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Following is a question by the Hon Michael Mak Kwok-fung and a written reply by the Secretary for Health and Welfare, Dr E K Yeoh, in the Legislative Council today (May 8):

Question:

The utilization ratio between public and private medical services is 94 to 6. In this connection, will the Government inform this Council:

(a) how the current utilization ratio between public and private medical services compares with that ten years ago; and the cause of change in such ratios;

(b) of the respective numbers of health care personnel/medical staff employed in public and private medical sectors and their ratios against attendance in the respective sectors in each of the past ten years;

(c) whether it has conducted survey and analysis on the financial status of patients utilizing services in public hospitals and private ones; if it has, of the results; if not, whether it will conduct such survey and analysis;

(d) whether it has considered balancing the current utilization ratio between the public and private medical services by increasing the fees of public medical services or other means; if it has, of the details; and

(e) whether it has set any targets for changing the current utilization ratio between public and private medical services; if it has, of the details; if not, the reasons for that?

Reply :

Madam President,

(a) Based on in-patient bed occupancy rate, the in-patient service utilization between public and private sector was 90.4% and 9.6% respectively in 1992. In 2001, the percentage changed to 93.4% and 6.6% respectively.

It should be noted that in the area of out-patient service, the utilization pattern is reversed, with private sector providing 85% of the total out-patient service in the year 2000.

There are a number of plausible reasons to account for the above ratios. The highly affordable and improved quality of care in HA hospitals over the years, coupled with the accessibility of the facilities, might have been the reason for increased utilization of public in-patient service by the general public. On the other hand, the convenience and relatively affordable service provided by private medical practitioners are considered to be the primary reason for a large percentage of out-patient service being provided by the private sector.

(b) Table 1 and Table 2 show the staff strength, bed occupancy rate and the number of attendances in different categories of medical services from 1991 to 2000 in Hospital Authority and private hospitals respectively.

Table 3 below shows the bed occupancy rate in private hospitals from 1991 to 2000.

Statistics on the number of staff employed and patient attendances in the private sector are not available.

Due to the fact that different types of medical care, i.e. general out-patient, special out-patient, Accident & Emergency, and in-patient services, have different requirement on medical staff in terms of intensity, activities and expertise required, an overall staffing ratio is not an accurate reflection of the work condition of health care staff in a clinical setting, nor is it a reliable indicator of the adequacy of medical services provided to patients.

(c) In the Thematic Household Survey conducted by the Census and Statistics Department in the 1st quarter of 2001, about 10,000 households were interviewed and information on in-patient utilization by different household income groups and type of hospital was collected. Based on the question asked on in-patient service utilization in the last six months from the date the respondent was enumerated, it is observed that the median monthly household income of all in-patients was $19,500. In-patients last admitted to private hospitals had a higher median monthly household income of $31,100, compared to $17,200 for those who were admitted to HA hospitals. In addition, the survey results indicate that the hospitalization rates in respect of in-patients in HA hospitals were higher for persons from low income households, whereas for in-patient in private hospitals, the situation was reversed, i.e., the rates were lower for persons from lower income households.

(d) As stated in the Consultation Document on Health Care Reform, we are committed to achieving a better interface between the public and private sectors. To this end, a number of measures are being undertaken. First, under the chairmanship of the Secretary for Health and Welfare, two dedicated working groups have been formed with representatives of public hospitals and private medical practitioners. The working groups serve as the focal point for exploring viable options and schemes that could lead to a closer collaboration and better interface between the public and private sectors. For instance, discussions are being held on the development of common clinical protocols, patient referral guidelines and possible joint efforts between the public and private sectors in offering health care products for patients. Meetings are held on a regular basis and we are aiming at identifying viable options within this year. In addition, we are at the final stage of a comprehensive review on the fee structure in the public sector. One of the effects of the fee revision will be to influence patients' health-seeking behavior and decision in the course of their treatment process and as a result, it would change their utilization of public sector services. The revamped fee structure could also create more opportunities for closer collaboration with private sector, with new health care packages devised for patients' selection.

(e) We have not set a target for altering the current utilization ratio between public and private medical services. The decision to utilize public or private medical services rests ultimately with patients themselves, based on their perceptions of the differential between the public and private sectors, and their willingness to pay. It has been the accepted policy that the public sector cannot refuse a patient on the basis of his/her income level. That said, it is the government's declared policy that there should be a dual system of health care in Hong Kong, with public and private sector each playing a complementary role. The Hospital Authority is exploring ways and means to facilitate patient choice to consider the alternative of private sector services through development of common clinical protocols, patient referral guidelines and new shared care programs with their private sector counterparts. In combination, these measures should gradually lead to a better utilization of the talents and resources in the private sector.

End/ Wednesday, May 8, 2002

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