Replies to LegCo questions
LCQ5: Fees and charges for public health care services
Following is a question by the Dr Hon Yeung Sum and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (April 26):
Question:
The Chairman of the Hospital Authority (HA) told the media that he hoped to
substantially increase a number of fees and charges for public health care
services this year in order to maintain the quality of such services and prevent
abuse. In this connection, will the Government inform this Council:
(a) whether it knows the rationale put forward by the Chairman of HA to
substantiate his claim about the abuse of health care services and the ability
of increased fees and charges to reduce such abuse, and whether the authorities
will, before deciding whether or not to agree to the fee and charges increases,
explore whether they can use other methods, such as improving the service
delivery model and operation, etc, to reduce inappropriate use of health care
services;
(b) of the number of submissions which opposed the substantial increases in fees
and charges for public health care services received by the authorities in their
consultation last year on the future service delivery model of health care
services; whether the authorities, in studying whether or not to increase the
fees and charges, will respond to these opposing views and consider putting in
place a mechanism, whereby any adjustment in fees and charges for health care
services must have the support of the public or their representatives; and
(c) whether the authorities will consider devising a set of clear and objective
criteria to determine whether or not to increase the fees and charges for public
health care services, such as linking the fees and charges for public health
care services to the median income of the public for assessing and calculating
such fees and charges?
Reply:
Madam President,
(a) The public medical services currently provided by the Hospital Authority
(HA) are heavily subsidised. As a result, some users of HA's services may not be
aware of the actual costs of the services they received, which may in turn lead
to abusive use of such services and wastefulness of medical resources. It is,
therefore, an important task of the Government to instil a more appropriate
sense of value amongst the public so as to reduce instances of abuse and misuse.
The Administration and the HA are now conducting a new round of review of public
medical fees with a view to targeting government subsidies on patients and
services most in need as well as redressing the imbalance between the public and
private services. In the review, we would also examine the existing fee waiver
mechanism for public medical services to ensure that adequate services remain
accessible to persons in economic hardship, including those not receiving
Comprehensive Social Security Assistance.
At the present moment, the review is still in progress. Pending outcome of the
review, the Administration and the HA would not have preconceived conclusion or
decision on any possible proposals, including the possibility of increasing
public medical fees.
Increasing public medical fees is indeed only one of the feasible options for
reducing the misuse of medical services. The Administration and the HA would
consider other options, including strengthening collaboration between the public
and private medical sectors so as to ensure that our limited resources are used
most effectively on those with genuine needs.
(b) In July 2005, the Health and Medical Development Advisory Committee issued
the discussion paper "Building a Healthy Tomorrow". The main objective of the
discussion paper is to explore the future service delivery model for our health
care system. Amongst the topics discussed are elements that should be
incorporated in the future delivery model, collaboration between the public and
private medical sectors, positioning of the various levels of medical care, and
the direction and principles for moving towards the future delivery model.
About 600 written submissions were received from various sectors of the
community in response to the discussion paper. Of the submissions received,
* 7 submissions opposed clearly to any proposal for increasing the fees for
accident and emergency services, specialist out-patient services and the supply
of drugs in public hospitals;
* 15 submissions supported increasing the fees for such services so as to
discourage the misuse of public medical services and redress the imbalance
between the public and private medical sectors;
* 2 submissions supported in principle that medical fees should be increased,
but suggested at the same time that the Government should establish some
benchmarks for the determination of medical fees by private medical
organisations.
We also received 77 messages posted on the Public Affairs Forum of the Home
Affairs Bureau in response to the discussion paper. Of these messages,
* 7 respondents were of the view that improper use of accident and emergency
services and ambulance services had put extra strain on HA's stringent financial
resources. They suggested that the fees for these services should be increased
so as to reduce abuse; and
* 4 respondents considered that the existing medical fees were too low. They
supported increasing medical fees and that patients should be charged different
levels of fees based on their affordability.
While the discussion paper was not published to solicit views on public medical
fees particularly, we will take into consideration the views received from the
public in respect of patients' affordability and consult the Legislative Council
when evaluating any fee revision proposal.
(c) The Administration already has in place a set of comprehensive criteria for
the review of public medical fees. The factors that will be taken into account
include the overall costs of the public medical services; the level of
government subsidies; how to better target existing government subsidies on
patients most in need; and the need to instil a more appropriate sense of value
of HA's services amongst users so as to reduce abusive use and wastefulness of
medical resources. In addition, we will consider the affordability of users and
provide a safety net for those in need.
In the provision of public medical services, the Administration has four
priorities areas, which include, amongst others, the low-income group and the
underprivileged, and the provision of acute and emergency care services. We will
give due regard of these service priorities in our consideration of any fee
revision proposal. Therefore, the factors that need to be taken into account
have to be comprehensive and wide-ranging. Affordability of members of the
public is also one of the factors to be considered. The important point is that
we already have in place a well-established fee waiver mechanism to provide a
safety net for those who need to use public medical services but have difficulty
in paying for the fees, and to ensure that they would not be deprived of the
appropriate medical care due to financial hardship.
Ends/Wednesday, April 26, 2006
Issued at HKT 12:59
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