Action

I.Confirmation of the Minutes of Previous Meetings

(LegCo Paper No. PL 946/95-96
LegCo Paper Nos. CB(1) 1236/95-96 and CB(2) 1176/95-96
LegCo Paper Nos. CB(2) 1156/95-96 and CB(2) 1157/95-96)

The minutes of the following meetings were confirmed:

(a) Joint meeting with the LegCo Panel on Environmental Affairs held on 30 January 1996;

(b) Panel meetings held on 11 March and 15 April 1996; and

(c) Special Panel meetings held on 21 and 29 March 1996.

II. Meeting with Deputations

Elderly Rights League (HK)

2. Miss FOK Tin-man, Ms NGAN Sau-fong and Mr NG Wai-tung briefed members on the written submission tabled by the Elderly Rights League (HK). In brief, they requested the Administration to conduct a comprehensive review of health services for the elderly. Mr NG also drew members' attention to Appendix I of the written submission, where a comparison was made among the four main types of health services available for the elderly, namely, health services provided by community nursing, community geriatric assessment teams, psychogeriatric teams and Elderly Health Centres (EHCs). He requested the Administration to coordinate these four types of services and to make a fair allocation of resources among them.

(Post-meeting note: The written submission was issued to the absent member after the meeting under LegCo Paper No. CB(2) 1234/95-96.)

3. Ms TAM Dip-wan requested the Administration :

(a) to take measures to shorten the waiting time for general out-patient service. According to her experience, the average waiting time in the clinic was about 5 to 6 hours;

(b) to increase the number of EHCs, preferably one for each of the 18 Districts in Hong Kong. At present, there were only 4 EHCs in Hong Kong. It was highly inconvenient for the elderly people to go to the EHCs which were not located near their residential districts; and

(c) to introduce a concessionary medical charging scheme for elderly patients.

(a) General out-patient service

4. Regarding waiting time for general out-patient service, Mr Howard YOUNG noted from the information paper provided by the Administration that it was the pledge of the Department of Health (DH) for the patients to be seen within 60 minutes of the appointed time (para. 5 of Appendix II of LegCo Paper Nos. CB(2) 1206 and 1219/95-96). There was a great difference between this pledge and the practical experience presented by Ms TAM Dip-wan at para. 3(a) above. In response to Mr YOUNG's enquiry, Ms WU Yuet-sheung quoted an example where in Our Lady of Maryknoll Hospital, she had once got No.6 disc but had had to wait beyond No. 40 disc to be seen by the doctor. She had sought clarification with the hospital and was advised that the delay was caused by the difficulty in locating her previous treatment record. Ms WU therefore considered that in order to reduce the waiting time, more priority discs should be reserved for the elderly each day and additional manpower resources should be provided for hospitals/clinics.

5. In response to Mr MOK Ying-fan's enquiry, Miss FOK Tin-man pointed out that the facilities in the waiting areas outside General Out-patient Clinics (GOPCs) should be improved. For example, more seats in sheltered spaces should be provided so that the elderly people would not have to queue in the open.

(b) Psychogeriatric teams

6. Mr MOK Ying-fan noted that one of the columns in Appendix I of the written submission regarding the number of people serviced by the psychogeriatric teams was left blank. Mr NG Wai-tung explained that the relevant information was not available. Mr MOK requested the Administration to provide the Panel with the relevant information.

Adm

(c) Elderly Health Centres

7. Members noted that the Governor had committed in his policy address in 1992 to establish seven EHCs by 1997. However, the Elderly Rights League considered this insufficient to cope with the demand. In this connection, Mr Howard YOUNG wondered whether there was a need to transfer the control over EHCs from DH to Hospital Authority (HA), if more EHCs were to be established. Miss FOK Tin-man considered that EHCs should remain under the control of DH as the latter was responsible for primary health care.

Coalition of Citizen's Rights

8. Miss YUNG Wai-mui, Ms LEE Yuk-ching and Ms YEUNG Lai-chun briefed Members on the Coalition of Citizen's Rights (the Coalition)'s further submission dated 6 May 1996 which was tabled at the meeting. They were mainly concerned that the new assessment criteria for medical subsidy adopted since 1 December 1995 were too harsh. They requested the Administration to conduct a review on the medical subsidy scheme, in particular the assessment criteria, so that more people would be aware of and eligible for assistance from the scheme.

(Post-meeting note : The Coalition's further submission was issued to the absent member after the meeting under LegCo Paper No. CB(2) 1234/95-96).

