LegCo Paper No. CB(2) 2077/95-96
[These minutes have been seen by the Administration]
Ref: CB2/PL/HS/1

LegCo Panel on Health Services

Minutes of Meeting
held on Monday, 8 July 1996 at 8:30 a.m.
in Conference Room A of the Legislative Council Building

Members Present :

    Hon Michael HO Mun-ka (Chairman)
    Dr Hon YEUNG Sum
    Hon Howard YOUNG, JP
    Hon CHAN Yuen-han
    Dr Hon LAW Chi-kwong
    Hon MOK Ying-fan

Members Absent :

    Dr Hon LEONG Che-hung,OBE, JP (Deputy Chairman)] away from Hong Kong
    Dr Hon HUANG Chen-ya, MBE ] other Commitment

Public Officers Attending :

Health and Welfare Branch
Mr Clement CHEUNG
Deputy Secretary for Health & Welfare (Acting)
Mr Derek B GOULD
Principal Assistant Secretary for Health & Welfare
Miss Helen TANG
Principal Assistant Secretary for Health & Welfare (Acting)
Miss WONG Yuet-wah
Assistant Secretary for Health & Welfare
Deaprtment of Health
Dr P Y LAM
Deputy Director of Health (Acting)
Hospital Authority
Dr W M KO
Deputy Director, HA

Staff in Attendance :

Ms Doris CHAN
Chief Assistant Secretary (2)4
Mr Alfred CHAU
Senior Assistant Secretary (2)4

Closed Meeting

The Chairman proposed and members agreed to discuss the research paper on Emergency Ambulance Service in September 1996.

2. The Chairman said that the Administration should furnish the Panel with all outstanding information requested by members within two months.

Clerk

Open Meeting

I. Confirmation of minutes of meeting and matters arising

(LegCo Paper No. CB(2) 1785/95-96)

3. The minutes of the meeting held on 20 May 1996 were confirmed.

4. The Chairman suggested and members agreed that the Panel meeting on 12 August 1996 should be rescheduled to 9 September 1996.

II. Charging policy in respect of privately purchased medical items

(Appendix I of LegCo Paper No. CB(2) 1782/95-96)

5. Dr W M KO briefed the Panel on the information paper and highlighted the recent developments including the relaxation of assessment criteria of the Samaritan Fund and the removal of two more items (erythropoitin and artificial heart valves) from the list of privately purchased medical items with effect from 1 July 1996.

6. Mr Howard YOUNG requested an annual estimate of the expenditure of those nine items and a comparison with the amount available under the Samaritan Fund. In reply, Dr KO stated that, excluding item 9, the annual estimate for the eight items in 1995 was between $80 million and $100 million. Mr Clement CHEUNG added that in identifying those nine categories, special emphasis would be placed on helping chronically ill patients and the views expressed by LegCo members. Whether and how these items were to be charged in future would be determined in the context of the overall review on healthcare financing.

7. Dr YEUNG Sum enquired about the criteria used in identifying those nine categories. Responding to his enquiry, Dr KO said that for the nine categories, the Hospital Authority (HA) followed past practices and pending outcome of the overall review on healthcare financing, HA had removed a few categories to meet the special needs of patients. Mr CHEUNG added that most patients who would benefit from this latest relaxation were receiving subsidies from the Samaritan Fund.

8. Dr LAW Chi-kwong asked whether the policy that those hospitals which did not charge patients for those categories would continue to do so still prevailed, and requested clarifications on categories 2 and 6 of the list. In reply, Dr KO explained that for category 2, cardiac peacemakers were translated into different Chinese terms, and a few latest models could perform more functions than the old ones. For category 6, the word "purely" was used to describe those cosmetic surgeries which were solely for cosmetic purposes. As regards the policy, Dr KO confirmed that it was still valid. With the advance of medical technology, HA would examine new items before their introduction to the public hospital services. Dr LAW Chi-kwong asked whether a situation would arise when patients would be charged for using expensive products of latest medical technology replacing cheap products which were provided free of charge. Dr KO did not expect that new categories would be introduced before the completion of a major review on medical services. Mr CHEUNG explained that for new models of the same category, HA still required patients to purchase. However, for new products not on the list, HA would maintain the present policy before Government completed its overall review on healthcare financing.

9. Dr LAW requested HA to keep the categories as they were and not to include more categories before completion of the review. Mr CHEUNG reiterated that the Administration would not add new categories to the list before completion of the overall review on healthcare financing. Dr KO understood that members expected HA to make consistent and systematic arrangements on those categories to avoid confusion to patients. Addressing Mr Howard YOUNG’s concern on new but expensive medical devices, Dr KO remarked that in the long run, overall policies on financing hospitals and charging patients should consider the impact of new medical technology and its effect on patients.

10. The Chairman requested clarifications on the current practices of some hospitals which did not charge patients for those categories, and on that of relocations such as the new Taipo Nethersole Hospital. Dr KO replied that existing hospitals were advised to stick to the existing policies and for new hospitals, HA would carefully consider the merit of introducing these services for which patients were to be charged.

