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Following is a question by the Dr Hon Yeung Sum and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (May 16):
Question:
Under the Hospital Authority (HA) Ordinance (Cap.113), the Hospital Governing Committee (HGC) of an individual HA hospital or HA (if there is no HGC established for a public hospital) may, without subject to the approval by the Legislative Council (LegCo), determine on its own the fees for hospital services provided by the hospital concerned. Regarding the powers and procedures for determining and revising medical services-related fees and charges, will the Government inform this Council:
(a) of the medical services-related fee items and the number of people affected last year, broken down by the powers and procedures for fee determination and revision (subject to LegCo's approval, or may be decided and implemented, without subject to LegCo's approval, by the executive authorities, HA or the HGCs concerned on their own);
(b) of the rationale and principle for conferring on individual HGC the power to determine the fees for hospital services; how the Government addresses the problems of additional fees charged by individual public hospitals (for example, Tuen Mun Hospital charges additional fees for acute wards) and the inconsistency in the fee-charging policies adopted by different public hospitals; and
(c) whether it will consider amending the legislation to abolish the arrangement for individual HGCs to determine on their own the fees for hospital services provided by the hospital concerned, and to enhance the monitoring of fee determination by HA (for example, requiring that such determination shall be subject to LegCo's approval)?
Reply:
Madam President,
The Hospital Authority (HA) is a statutory body established under the Hospital Authority Ordinance (Cap. 113). The functions and powers of the HA, including the power to determine the fees payable for hospital services provided by public hospitals, are clearly stipulated in the Ordinance.
Pursuant to section 18 of the Hospital Authority Ordinance, a Hospital Governing Committee (HGC) of a public hospital may determine the fees payable for hospital services provided by the public hospital(s) under its charge. For hospitals without an HGC (only two of the 41 hospitals under the HA, namely the Wong Chuk Hang Hospital and St. John Hospital, are operating without an HGC), the power for determining fees is exercised by the HA. Any determination so made by an HGC or the HA should be published in the Gazette. Section 18 also stipulates that the Secretary for Health, Welfare and Food (SHWF) may give directions to the HA over the determination of fees for hospital services; and the HA may also, subject to SHWF's directions, give directions to an HGC over the determination of fees for hospital services. The above arrangement provides the HA, as an independent statutory body, the necessary power to standardise the fees charged for various hospital services, thus able to avoid irregular fee-charging practices among different public hospitals. The arrangement also enables the Administration to participate in the determination of fees for hospital services through the issue of directions.
(a) The fees for the main services of the HA and the number of patients served in 2006 are set out in the Annex.
(b)&(c) The rationale for conferring upon individual HGCs the power to determine the fees payable for hospital services was based on the fact that prior to the establishment of the HA, the fees for hospital services charged by some of the subvented hospitals were not entirely the same as those charged by Government hospitals. In the process of drafting the Hospital Authority Ordinance, the Administration considered that subvented hospitals should be allowed to retain a certain degree of flexibility in the determination of hospital service fees, so as to enable their parent organisations to provide some free medical services to the community with their own resources. For example, members of the public can still enjoy free general out-patient and specialist out-patient services at the Tung Wah Eastern Hospital, Tung Wah Hospital and Kwong Wah Hospital today. However, there are only a handful of hospitals left within the public healthcare system with such arrangements for free hospital services or for the provision of hospital services at reduced rates. After its establishment, the HA has already put in place an overall medical fee waiver mechanism in public hospitals to assist patients with financial difficulties. It has also standardised the fees for public services in 1996 and then the fees for private patient services in 2003.
While the legislation confers upon individual HGCs and the HA the power to determine the fees payable for hospital services, as a matter of actual practice whenever there are new policies on or major changes in the charging of public hospital fees (e.g. the introduction of charges for accident and emergency service in 2003), the Administration and the HA have always consulted the Legislative Council Panel on Health Services and explained the policy and fees involved.
Since the mechanism for determining the fees charged by public hospitals has been working well for many years, the Administration does not have any plan to amend the relevant legislative provisions and abolish the arrangement for individual HGCs and HA to determine the fees payable for hospital services.
Emergency Medicine Wards are a new type of wards in public hospitals. The services provided in this type of wards are inpatient services by nature, and are different from the services provided by Accident and Emergency Departments. The objective of establishing this new type of wards is to provide patients in acute clinical conditions with multi-disciplinary healthcare services. The Emergency Medicine Wards are under the charge of specialists in emergency medicine, who employ a more pro-active "treatment and review" approach. In addition to conducting rapid examination and tests, the doctors in Emergency Medicine Wards will administer emergency treatment in accordance with patients' conditions, where necessary, and devise longer-term treatment plans. Generally speaking, a determination will be made within 24 hours as to whether the patients can be discharged or need to remain hospitalised. Moreover, Emergency Medicine Wards adopt an integrated and multi-disciplinary treatment approach to provide specialist consultation to patients in need and facilitate their early recovery. Apart from Tuen Mun Hospital, Emergency Medicine Wards have also been set up in the Queen Elizabeth Hospital. Since the services provided by Emergency Medicine Wards form part of the inpatient services (acute beds) of public hospitals, patients in such wards are charged $100 per day, which is the standard maintenance fee applicable to all acute beds in public hospitals as published in the Gazette.
Ends/Wednesday, May 16, 2007
Issued at HKT 13:25
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