified medical management platform should be established. value. The need for adjustment rationalizing the input of medical installed, enabling medical care at different localities and making from medical practitioners reflect a deviation from their real labor accreditation of the medical practitioners is very much needed. practitioners, and their salary reward, is therefore a pressing issue. it more cost-efficient in medical treatment. In this regard, a unified REFERENCES The remaking of the values of the practitioners should be based on 1. (2018) Macao healthy city committee of Macao SAR government. four aspects, including input of time, input of labor, input of know- valuehow, asshould well asbe riskextended and stress.not just Based to Mainland on these practitioners, four factors, but the 2. Healthy city 2017 work report and 2018 work plan. Health Department. service and labor value can be realized [26]. Rationalization of labor (China) Healthy city leadership programme for the prevention and also to Macao practitioners, so that the overall medical professional control(2014) Worldof noncommunicable Health Organization-Western diseases. World Pacific Health Region. Organization. WHO-Macao can have the incentive they deserve in order to better perform and improve. Perfecting Entry and Evaluation, Insurance, Oversight 3. Health Bureau of Macao SAR Government (2019) Zhuhai City Medical Security and Health Department Joint Press Conference Announce that and Related Logistic Policies (T) Macao residents living in Hengqin from July 1 can participate in Zhuhai 4. BasicHealth Medical Bureau Insurance. of Macao SAR Health Government Bureau of (2018) Macao Entertainments SAR Government. places and their evaluation should be based on their education and training, except places established with new standard in place and those granted A system on entry qualifications of new medical practitioners starting from Jan 1, 2019 will enforce now all-around smoking control,

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