11. Regarding Dr YEUNG Sum’s request, Dr KO agreed to produce a progress report on the review of the Samaritan Fund including the revised application procedures by the end of 1996. In response to Mr YOUNG’s query, Dr KO said that in the first six months after the relaxation, the number of grants and the amount of funds both grew about four times as expected. Dr KO further explained that the growth was attributed to the awareness of patients and the increase in utility rate.

Adm

12. The Chairman relayed views of a patients’ association commenting on the hurdles for accessing erythropoietin and inquired of the criteria of administering the treatment to patients. In reply, Dr KO stated that the final decision of administering erythropoietin was vested in the doctor in charge who would determine the need of the patient according to the clinical criteria agreed by the HA’s expert committee. It was estimated that among 2000 plus patients, about 1000 needed the treatment of erythropoietin. The Chairman further asked whether guidelines were issued to the hospitals about the use of erythropoietin and how HA would monitor the uneven distribution of patients at certain hospitals requesting erythropoietin. Dr KO stressed that guidelines to hospitals on this issue included the assessment of the patients’ needs and if the needs justified the treatment, financial constraints should not be the hurdle. A computer system was in place to monitor the situation in all hospitals.

13. In reply to the Chairman’s questions on the expenditures on joint replacement and blood filters, Dr KO did not expect great changes in those two areas. He pointed out that although a high cost, high efficiency blood filters were being used now, the Hong Kong Red Cross Blood Transfusion Service was developing a method to filter blood at the same efficiency at a lower cost. Regarding the Chairman’s query on cardiac pacemakers, Dr KO said that the experts did not recommend one model as the standard equipment and would leave the decision to doctors in charge who would assess individual patient’s need before making a decision. For joint replacement, a committee was formed to assess the applicability of different models to different groups of patients.

14. The Chairman asked when a review of the charging policy in respect of privately purchased medical items would be conducted. Mr Clement CHEUNG and Mr GOULD said that this would be subsumed into the overall review on healthcare financing.

15. Mr Howard YOUNG made a comment on the Review of Health Care System that a long-term and objective perspective would be needed, and that a charging policy should be established considering the impact of the advancement of medical technology in such a way that the charging policy would not become a road block to the introduction of high technology to the Health Care System. Mr CHEUNG stated that one major aspect of the review would be how to focus limited resources on patients in need. Dr YEUNG Sum reminded the Administration that it would be meaningless to provide services so expensive that patients could not afford them.

16. As regard growth hormone and interferon, Dr KO explained that not all patients who needed growth hormone would be charged and all hospitals were clear when to supply growth hormone free. Recommendations from the committee on paediatrics were yet to be finalized.

III. Report on matters considered by the Health and Medical Development Advisory Committee (HMDAC)

(Appendix II of LegCo Paper No. CB(2) 1782/95-96)

17. Miss Helen TANG briefed the Panel on the information paper.

18. On Healthcare Financing, Dr YEUNG Sum was worried about that ceilings on healthcare expenditure would affect the aging population most, and asked how public expenditure on healthcare would be capped. Mr Clement CHEUNG said that the relevant discussion paper considered by HMDAC had already been provided to the Panel.

19. Dr LAW Chi-kwong pointed out the Chinese version of the information paper did not convey the concept of ceilings on public expenditure on healthcare, and requested the Administration to clarify to what the ceilings were referred. He further commented that the information paper contained previous discussions by HMDAC and suggested that the Panel should be advised of the items to be discussed by HMDAC for the benefits of synchronising discussion items of the two bodies and inviting public opinions. Dr LAW noted that the Administration took an initiative to review the roles of various advisory bodies, and asked whether HMDAC would discuss the matter. Mr CHENG agreed to consult the Chairman of HMDAC on this issue. As regards a review on the roles of advisory bodies, the Administration would reflect the views of members of the LegCo to HMDAC.

Adm

20. The Chairman said that the Panel would benefit if the Administration would advise the Panel of the items to be discussed by HMDAC as the major items to be discussed by the Panel was publicized at the beginning of the term of the Legislative Council, and that the Panel was interested to know whether healthcare financing would be on the agenda of HMDAC. The Chairman requested the Administration to furnish the Panel with the views of HMDAC and the items to be discussed as soon as possible. Mr CHEUNG agreed to contact the Chairman of HMDAC on this issue and to match the timing of discussion items by HMDAC and the Panel as far as possible.

Adm

21. Mr Howard YOUNG queried whether HMDAC would take into consideration the experiences of overseas countries in employing different medical structures. Mr CHEUNG replied that HMDAC would aim at problems facing the local community.

22. In reply to Dr YEUNG Sum’s request for interim reports on the review of health financing, Mr CHEUNG said that an overall review of health financing would be completed by December 1997 and agreed to discuss the progress of health financing in December 1996.

