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LCQ2: Private consultation services by Faculties of Medicine staff

    Following is a question by Dr the Hon Kwok Ka-ki and a reply by the Secretary for Education and Manpower, Professor Arthur K C Li, in the Legislative Council today (May 9):


     It is learnt that the Faculties of Medicine of the two universities have not kept detailed records of the number of consultation sessions provided by clinical teaching staff for non-private patients at public hospitals ("general patients") and the number of such attendances. One of these universities also has not kept records, such as the number of sessions, for private consultation service. Not only are members of the public concerned about the proper use of public health care resources, they also worry that these teaching staff are preoccupied with private consultation service, which gives the university a share of the income, resulting in general patients being adversely affected. In this connection, will the Government inform this Council whether it knows if the two universities concerned and the Hospital Authority:

(a) will consider keeping more detailed information on private and non-private consultation services, so as to monitor if the two Faculties of Medicine and the teaching hospitals are preoccupied with private consultation service;
(b) have any new measures to ensure and monitor the proper use of the income generated from private consultation service; and

(c) will set targets on the number of hours spent each week on the treatment of general patients and the number of such patients treated by each clinical teaching staff, so as to ensure that the general patients of the teaching hospitals will not be discriminated and will receive treatment by clinical teaching staff?

Madam President,

(a) Through its computer system and paper documents, the Hospital Authority (HA) has in place an effective mechanism for keeping detailed records of all public and private consultation services provided in public hospitals. The information captured includes details of the attending doctors and patients, the doctors' diagnoses, the examination and treatment required by patients, the medication prescribed by the doctors and the charges payable, etc.

     Queen Mary Hospital (QMH) and Prince of Wales Hospital (PWH) are the teaching hospitals of the University of Hong Kong (HKU) and the Chinese University of Hong Kong (CUHK) respectively. The two hospitals provide primarily public medical services for the community at large, and private patient services account for a very small fraction of the services provided by them. According to the HA's records, in 2006-07, there were a total of 33 890 private specialist out-patient (SOP) attendances at the two teaching hospitals, which accounted for 2.9% of their total SOP attendances. The number of private bed-days utilised was 25 076, which accounted for 3.2% of the total bed-days utilised at the two teaching hospitals. A breakdown of the relevant figures is provided as below:

Private patient and public medical services at
Queen Mary Hospital (QMH) and Prince of Wales
Hospital (PWH)

                       QMH         PWH        Total
                       ----        ---        -----
Number of private    22 793     11 097       33 890
SOP attendances

Total number        545 662    623 411    1 169 073
of SOP attendances

Number of private    18 367      6 709       25 076
bed-days utilised

Total number of     391 731    403 541      795 272
bed-days utilised

     As regards the universities, details regarding the consultation service provided by the clinical teaching staff of HKU and CUHK for both private and non-private patients at public hospitals are recorded through the computer systems and paper documents of QMH and PWH respectively. In addition, HKU has kept its own records on private consultation service provided by its clinical teaching staff. CUHK has also introduced a new web-based time-logging system in 2006 to record the time spent and activities in respect of private clinical practice by individual clinical teaching staff so as to facilitate the monitoring of such activities by department chairmen and the CUHK Faculty of Medicine.

(b) At present, the HA manages the collection of private patient fees at public hospitals through its Patient Billing and Revenue Collection (PBRC) system. The PBRC system is the core billing system of the HA responsible for calculating, recording and managing the different fee levels in accordance with the published rates, and for tracking the settlement of bills following the standard overall financial regulations and operational guidelines of the HA. The income received by the HA from private patient services is recorded together with its public fee income. All of the income received, along with the Government's subvention to the HA, will be used as HA's operating funds to meet the expenditure of public hospitals and clinics.

     Regarding the institutions, to ensure the proper use of the income generated from private consultation service, both HKU and CUHK have established guidelines on the usage of such income and the approving criteria. For HKU, income generated from private consultation services can only be used for academic research, attendance of overseas academic seminars and professional development. Requests for the use of such income are subject to the scrutiny and approval of the department head and the university administration. These applications are also subject to independent audit by HKU's internal audit office and external auditors on a regular basis. The HKU has also recently established a Committee of Enquiry to review issues relating to the fees charged for private consultation services.

     For CUHK, according to the University's guidelines on Private Clinical Practice (PCP), the income derived from PCP may be used on the following areas:

a) purchase of special equipment required for departmental research;
b) purchase of books and journals for departmental research;
c) financial assistance for research projects where necessary;
d) travel by teachers to and from, and attendances at, academic conferences and training courses;
e) fees and subsistence allowances for attending academic conferences and training courses; and
f) entertainment of official visitors at departmental level, subject to the University's established standards for such expenditure.

     Eligible clinical teaching staff of CUHK Faculty of Medicine may submit applications to use the income derived from PCP for the above-mentioned purposes for consideration by the concerned department. Department chairmen are vested with the responsibility and powers to vet such applications. Moreover, department chairmen themselves may also apply to use the PCP income for the above-stated purposes. All applications will be considered jointly by the CUHK Faculty of Medicine and the University Bursar to ensure that the proposed disbursements comply with the rules and regulations stipulated by CUHK for procurement, research, staff development, conference attendances and entertainment. All income and expenditure are subject to external and internal auditing exercises.

(c) Both HKU and CUHK have established clear guidelines regulating the extent of outside clinical practice that their clinical teaching staff may undertake. In the case of HKU, clinical teaching staff are required to provide clinical service as well as carry out teaching and research work. Whilst they have the right to decide whether or not to provide private consultations, the amount of private consultations, if provided, should not exceed two half-day sessions (about 8 hours) every week. Clinical service for non-private and private patients provided by each subspecialty is under the supervision of the relevant division chief and departmental chief of service respectively. Duties regarding non-private clinical service are shared by all staff members of each clinical department.

     For CUHK, under the University's existing regulations, clinical teachers are required to devote their time to both clinical services and academic services, i.e. teaching and research. Clinical appointees, who are honorary staff of HA, may provide private clinical services of not more than 8 hours per week. Provision of other clinical services (including non-private clinical service) and the number of hours spent on these services are subject to the arrangements of the chief of service of the respective disciplines.

Ends/Wednesday, May 9, 2007
Issued at HKT 12:00


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