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Following is a question by Dr Hon Joseph Lee Kok-long and a reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, in the Legislative Council today (June 23):
Question:
Recently, I have received complaints from patients with stoma alleging that the Social Welfare Department (SWD) lacks objective criteria and transparency in vetting and approving applications for Disability Allowance (DA) and ignore patients' needs, causing them serious inconvenience. In this connection, will the Government inform this Council:
(a) given the authorities' reply to a question raised by a Member of this Council on October 28, 2009 that they could not provide the number of patients with stoma who were granted DA in the past five years and the reasons why some patients with stoma were not granted DA, whether the authorities still do not have such data at present; if so, of the reasons for that and whether they will undertake to provide such data in future; if they have the relevant data, of the details;
(b) of the reasons why some patients with stoma being issued Registration Cards for People with Disabilities and classified as having permanent disabilities are not granted DA; of the criteria adopted by the authorities for determining patients with stoma who are suffering from visceral diseases to the extent of being severely disabled; and
(c) given that some patients with stoma consider that the vetting and approving system lacks transparency as SWD does not provide specific reasons for not approving DA applications, whether the authorities will consider providing, according to the patients' requests, specific reasons, including the relevant medical assessment results; if they will, of the details; if not, the reasons for that; given that patients with stoma who are not satisfied with the assessment results may appeal to the Social Security Appeal Board, how the Appeal Board specifically considers the appeal cases of patients with stoma; of the respective numbers of such appeal cases which were allowed and rejected in the past five years, as well as the reasons for rejection?
Reply:
President,
Disability Allowance (DA) under the Social Security Allowance (SSA) Scheme aims to help Hong Kong residents who are severely disabled meet their special needs arising from severe disability. To be eligible for DA, the medical condition of an applicant has to be certified by the Director of Health or the Chief Executive of the Hospital Authority (HA) (or, under very exceptional circumstances, a registered medical practitioner of a private hospital) to be severely disabled (i.e. in a condition broadly equivalent to 100% loss of earning capacity according to the criteria in Schedule 1 of the Employees' Compensation Ordinance (Cap.282)), and that the disabling condition will persist for at least six months. To ensure consistency and objectivity in medical assessments, medical practitioners of public hospitals/clinics will assess the disabling conditions of DA applicants with the aid of a standardised Medical Assessment Form (MAF) and Checklist.
My reply to the question raised by Dr Hon Joseph Lee is set out below:
(a) In accordance with the MAF and Checklist, an applicant may be eligible for DA for reason of "any other disabling conditions resulting in total disablement". As at the end of May 2010, some 68,000 DA recipients belonged to this category. Most DA recipients with stoma are receiving the allowance based on that criterion.
As explained in my reply to a Member's question on October 28, 2009, the Social Welfare Department (SWD) does not have the statistical breakdown of DA recipients with stoma. This is because DA is, in principle, provided to recipients according to the severity of disabilities but not the types of illness.
(b) The Registration Card for People with Disabilities (Registration Card) is not a documentary proof of eligibility for DA. Its purpose and targeted recipients are different from those of DA.
The Registration Card is issued by the Central Registry for Rehabilitation of the Labour and Welfare Bureau to persons with permanent or temporary disabilities which affect their life activities and participation in economic and social activities, so that they will be able to produce it as a documentary proof of his/her disability status and type of disabilities if necessary.
While the Registration Card may prove that a person is permanently disabled, from the medical point of view, the duration of disability bears no relation to the severity of disability. For example, a person with mild low vision may be permanently disabled and issued with the Registration Card, but this visual problem is not a disability at a severe level; on the contrary, elders suffering from poor health condition after a stroke may be severely disabled, though not necessarily on a permanent basis. The latter can receive DA upon confirmation of eligibility after medical assessment, even if he/she is not a Registration Card holder.
In respect of stoma patients, although stoma is one type of "visceral disability" which may fall under "any other disabling conditions resulting in total disablement", it is only one of the conditions created pursuant to clinical needs (e.g. post operation for Carcinoma of Colon). Stoma in itself is not a disability, and an applicant would not be eligible for DA simply because he/she has a stoma on the body. In processing DA applications by stoma patients, doctors assess the applicants' eligibility by applying their professional knowledge and judgment, with relevant factors including reasons for receiving stoma operation, clinical and health condition, etc. being taken into account. This comprehensive assessment is conducted based on the prescribed criteria for severe disability under the DA scheme.
(c) If an applicant's DA application is rejected, SWD will issue to him/her a notification letter explaining the reason of not approving the application, e.g. failure to comply with residence requirements, in receipt of other social security benefits, or that his/her condition does not fall within the definition of severe disability. The applicant may ask SWD for a copy of the MAF in accordance with provisions under the Personal Data (Privacy) Ordinance (Cap 486).
Applicants aggrieved by the decisions of SWD may appeal to the Social Security Appeal Board (Appeal Board). The Appeal Board is an independent body consisting of a non-official Chairman and non-official members appointed by the Chief Executive. In handling appeals involving medical assessments, the Appeal Board will jointly arrange with HA a Medical Assessment Board (MAB) to re-assess the disabling conditions of the appellants in accordance with the same standardised MAF and Checklist used by medical practitioners of public hospitals/clinics. The MAB consists of a medical practitioner from HA and two representatives from the Hong Kong Medical Association.
Between 2005-06 and 2009-10, the MAB handled a total of 1,187 DA appeal cases. The decision of the MAB in about 30% of these cases involved variation of the original medical assessment result. Appeals in the remaining cases were rejected as the MAB agreed that the condition of the appellants did not fall within the definition of severe disability. SWD does not have the number of stoma patients among the appellants.
Ends/Wednesday, June 23, 2010
Issued at HKT 14:10
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