VZCZCXRO1824
PP RUEHCN RUEHGH RUEHVC
DE RUEHHK #1773/01 1840707
ZNR UUUUU ZZH
P 030707Z JUL 07
FM AMCONSUL HONG KONG
TO RUEHC/SECSTATE WASHDC PRIORITY 2174
INFO RUEHOO/CHINA POSTS COLLECTIVE PRIORITY
RUEHGV/USMISSION GENEVA PRIORITY 1098
RUEHRC/DEPT OF AGRICULTURE WASHDC PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY

UNCLAS SECTION 01 OF 03 HONG KONG 001773 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
STATE FOR EAP/CM AND EAP/EP TWANG 
STATE FOR G/AIAG JLANGE, HFOSTER, RFENDRICK 
STATE FOR M/MED AND M/MEDEX PETER WOOD 
STATE FOR INR/EAP 
HHS FOR OGHA - STEIGER, BHAT 
BANGKOK FOR RMO, CDC 
STATE PLEASE PASS TO USDA FOR DU/US LAMBERT 
BEIJING FOR DSELIGSOHN 
 
E.O. 12958: N/A 
TAGS: ECON TBIO SENV EAGR AMED KFLU HK CH
SUBJECT: MACAU HEALTH CARE:  RESPONDING TO NEW REALITIES 
AND OPPORTUNITIES 
 
REF: A. HONG KONG 189 
     ¶B. HONG KONG 193 
     ¶C. HONG KONG 1510 
     ¶D. HONG KONG 1661 
 
 ¶1. (SBU)  Macau's health care system is coping wth the 
territory's quick economic expansion, rapd population 
growth, and large influx of tourist.  A system that was 
created to care for 400,000residents now provides health 
care services to oer 500,000 people and approximaely 21 
million tourists (and rising) per year.  While existing 
health care facilities are able to provide preventive care to 
local residents, health care officials acknowledge that 
emergency response capabilities must be expanded.  Macau 
experiences a shortage of trained medical professionals -- 
particularly specialized physicians, nurses, and physical 
therapists -- and is looking to mainland China to fill the 
gap. 
 
¶2. (SBU) Macau's Center for Disease Control and Prevention 
greatly depends on Hong Kong and other international partners 
for information on emerging infectious diseases and how to 
develop response strategies.  Macau plans to follow Hong 
Kong's lead in responding to an Avian Influenza (AI) or other 
pandemic.  Tuberculosis, HIV/AIDS and dengue fever also 
remain immediate public health concerns.  A recent health 
survey by Macau Polytechnic University reveals that the local 
sex industry could contribute to the expansion of AIDS in the 
region.  (NOTE:  This cable follows previous reports on the 
strains of rapid development on Macau's existing public 
infrastructure and how the Macau Special Administrative 
Region Government (MSARG) plans to respond.  See reftels.) 
END SUMMARY. 
 
---------- 
BACKGROUND 
---------- 
 
¶3. (SBU) Macau's health care infrastructure, developed under 
Portuguese rule, envisioned universal health care coverage 
for a population of 400,000 through a system of two hospitals 
and six health care clinics.  These facilities are largely 
geared to serve the population of the urban Macau peninsula, 
while two satellite facilities serve the populations of the 
outlying islands of Taipa and Coloane.  (Note:  Macau, with a 
current population of over 500,000, consists of the Macau 
peninsula, two islands, and Cotai, a 16 kilometer landfill 
area between the islands.  Over the next few years, Cotai 
will become the heart of Macau's casino, gambling and 
convention industry.) 
 
¶4. (SBU) Currently, the health care system's annual budget of 
1.7 billion patacas (approx. US$200 million) is financed 
through government revenue, which has increased recently due 
to the liberalization of the gaming industry.  The Department 
of Health has a staff of 100, including nine public health 
physicians, 12 public health "technicians," two public health 
nurses, and 33 sanitary inspectors.  All of these technical 
specialists could be mobilized during a public health 
emergency.  The Department of Health also contains Macau's 
Center for Disease Control and Prevention, which employs 
three physicians.  Macau's two functional hospitals -- a 
government facility and a private facility -- are 
supplemented by an recently-opened private hospital at Macau 
University of Science and Technology.  This small 
experimental facility combines western and traditional 
medicine.  Macau residents receive the bulk of medical 
services through public clinics, which provide preventive 
care and health promotion outreach at little or no cost.  The 
most pressing problem in the health care system now is 
emergency response capabilities -- both those involving 
pandemic diseases and routine emergencies.  While this 
problem should not impact the daily provision of medical 
services, it could complicate the MSARG's ability to respond 
to a crisis. 
 
--------------------------------- 
Emergency Services & Future Plans 
 
HONG KONG 00001773  002 OF 003 
 
 
--------------------------------- 
 
¶5. (SBU) Head of Macau's Center for Disease Control and 
Prevention Tong Ka Io told us that the provision of emergency 
health services remains a problem for Macau, particularly in 
the outlying regions of the territory.   To address this 
issue, Macau's private hospital recently opened a satellite 
emergency clinic to serve Taipa, but Tong acknowledged that 
this small facility cannot handle all emergencies.  He also 
stated that Macau does not yet have adequate plans for 
providing health care and emergency response services in the 
Cotai strip.  He acknowledged that the lack of facilities in 
this area could affect the MSARG's ability to respond to a 
large scale public health issue in this future tourist hub, 
where 16 international hotels and casinos are slated to open 
in the next few years.  Tong said that the government plans 
to contact casino operators about response plans and believes 
that some casino operators could be developing their own 
facilities/plans to respond to various emergency situations. 
 
