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The Government today (December 15) launched a public consultation on the Review of Regulation of Private Healthcare Facilities to solicit views from the public on revamping the regulatory regime for private healthcare facilities (PHFs). The consultation period will last for three months until March 16, 2015.
Speaking at a press conference to launch the public consultation exercise today, the Secretary for Food and Health, Dr Ko Wing-man, said that as Hong Kong's healthcare system runs on a dual-track basis comprising both the public and private sectors, private healthcare is an essential component of our healthcare system. With the advancement of medical technology and rapid changes in medical practice, the mode of service provision of PHFs has also been evolving. For example, high-risk medical procedures/practices once confined to hospitals are increasingly performed in an ambulatory setting, and community outpatient clinics that used to be run by individual medical practitioners have increasingly given way to incorporated clinics, where ownership is not confined to the medical practitioners delivering the medical services.
Dr Ko said, "In light of the above, there is a genuine need to conduct a detailed review of PHFs regulation and introduce a robust and comprehensive regulatory regime for PHFs so that other facets essential to their regulation such as corporate governance, clinical governance and price transparency can be adequately provided for, thereby protecting the rights of the consumer and contributing to the sustainable development of Hong Kong's healthcare system."
In 2012, the Government established the Steering Committee on Review of the Regulation of Private Healthcare Facilities to conduct a root-and-branch review of the regulation of PHFs. Taking into account the recommendations of the Steering Committee, the Food and Health Bureau today released a consultation document setting out the proposed regulatory regime for PHFs, which will help to address the main concerns raised by the public in recent years including price transparency, quality of healthcare service, consumer protection, standard of facilities and sanctions.
Regarding the legislative framework, the Government proposes to introduce new legislation to broaden the types of PHFs to be regulated, and to replace the existing Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (Cap. 165) and the Medical Clinics Ordinance (Cap. 343), which were enacted in the 1960s. The new regulatory regime will cover three classes of PHFs, enhance regulatory powers over PHFs and confer authority on the Director of Health to impose licensing requirements.
The three classes of PHFs are hospitals, facilities providing high-risk medical procedures in an ambulatory setting and facilities providing medical services under the management of incorporated bodies.
The Government proposes to define "hospital" as "any healthcare facility primarily for the provision of medical care and/or Chinese medicine practice with continuous medical support and lodging", so that community-based centres such as nursing homes providing care without or with minimal medical involvement will no longer be caught under regulations targeting medical facilities.
A PHF providing high-risk medical procedures in an ambulatory setting should be regulated under the new regulatory regime. A medical procedure is classified as high-risk if the procedural risk is high, if the risk of anaesthesia involved is high, or if the patient's condition is classified as unstable severe systemic disease (acute exacerbation) or worse.
Concerning PHFs run as incorporated bodies in which non-medical investors or managers may be involved in day-to-day operation, the consultation document proposes that it is necessary to introduce facilities-based regulation in addition to professional self-regulation for these PHFs, with a view to ensuring effective governance and maintaining service quality meeting professional standards.
To better protect patients' safety and consumers' rights, the consultation document proposes to constitute 19 regulatory aspects under five broad categories of control including corporate governance, standard of facilities, clinical quality, price transparency and sanctions. These regulatory aspects serve as essential requirements of the regulatory regime for private hospitals, with suitable adaptation commensurate with the lower degree of complexity and risks of medical services provided in other PHFs.
As regards corporate governance, the Government proposes mandatorily requiring the appointment of a person-in-charge for each regulated PHF and the establishment of a Medical Advisory Committee for each private hospital; a complaint management system for each private hospital and regulated PHF; the development of an information system connectable with the Electronic Health Record Sharing System (eHRSS), and maintenance of Hospital Accreditation Status.
Regarding standard of facilities, the scope of regulation includes premises management, physical conditions and infection control. It is recommended that PHFs should develop their policy and guidance on the control and prevention of infectious diseases for diagnosis, treatment, operation and other medical procedures (such as proper record keeping to ensure compliance with the guidance).
The Government considers it essential to monitor the quality of clinical works in order to enhance the quality of healthcare services, minimise clinical risk and improve efficiency of service provision. The revamped regulatory regime seeks to enhance clinical quality in six key areas, namely service delivery and care process, resuscitation and contingency, standards specific to procedures performed, credentialling of visiting doctors, establishment of a clinical audit system and sentinel events management.
Recommendations on enhancing price transparency include requiring all PHFs to prepare a fee schedule setting out all charges that may be levied; that patients should be informed of the estimated total charges on or before admission to private hospitals; requiring hospitals to publish key historical statistics on their actual bill sizes for common treatments/procedures; and encouraging all PHFs to provide Recognised Service Packages.
At present, the maximum penalty for operating a hospital without being duly registered is $2,000, while penalties for other non-compliance and the daily fine for continuous contravention are set at $2,000 and $50 respectively. This is clearly unlikely to have any deterrent effect at today's prices. We consider that regulated PHFs that fail to comply with regulatory requirements should be subject to sanctions commensurate with the seriousness of the offence. For example, it is proposed that the maximum penalty for unlawful operation of a hospital should be a fine of $5,000,000 and imprisonment for two years, and for other regulated PHFs a fine of $100,000 and imprisonment for three months.
Dr Ko said that certain short to medium-term administrative measures would be introduced to supplement the existing regulatory regime before the new regime is put in place.
These measures include:
(a) review the existing administrative Codes of Practices for the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance and the Medical Clinics Ordinance to strengthen existing requirements in the regulation of PHFs;
(b) conduct a survey to assess the number, types and range of services of PHFs that might be affected by the new regulatory regime; and
(c) introduce an administrative listing system for ambulatory facilities providing high-risk medical procedures in an ambulatory setting to monitor such facilities before the introduction of statutory registration.
The regulatory authority will also work with the Hong Kong Academy of Medicine to establish a mechanism for setting the standards required of ambulatory facilities providing specific classes of high-risk procedures. These procedure-specific standards will be promulgated to the profession as guidance before being incorporating into the future legislation as part of the statutory requirements.
Dr Ko added, "The proposals being put forward in the consultation document will help to enhance the sustainable development of our private healthcare system. We appreciate that some of them may have implications for existing private hospitals, facilities providing high-risk medical procedures in an ambulatory setting, clinics and relevant stakeholders. Members of the public, in particular healthcare professionals, are invited to offer comments and suggestions on the above and other issues during the public consultation period. If the community supports the proposals on regulation of PHFs, we will proceed with legislative procedures in order to implement those proposals."
Copies of the Review of Regulation of PHFs consultation document are available for collection at district offices or can be downloaded from the Food and Health Bureau website (www.fhb.gov.hk). The public can send their views on the consultation document on or before March 16, 2015, by email (hpdo@fhb.gov.hk), by post (Healthcare Planning and Development Office, Food and Health Bureau, 19/F, East Wing, Central Government Offices, 2 Tim Mei Avenue, Tamar, Hong Kong), or by facsimile (2102 2493).
Ends/Monday, December 15, 2014
Issued at HKT 16:32
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