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Following is a question by the Hon Yeung Sum and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (July 11):
Question:
It is learnt when patients undergo Percutaneous Transluminal Coronary Angioplasty (commonly known as "balloon angioplasty") in public hospitals, they have to purchase at their own expenses membrane stent to be implanted into the body. In this connection, will the Government inform this Council:
(a) of the number of balloon angioplasty carried out in public hospitals and the average amount spent by each patient on purchasing the surgical implants in each of the past five years, as well as the factors that should be considered by front-line doctors in deciding whether or not to carry out balloon angioplasty on a patient;
(b) apart from balloon angioplasty, of the number of patients who received treatment of cardiovascular diseases in public hospitals by drugs and other surgical operations in each of the past five years; and whether these patients were required to purchase at their own expenses the relevant drugs and surgical implants; and
(c) of the number of cases in which the patient received financial assistance from the Samaritan Fund to purchase surgical implants related to balloon angioplasty, as well as the amount involved, in each of the past five years; the reasons for requiring patients to purchase the relevant medical items at their own expenses; as well as the mechanism and criteria adopted by the Hospital Authority for determining the addition of items to, or removal of items from, the list of medical items to be purchased by patients at their own expenses?
Reply:
Madam President,
(a) The number of Percutaneous Transluminal Coronary Angioplasty (PTCA) carried out in public hospitals and the average amount of expenses by each patient on the necessary surgical implants in each of the past five years are set out in Table 1.
Coronary heart disease is a disease resulting from the narrowing of coronary arteries caused by the deposit of atherosclerotic plaque. Generally speaking, in deciding whether to carry out PTCA on a patient with coronary heart disease, the doctor's main factors of consideration are the clinical condition of the patient and the risk of the procedure, including -
* the onset time;
* whether the patient has experienced any shock or unstable angina pain;
* whether there is any new change in the patient's electrocardiogram;
* whether there is any recurrent ischemia after intensive anti-ischemia treatment;
* any rise in troponin level;
* the suitability for surgery in view of the pathological conditions of the patient's coronary artery; and
* whether the patient has any serious co-morbidity.
Where it is considered, on the basis of clinical conditions, that a patient is suitable for PTCA, the doctor will clearly explain both the benefits and the risks of the procedure to the patient. However, it is the patient's decision whether to undergo the procedure or not.
(b) Generally speaking, all patients with coronary heart disease receive drug therapy to prevent deterioration and arterial blockage. Currently, the Hospital Authority (HA) does not routinely collate statistical information on the number of patients with coronary heart disease receiving drug therapy in the HA or the amount of cost on the relevant drugs and surgical implants.
Apart from drug therapy, two forms of invasive therapies, namely PTCA and Coronary Artery Bypass Grafting (CABG), are available to patients with coronary heart disease. By comparison of the two procedures, PTCA is less invasive and of lower risk. The patients' recuperation time is shorter and it is less painful for the patients. The choice between PTCA and CABG is dictated by the clinical condition of the patient concerned, such as the pathological conditions of the arteries and the number of arteries involved, and the risk of the procedure to the patient. The number of CABGs performed in the HA in each of the past five years is shown in Table 2.
Drugs required by patients with coronary heart disease are covered by HA's Drug Formulary. Patients have access to these drugs at the standard medical fees of the HA. However, if a patient's condition does not meet the clinical guidelines on the use of certain special drugs in the Drug Formulary, but the patient wishes to use such drugs at his own choice, then he would have to purchase them at his own expenses.
As for the invasive therapies for coronary heart disease, patients undergoing PTCA have to bear the cost of the surgical consumables used in the procedure (e.g. catheter and vascular stent), whereas such expenses do not arise in CABG.
(c) The number of cases in which patients received financial assistance from the Samaritan Fund or other charitable funds for consumables related to invasive heart surgeries (including PTCA) and the total amount of funding support provided in each of the past five year are set out in Table 3.
At present, hospital maintenance fees or out-patient consultation fees in public hospitals/clinics are heavily subsidised by the Government and cover a wide range of medical services, procedures and consultations. However, patients are required to purchase certain medical items which are not covered by the standard medical fees of the HA. These privately purchased medical items include surgical implants/prostheses and consumables, items purchased by patients for home use, such as wheelchairs and home use ventilators, as well as costly medical procedures not available in public hospitals, such as gamma knife surgery and harvesting of bone marrow outside Hong Kong.
The main rationale for including surgical implants and consumables on the list of medical items to be purchased by patients at their own expenses is that such items are implanted into the body of individual patients or can only be used on a patient once. As public resources are limited, it is imperative for the Administration to prioritise on services that can benefit the greatest number of patients under the targeted subsidy principle. Those patients, who require the use of such surgical implants and consumables and have the financial means, should pay for the relevant expenses themselves. Those who have financial difficulties may apply for assistance under the Samaritan Fund. Eligible applicants may be given full or partial assistance of the cost, depending on their financial situation.
Under the user pay principle, and having regard to the introduction of efficacious but expensive new medical technologies, the HA adopts the following criteria when deciding whether certain medical items should be purchased by patients at their own expenses - evidence-based medicine, rational use of public resources, targeted subsidies, opportunity cost and facilitation of patient choice. If the new medical technology item involve is a pharmaceutical product, the assessment will be made by HA's Drug Advisory Committee. For other new medical technology items (i.e. other than pharmaceutical products), consideration will be made on a case by case basis by the Quality and Safety Division of the HA, having regard to the safety, efficacy, clinical effect and cost effectiveness of the new medical technology item concerned. Subject to available resources, the HA will migrant certain privately purchased medical items to within the scope of HA's subsidised service or the safety net established for such items in its Annual Plan. The Government will be consulted in the process.
Ends/Wednesday, July 11, 2007
Issued at HKT 15:28
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