------------------------- 
Staffing & Finance Issues 
------------------------- 
 
¶6. (SBU) The Macau health care system faces a shortage of 
qualified personnel.  Macau has enough general practitioners, 
but lacks specialists, trained nurses and physical 
therapists.  For the past few years, it has imported doctors 
from prestigious hospitals and medical schools in the 
Mainland.  However, as salaries and private opportunities 
rise on the Mainland, Macau is facing strong competition for 
these professionals.  Macau recently drew up a "Ten Year 
Human Resource Nursing Plan" to increase the number of 
nurses;  Macau will have to import foreign nurses from 
mainland China to meet this goal, although importing labor, 
even skilled labor, is controversial with the Macau public. 
Nonetheless, he underscored that bringing in non-Macanese 
doctors and nurses is the most efficient and cost effective 
way of expanding health care services for the population.  He 
also stated that increased government revenue provided 
opportunities to the MSARG to reform and expand the health 
care system, including hiring more personnel and creating 
additional facilities.  However, the public is opposed to any 
changes to the health care financing system.  In fact, the 
government backed down to public opposition during previous 
attempts at reform.  Tong later acknowledged that economic 
and population growth will eventually mandate changes to the 
financing system even if the government does not yet have 
popular support or a concrete reform proposal.  Ultimately, 
the Macau Secretary for Social Affairs and Culture, who is 
responsible for the health sector, will make these policy 
decisions. 
 
--------------------------------------- 
Infectious Diseases and Avian Influenza 
--------------------------------------- 
 
¶7. (SBU)  Emerging infectious diseases are a major concern 
for Macanese authorities.  Given Macau's small size and its 
lack of domestic research institutions, it depends largely on 
Hong Kong for information and guidance.  Tong noted that 
Macau experienced a devastating outbreak of dengue fever in 
2001, when over 1,400 people became infected.  The MSARG 
responded by creating and later strengthening the powers of 
the Macau Center for Disease Control and Prevention.  This 
proactive approach helped Macau prepare for the SARS crisis, 
although Tong admitted that they largely took a trial and 
error approach to SARS.  Macau health authorities closely 
monitored the situation in Hong Kong and Guangdong, 
replicated treatment and prevention techniques that appeared 
to work elsewhere, and altered protocols that were not having 
success in the Mainland.  Despite Macau's ability to avoid a 
devastating epidemic, Tong implied that they were lucky not 
to have had any deaths during the SARS crisis. 
 
¶8. (SBU) He noted that information sharing has improved 
between Hong Kong, Guangdong and Macau.  He said that Hong 
Kong has been particularly helpful in allowing Macau to use 
 
HONG KONG 00001773  003 OF 003 
 
 
its laboratory services for testing, accepting patients that 
Macau cannot treat effectively, and providing occasional 
training.  He said Macau, like Hong Kong, is completely 
transparent in disclosing information on diseases, but that 
mainland authorities could be more forthcoming.  Tong said 
that the lack of intensive care facilities remains a major 
gap in Macau's pandemic preparedness plans.  Macau currently 
has about 40 intensive care beds and can increase that 
capacity to 50 in an emergency.  MSARG has plans to build a 
stand-alone infectious disease facility at the government 
hospital that would be used to isolate patients during a 
pandemic.  MSARG is also stockpiling anti-virals.  In a 
preventive move, the MSARG already closed poultry farms, 
implemented stricter biosecurity and sanitation requirements 
at wetmarkets, and mandated that imported birds be 
slaughtered the day they enter Macau.  Tong also cited 
tuberculosis, HIV/AIDS and dengue fever as immediate public 
health concerns. 
 
-------- 
HIV/AIDS 
-------- 
 
¶9. (SBU) In a separate meeting, Cheng Bing Shu, Associate 
Professor in the School of Health Sciences at Macau 
Polytechnic University, stated that Macau has a good system 
of primary health care, but that the government does not have 
an adequate handle on infectious diseases, particularly 
HIV/AIDS.  He told ConGen staff that HIV could become a 
larger problem in Macau society.  In an on-going university 
survey of 3,000 Macau residents, Cheng claimed that 18% of 
adult Macanese men admitted to having visited prostitutes, a 
figure that Cheng stated is not reflected in current 
government statistics.  He said that respondents were chosen 
by computer generated software to include a random, but broad 
section of society.  In the survey, respondents underwent 
complete physicals, received blood and urine analyses, and 
spoke at length about lifestyle and diet.  Cheng believes 
that the MSARG should take a stronger role in regulating the 
sex industry, including conducting regular medical tests on 
sex workers.  This academic survey could have broader 
implications for HIV/AIDS infections in southern China.  The 
final study, with a detailed methodological review, will be 
published in late 2007.  CongGen Hong Kong will follow up 
with Macau Polytechnic University when the survey is 
finalized. 
 
------- 
COMMENT 
------- 
 
¶10. (SBU) The MSARG recognizes the need to implement changes 
to its health care system to meet the challenges of the new 
Macau.  With growing gaming and tourist revenue, the 
government should have adequate financial resources to 
implement changes and improve response services during public 
health or other emergencies.  However, the MSARG currently 
lacks the policy and regulatory expertise, areas where the 
USG could offer advice.  Equally important, the MSARG appears 
to lack the political will to execute broad policy changes. 
As in other areas, the MSARG seems unwilling to take 
potentially unpopular measures, even if those measures would 
expand the availability of services and guarantee a more 
sustainable health care system for the people of Macau. 
Cunningham