9. Members noted that there were two components to the new assessment criteria - the monthly median domestic household income (MMDHI) and the savings limit. Patients who met both criteria would be eligible for assistance from the scheme. However, the Coalition considered this requirement too harsh and proposed that those who met either one of the following three criteria should be eligible for assistance:

(a) household income below the MMDHI corresponding to the household size; or

(b) household savings below the level of household savings corresponding to the household size; or

(c) household savings below three times the unit cost of the medical item required.

10. In response to Mr Fred LI's enquiry, Miss YUNG Wai-mui considered that the Coalition's proposed assessment criteria were not too loose.

Meeting with the Administration

III. Medical Services for the Elderly

Coordination of medical and health services for the elderly

(a) Coordination at the policy level

11. In response to the Elderly Rights League's allegation that there was no coordination of medical and health services for the elderly, Ms Lorna WONG advised that at the policy level, a new Elderly Services Division (ESD) had been set up in Health and Welfare Branch (HWB) since October 1994 to oversee policy formulation and coordination of welfare, medical and health services for the elderly. As the officer-in-charge of the ESD, Ms WONG had maintained frequent contact with DH, HA and the concerned organizations to coordinate the services provided by them so as to avoid duplication of efforts and resources.

12. The Chairman proposed and Ms Lorna WONG agreed to have a direct dialogue with the Elderly Rights League to ascertain their views in this aspect.

Adm

(b) Central Committee on the Elderly

13. Dr LEONG Che-hung pointed out that in the LegCo Sitting on 1 May 1996, he had moved a motion to urge the Government to expeditiously come up with a comprehensive plan for the care of "the elderly at risk". In this connection, some Members had proposed the setting up of an independent Central Committee on the Elderly. Dr LEONG supported this proposal and considered the present arrangement where the ESD of the HWB took up the coordinating role not so satisfactory and effective. It was because the ESD did not have sufficient power to coordinate relevant services provided by other policy branches. Dr LEONG requested the Administration to give a definite reply as to whether it would consider setting up the independent Central Committee on the Elderly. Mrs Doris HO advised that the Administration did not see the need to do so but would not rule out the proposal entirely. Ms Lorna WONG also advised that the ESD had been maintaining close contact with the Housing Authority and the Housing Department which handled housing matters for the elderly.

(c) Allocation of additional resources to DH

14. Dr LEONG Che-hung considered that at present, DH did not have sufficient resources to carry out its services and therefore, the Administration should provide additional resources to DH. Mrs Doris HO advised that expenditure on Health & Welfare Services for Elderly Persons amounted to 26% of the total Health & Welfare expenditure. Mrs HO further advised that the resources allocated to DH had been increasing annually since 1994/95. In response to the Chairman's enquiry, Mrs HO agreed to take Dr LEONG's views into consideration in this year's allocation of resources.

Adm

General out-patient service

(a) Waiting time

15. Dr P Y LAM advised that the Administration had been very concerned about the waiting time in GOPCs for the elderly because people aged 65 and above were by far the biggest user of the service, representing 34% of the total attendance of patients at GOPCs in 1995. At present, over 10% of the daily consultation capacity (approximately 1,500) were set aside for the elderly. In addition, a prior appointment system for those with chronic disease was also available for which the daily capacity was 1,400. DH was currently reviewing the provision of priority discs for the elderly with a view to increasing the capacity to meet the increasing demand. It would also promote better use of the appointment system for the elderly with chronic diseases, such as by producing specially designed posters and cards.

16. As the elderly people were the major user of general out-patient service (34% of the total attendance at GOPCs), members queried why only 10% of the daily consultation capacity were set aside for them. They urged the Administration to increase the number of priority discs for the elderly. Mr Howard YOUNG asked whether the Administration would aim at increasing the number to cope with the demand (34% of the total attendance at GOPCs). Dr P Y LAM considered it difficult to maintain demand and supply of the service at the same level. Nevertheless, the Administration would review the situation by analyzing the utilization rate of each GOPC and consider increasing the number of priority discs for the elderly accordingly. In response to Miss CHAN Yuen-han's enquiry, Dr LAM advised that the review would be completed within two months, after which the Administration would inform the Panel of the outcome.

Adm

17. In response to some members' enquiries, Dr P Y LAM advised that for most of the cases, the DH was able to achieve its performance pledge for the patients to be seen within 60 minutes of the appointed time. In view of the Elderly Rights League's allegation that the average waiting time was about 5 to 6 hours, the Chairman requested the Administration to provide information on waiting time in GOPCs.

