Replies to LegCo questions
LCQ14: Mainland women giving birth in Hong Kong
Following is a question by the Hon Li Kwok-ying and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (October 27):
Question:
It has been reported that the number of Mainland women giving birth in Hong Kong has been on the rise, resulting in an upsurge in the demand for obstetrician and neonatal services in hospitals, and that some woman patients who are about to give birth or have just given birth have to rest in mobile steel wheeled beds which are normally used for transporting patients into and out of nursing wards. In this connection, will the Government inform this Council whether it:
(a) knows the respective numbers of cases in which Mainland pregnant women have used the services provided under the public health and medical care system in Hong Kong, and the resources involved, in 2002, 2003 and so far in 2004, and the number of cases in which fees have not been paid and the total amount involved, as well as the measures the Hospital Authority (HA) has put in place to ensure that patients must settle the fees before they are discharged from hospitals;
(b) knows the current usage rates of obstetrician and neonatal services provided in public hospitals in various districts, whether they are being used to capacity, and the short-term measures adopted by HA to alleviate overcrowding in nursing wards as well as the pressure faced by front-line medical personnel; and
(c) has reviewed the demand for obstetrician and neonatal services in Hong Kong, having regard to its population policy and the trend of Mainland women coming to Hong Kong for childbirth; if so, of the review results; if not, the reasons for that, and whether it will review the relevant medical services in the light of the demand, and formulate long-term policies and measures accordingly?
Reply:
(a) The number of non-resident Mainland women giving birth in Hospital Authority (HA) hospitals, the resources involved, the number of default cases and the consequential amount written off are shown in Annex.
The following measures have been taken to minimize the write-off of medical fees:
* On admission, private inpatients and non-eligible persons are required to pay deposits. At present, the amount of the deposit is fixed at $19,800.
* During hospitalization, interim bills are sent to patients on a weekly basis.
* In case a patient fails to settle the bills, his/her next of kin will be contacted for payment.
* Reminder and final notice will be sent to the patient after dispatch of the final bill.
* In addition to mailing, telephone calls will be made to patient or his/her next of kin to request for an early settlement of medical fees.
* If the bills remain outstanding, legal actions will be instituted where appropriate, taking into account factors such as the amount in arrears and the chance of successful recovery. These legal actions include submission of cases to the Small Claims Tribunal and execution of bailiff.
In addition to the above,
* Patients are reminded of their responsibilities to pay hospital fees and provide correct correspondence details.
* To facilitate collection of outstanding debts from frequent defaulters, a 'frequent defaulter report' is generated on a weekly basis. The report lists out the amounts due by patients who are currently under maintenance at a particular hospital. Based on the list, hospital staff would follow up the outstanding fees with the patient and / or his next of kin.
* To facilitate payment by patients, various means of settlement are accepted including local and foreign currency cash and cheque, EPS, PPS and credit card. Settlement by Octopus card is being piloted and introduction of the China Union Pay card is being arranged.
(b) The overall utilization rates of obstetrics and neonatology services in HA hospitals were in the range of 56 per cent to 78 per cent over the past few months and there was no evidence of substantial increase. There is a seasonal pattern of workload with relatively high usage rate between August and January each year. Also, the majority of NEP mothers, who have little antenatal care, often discharge themselves within 24 hours after delivery, leaving very little time for optimal observation of the newborn babies and education of mothers on baby care. This has resulted in an increase in the number of babies requiring medical intervention because of infection, dehydration, severe neonatal jaundice or congenital anomalies.
For individual hospitals, United Christian Hospital recorded a bed occupancy rate of 113 per cent in September 2004. Prince of Wales Hospital and Tuen Mun Hospital recently reported relatively large number of NEPs presenting to labour units after 12 midnight, resulting in an increase in workload for the night-shift staff, which is normally smaller in number compared to other shifts.
To address rising workload of NEP deliveries, hospitals are improving mid-night staffing levels, with the deployment of more nurses with midwife qualifications to obstetrics units. To develop staff capacity, midwifery refresher courses are being organized for nurses with midwife background and more part-time nurses are being recruited.
(c) Obstetric services in HA hospitals have, in the past, been adjusted in view of reducing birth rates based on population projections. The HA has all along been monitoring the trends in births rates and will continue to do so in the light of rising proportion of NEPs. It is predicted that there will be a continuous rise in total birth rates and obstetric workload for the coming year. The areas of our concern are : lack of antenatal care for these NEP pregnancies and the short stay of NEP mothers, both of which would lead to increase of maternal and foetal complications and possible longer term health implications to mothers and children. Obstetric service and manpower will be adjusted accordingly. The Government and the HA are conscious of the importance of appropriate deployment of resources to ensure quality medical services for the local population, and are considering how best to tackle the rising trend of Mainland pregnant women coming to give birth in Hong Kong.
Ends/Wednesday, October 27, 2004
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Legislative Council Q14
Annex
Year |
Number of non-resident Mainland women who gave birth in HA hospitals
|
Estimate cost of resources used $ (Million) |
Number of default cases* |
Total amount written-off* |
|
2002/03 |
8 736 |
89.3 |
315 |
$2,668,306 |
|
2003/04 |
8 727 |
93.5 |
581 |
$4,057,388 |
|
2004/05 (6 months) |
5 356 |
54.4 |
4 |
$29,300 |
* Status as at 30 September 2004. For 2004/05, action is still being taken to recover the majority of debts, hence the amount written off is relatively small at this stage.