SARS: LESSONS TO LEARN FOR GPs WHEN HANDLING A PUBLIC HEALTH CRISIS

Severe acute respiratory syndrome (SARS) took the world by surprise and caught many health professionals off guard. On a positive note, this novel infection has uncovered many flaws and, inevitably, highlighted where reforms in our healthcare delivery systems need to be made. There were many similarities on the handling of SARS and the impact it had in Canada and Hong Kong:1 both places had never faced an epidemic that took such a direct toll on healthcare workers. Surveillance and warning systems were inadequate in preventing the outbreaks in both places. Their clinical and public health systems were not readily prepared for an emerging infectious disease outbreak.

The Chinese University of Hong Kong and University of Toronto carried out a postal survey on 183 and 150 academic GPs in May–June 2003 with 75% and 34% response rate, respectively. The results showed that doctors from Hong Kong were much more likely to order blood tests and/or chest x-ray (odds ratio [OR] = 37.8, 95% confidence interval [CI] = 12.65 to 113.06), whereas doctors from Toronto were more likely to wait longer for the results (OR = 50, 95% CI = 16.7 to 100). In addition, doctors from Canada were much more likely to experience appointment delays or cancellations (specialists OR = 20, 95% CI = 9.1 to 50; surgery OR = 6.25, 95% CI = 3.2 to 12.5) or difficulties in making specialist referrals (OR = 14.3, 95% CI = 7.1 to 33.3).

Generally speaking, GPs have the role of gate-keeping for hospital care, but in Hong Kong 70% of primary care is provided by the private sector, whereas 90% of hospital care is carried out in public institutions.2 There is little interface between primary and secondary care, let alone collaborations between the private and public sectors. In the fear and panic created by SARS, many private doctors in the community found it difficult to manage patients with common symptoms, such as fever or cough, without resorting to many unnecessary investigations. If GPs in Hong Kong had direct access to basic diagnostic procedures and support from hospital staff, they could screen suspected cases more effectively, avoiding extra strain in the overstretched public health system. On the other hand, the health care in Canada is provided through provincially administered universal health insurance plans with no parallel private systems. Thus, overwhelming cancellations and delays in appointments and laboratory results were evident when there was no surge capacity in a public health crisis.3

One of the ways forward is the establishment of private–public partnership, for example, sharing clinical information; outsourcing clinical support (laboratory or radiology) services; preventive services, such as contraceptive, childhood immunisation, and developmental surveillance; and specialised clinical services, such as antenatal or chronic disease care or even private management of public hospitals. Not only will this allow additional resources for health at a time when they are scarce, but private institutions can bring with them better management and marketing skills to complement the social commitment of the public sector. Another advantage is that the quality of health and allied services are likely to be improved because the monopoly for provision of goods and services by the public sector will be replaced with competition among different participants. This will ensure that resources are allocated more efficiently, with those able to pay using private services, while public resources are targeted to reach those who cannot pay. We believe that this new model will be seen as a ‘win–win’ arrangement in which diverse players with varied motivations and philosophies of work will get together and be able to fufil different health needs and contribute to better health of the people.

• © British Journal of General Practice, 2005.