Adm

18. Dr LAW Chi-kwong suggested DH to revise its performance pledge for patients to leave the GOPC within 60 minutes of the appointed time, i.e. including the time for getting medicine from the dispensary. Dr P Y LAM advised that there would be operational difficulties in implementing this proposal as it required detailed record of the time that individual patients got their medicine from the dispensary. At present, DH did not keep such record.

(b) Facilities in GOPCs

19. In response to Mr Fred LI's enquiry, Dr P Y LAM advised that DH had commissioned a consultant to study how the environment and facilities of GOPCs could be improved.

Adm

Elderly Health Centres

20. Dr P Y LAM advised that at present, there were 4 EHCs established with an average utilization rate of about 50%. DH had been organizing joint activities with District Boards for promotion of EHCs. It also planned to review in mid-1996 the services provided by EHCs, including the annual charge.

21. Dr YEUNG Sum requested the Administration to consider his proposals as follows:

(a) to lower the age limit for joining EHCs from 65 to 60 so that more elderly people would be benefited;

(b) to increase the number of EHCs to 18, one for each of the 18 Districts in Hong Kong. Normally, the elderly people would be more willing to join EHC if it was situated near their home; and

(c) to waive the annual charge of $220.

22. Mrs Doris HO advised that the Administration would take into account Dr YEUNG Sum's views at para. 21(a) and (c) above when reviewing the services provided by EHCs in mid-1996. Regarding para. 21(b) above, the Administration would review the need to increase the number of EHCs after the establishment of the 7 planned EHCs. Dr P Y LAM also pointed out that there might be difficulties in identifying suitable locations in each of the 18 Districts for the establishment of EHCs. In fact, the Administration was exploring alternatives such as combining the structure of EHCs with GOPCs so as to facilitate extensive provision of these two types of services.

23. Dr YEUNG Sum did not agree that the Administration should review the situation after the establishment of the 7 planned EHCs. This approach would result in commencing the review after 1997, thus causing unnecessary delay of the whole process. He requested the Administration to consider adopting a more flexible approach by proceeding with the review and the planning work of the 7 EHCs at the same time.

Adm

24. Mr MOK Ying-fan suggested the Administration to set up EHCs in those districts with a high population of the elderly. Dr P Y LAM advised that the location of the seven pilot EHCs had all been determined. Mr MOK's suggestion would be taken into consideration in the planning of Elderly Health Services beyond these seven EHCs.

Adm

25. Dr LEONG Che-hung noted from the information paper provided by the Administration (para. 9 of Appendix II of LegCo Paper Nos. CB(2) 1206 and 1219/95-96) that in 1995, a total of 2,031 clients had used the service provided at Nam Shan EHC and Kwun Tong EHC. As a daily average, only 3.9 clients used the service provided at either one of these two centres. In view of the low utilization rate, Dr LEONG wondered whether it was really necessary to set up more EHCs. Dr P Y LAM clarified that as the same client might visit a EHC more than once, the 2,031 clients already accounted for more than 20,000 attendances at the two EHCs in 1995.

Dental Service

26. Mr Fred LI noted from the information paper provided by the Administration that DH "has plans to provide oral health education for the elderly at the EHCs in order to increase their dental awareness." (para. 10 of Appendix II of LegCo Paper Nos. 1206 and 1219/95-96). He considered that oral health education would only be effective if a system was in place for referring the elderly people to a dental clinic for follow-up service. Dr P Y LAM advised that the present Government policy on dental service to the public was to provide preventive and promotive services. No referral system would be introduced for the time being.

27. In response to the Chairman's enquiry on whether the present policy would be reviewed, Mrs Doris HO advised that the subject would be covered in the review on healthcare financing.

Adm

IV. Medical Subsidy Scheme

28. Dr W M KO considered that the assessment criteria for medical subsidy stated in the Coalition's submission were in fact referring to those for the Samaritan Fund (the Fund). In response to the Coalition's views on the new arrangements for the Fund, Dr KO made clarifications as follows:

(a) New assessment criteria more stringent than the old one

The Coalition claimed that during the last year, only 290 cases applying for assistance under the Fund were approved. In fact, this was the figure for 1994/95, before the introduction of the new assessment criteria on 1 December 1995. The number of successful cases in the first three months since the relaxation of assessment criteria was 355. The amount of grant had increased from about $1 million to $4.4 million over the same period.