23. At the request of the Chairman, Mr Derek GOULD advised that the consultation document on reproductive technology was in the process of translation and was expected to be publicized in July 1996. As regards the scope of the consultation, Mr GOULD said that it would focus on areas not covered in the last consultation paper and would solicit public opinions on a proposed licensing system to regulate providers of reproductive technology services. He further explained that in addressing the new technology in the consultation paper, the public would be reminded of the ethical, moral and social issues involved. Taking into account public views, the Provisional Council on Reproductive Technology would then consider all arguments and dimensions, and advise Government on the way forward. The Chairman said that the Panel was interested in not only the technology but also how the related services could be applied in Hong Kong. Mr GOULD agreed to provide the terms of reference of the Provisional Council.

Adm

24. At the request of Dr YEUNG Sum, Dr P Y LAM agreed to provide the Panel with the progress report on the implementation of phase two of the Student Health Services to be submitted to HMDAC later this year.

Adm

25. Regarding Student Health Services, Miss CHAN Yuen-han requested and Dr LAM agreed to provide the Panel with a comparison and comments on the previous system and the present system.

Adm

IV. Any other business

Pok Oi Hospital (POH)

26. Regarding to the recent incident at POH, the Chairman reminded members of the Panel to focus discussions on problems arising from the incident, such as training, doctors and so on.

27. Dr W M KO said that the services provided by POH were not as comprehensive as some other general hospital such as Tun Mun Hospital (TMH), Queen Mary Hospital and Queen Elizabeth Hospital. However, the training opportunities of staff in POH were the same as in other hospitals. As regards facilities, POH was not originally designed to meet the increasing population in the northwestern part of New Territories. HA would assess the medical needs of the estimated population in the area before proposing options on how those needs could be met. One possibility would be to increase and improve the facilities in POH.

28. In response to Dr YEUNG Sum’s quenstion on the competence of doctors trained in the Peoples Republic of China (PRC) or overseas and guidelines to doctors on admitting patients in hospitals, Dr KO stated that doctors trained in PRC and overseas had to obtain a licence through examination conducted by the Hong Kong Medical Council in order to practise medicine in Hong Kong, except those who were directly registrable. As regards admitting patients to hospitals, it was basically a matter of professional judgement. Globally, a ratio had been established to monitor the number of patient visits to the number of patients admitted to a hospital. On the average, it was about 20%. Medical audits would be carried out to ensure the quality of medical services provided. The meeting agreed that doctors registrable by the Hong Kong Medical Council irrespective of their training should not be discriminated against because they attained an acceptable level of professional competence.

29. Due to the recent increase in population in the northwestern part of New Territories, Miss CHAN Yuen-han asked what HA planned to do in the provision of hospital services to meet the demands, and what the mechanism was in Accident and Emergency (A&E) Department of POH involving consultants and/or senior medical officers in supervising front-line doctors in admitting patients to the hospital. Dr KO clarified that the population in the northwestern part of New Territories was increasing and different options were being developed to meet population demand. In order to improve the quality of services provided, a consultant position was established at POH recently.

30. Miss CHAN Yuen-han inquired what channels existed for those patients who might need to appeal against a decision on admission or to express their views. Dr KO pointed out that medical consultants and senior medical officers were made available to support and supervise front-line doctors, and there should be no need for patients to appeal against doctors’ decisions in a confrontational manner. However, there were channels for patients to express their views, for instance, patients might approach the nursing officer in charge of the Department.

31. Mr MOK Ying-fan asked whether patients were well informed of those channels. In response, Dr KO agreed to take action to ensure that patients would be informed. The Chairman enquired whether guidelines were given to staff in this respect. Dr KO said that there was no guideline to staff but instructions would be given to patients and during the day time, patient liaison officers might help patients. In reply to Mr MOK Ying-fan’s request to follow up the matter, Dr KO agreed to check whether there were sufficient instructions to patients in hospitals in this respect.

Adm

32. The Chairman pointed out that even though the training opportunities in POH were the same as other hospitals, POH was not an accredited hospital of the Hong Kong Academy of Medicine. He envisaged that it might affect the recruitment of staff to join POH. In reply, Dr KO said that some hospitals would aim at recruiting qualified and experienced doctors while other hospitals formed a network with accredited hospitals to arrange doctors on a rotation basis to receive training. Dr KO agreed to evaluate the case of POH and to strengthen its relationship with TMH.

33. In conclusion, the Chairman requested HA to evaluate the workload and the work pressure in hospitals, and to promote the supervision and training in hospitals such as forming networks with accredited hospitals so that better services could be provided.

Medical services to Identity Card holders

34. Mr Howard YOUNG asked whether holders of different types of Identity Cards might receive different medical services in hospitals. Mr Clement CHEUNG said that all holders of a valid Identity Card were entitled to the full range of subsidized medical treatment in public hospitals and clinics.

35. The meeting ended at 10:15 a.m.

LegCo Secretariat
18 September 1996

Last Updated on 19 Aug, 1998