(b) Two components to the new assessment criteria

The Coalition alleged that the savings criterion of the Fund was more stringent than that imposed by the Comprehensive Social Security Assistance (CSSA) scheme. However, the CSSA scheme and the Fund operated on different principles. The former provided financial assistance for the needy to meet their daily expenses which would otherwise drain savings that they did not have the earning capacity to replace. The Fund provided assistance for needy patients to meet mostly one-off medical expenses, which they might partly be able to afford from savings. By linking the savings criterion to the cost of the medical item required, it could be ensured that no family temporarily used up more than a third of its savings to purchase the item. If the Coalition's proposal to use only one assessment criterion - MMDHI, half of the families in Hong Kong would be eligible. It would then be against the principle of focusing the limited resources on those in need.

(c) Low public awareness of the Fund

Members of the public who were not in need of purchasing the required medical item might not be aware of the Fund. Nevertheless, HA would continue to explore new ways to publicize the existence of the Fund, such as incorporating relevant information into the promotional pamphlets available at public hospitals.

29. Dr YEUNG Sum did not support the new assessment criteria. He suggested the Administration to consider using only the MMDHI as the criterion. Mr Fred LI, Miss CHAN Yuen-han and Dr LAW Chi-kwong shared his view. Dr W M KO had reservations on this proposal. He pointed out that there had been cases in which the household income of the patient was below the MMDHI and yet his household savings were between $200,000 to $300,000. Moreover, in order to cause less trouble to the patients and less workload to the social workers, there was no strict requirement for patients to provide documentary proof of their household income. If Dr YEUNG's proposal was to be implemented, documentary proof would be required. This might cause inconvenience to both the patients and social workers. Nevertheless, HA would further consider Dr YEUNG's proposal in the review.

HA

30. Dr YEUNG Sum considered the existing arrangement odd where stringent assessment criteria were used but without the requirement for the patients to prove their household income. He requested HA to seriously review the issue.

HA

31. Dr LAW Chi-kwong considered it impractical to require the social workers to report all applications to the HA Headquarters. If the social worker knew that the applicant was ineligible for application, it would be unlikely for him to ask the applicant to provide the relevant information. Dr W M KO advised that every possible means would be taken to avoid causing inconvenience to the social workers and that the relevant application procedures had been simplified.

32. In response to the Chairman's enquiry, Dr W M KO advised that the review of the Fund would be conducted by the end of 1996, a year after the introduction of the new assessment criteria.

33. In response to Dr LEONG Che-hung's enquiry, Dr W M KO confirmed that between the relaxation of the assessment criteria on 1 December 1995 and the end of February 1996, there had only been one rejected application out of 356 cases. The Chairman wondered whether this low unsuccessful rate was caused by the fact that those applications from ineligible patients had not been reported to the HA Headquarters. Dr W M KO confirmed that all applications had to be reported. Nevertheless, he did not rule out the possibility that there might have been cases where the patients thought they were ineligible and therefore did not apply. The HA would step-up publicity of the Fund and the assessment criteria.

34. The Chairman suggested the HA to have a direct dialogue with the Coalition for a discussion on how the assessment criteria could be further relaxed.

HA

V. Tentative Timetable for Review of the Healthcare System

35. In view of the time constraints, the Chairman proposed and members agreed to defer discussion on this item to the meeting to be held on 10 June 1996.

VI. Items for Discussion at Future Meetings

Hospital Development Projects

36. The Chairman remarked that as agreed at the Panel meeting held on 11 March 1996, members were subsequently asked to indicate which of the Hospital Development Projects listed at Annex E of LegCo Paper No. PL 984/95-96 they would like to discuss at future meetings. Based on the returns and after a brief discussion, it was agreed that the Administration should provide further information to the Panel on item 2 (Upgrading piped medical gas supply system in public hospitals) and item 6 (Reprovisioning of the Sai Ying Pun Specialist Outpatient Clinic) of the list.

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Occupational Health Services

37. Dr LEONG Che-hung suggested to discuss at a future meeting the Administration's progress report on the implementation of the recommendations of the Expert Working Group on Occupational Health Services (LegCo Paper No. CB(2) 1000/95-96).

38. The Chairman suggested members to forward any other proposed items for discussion at future meetings to the Clerk.

VII. Close of Meeting

39. The meeting ended at 1:00 p.m.
LegCo Secretariat
14 May 1996