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Following is a question by the Hon Joseph Lee Kok-long and a written reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, in the Legislative Council today (June 29):
Question:
The registration system for chiropractors has been implemented in Hong Kong for nearly 10 years, and the practising qualification of and the code of practice for chiropractors are under statutory control. In recent years, the demand for chiropractic services has continued to increase but the medical certificates (commonly known as "sick leave certificates") issued by chiropractors have still not been recognised under labour legislation. The Inter-bureaux/departmental Working Group (the Working Group) set up by the Government in 2005 to conduct a study on whether the sick leave certificates issued by chiropractors should be recognised under labour legislation pointed out that the chiropractic sector has yet to provide a set of guidelines on the issuance of sick leave certificates, and the Code of Practice issued by the Chiropractors Council of Hong Kong does not contain any explicit requirement on the maintenance of medical records of patients by chiropractors. Having considered various factors which include, inter alia, only a small number of members of the public have sought chiropractic treatment at present, reflecting that the public have limited knowledge of chiropractors, the Working Group does not recommend recognising the sick leave certificates issued by chiropractors. In this connection, will the Government inform this Council:
(a) given that some members of the chiropractic sector have relayed to me that at present, some organisations of the sector in Hong Kong (such as the Chiropractic Doctors' Association of Hong Kong) have already drawn up guidelines on the issuance of sick leave certificates for reference by their members, and quite a number of chiropractors have maintained medical records of their patients, whether the authorities have looked into and considered this latest situation; if not, of the reasons for that; whether they can provide the detailed report of the Working Group;
(b) whether it has assessed if the situation that only a small number of members of the public have sought chiropractic treatment and the public have limited knowledge of chiropractors is due to the fact that at present the Government has not yet introduced chiropractic services to public medical services; moreover, as the registration system for chiropractors has been implemented for a long time and the practising qualification of chiropractors is already subject to regulation, why the authorities have not yet introduced chiropractic services to public medical services;
(c) whether the authorities have planned to consult the public on issues including the registration system for chiropractors and the issuance of sick leave certificates by chiropractors, etc; if they have, of the timetable and details; and
(d) whether at present, the authorities have any plan to review afresh the feasibility of recognising the sick leave certificates issued by chiropractors under labour legislation; if they have, of the timetable; if not, the reasons for that?
Reply:
President,
My reply to the Dr Hon Joseph Lee Kok-long's question is as follows:
(a) In the course of studying whether the medical certificates issued by chiropractors should be recognised under labour legislation, the Inter-bureaux/departmental Working Group (the Working Group) held a meeting with the representatives of the Hong Kong Chiropractors' Association, Chiropractic Doctors' Association of Hong Kong and Chiropractors Council of Hong Kong (the Council), inviting them to express their views and provide useful information for the study. Afterwards, the Working Group received a number of documents from the chiropractic associations. However, it did not receive any notification that guidelines on the issuance of medical certificates had been prepared.
In general, if a healthcare sector considers it necessary to formulate any guidelines, the guidelines would be submitted to the relevant registration and regulatory body for vetting and promulgation. The guidelines should then be adhered to by all the practitioners in that sector. The Working Group wrote to the Council on July 31, 2007 and September 29, 2009 inquiring whether there was any plan to develop guidelines on the issuance of medical certificates. On December 4, 2009, the Council replied that chiropractic associations were working on a draft guideline and the finalised version would be put to the Council for consideration. The Labour Department (LD) had followed up with the Council on the issue. In March 2011, LD was informed that no guidelines had been received by the Council so far.
Regarding the maintenance of medical records, the Working Group understood that many chiropractors had kept their patients' medical records of their own accord. However, it was also noted that the Code of Practice for the Guidance of Registered Chiropractors (CoP) issued by the Council did not contain any explicit requirement on the maintenance of medical records. On December 4, 2009, the Council revealed that the CoP was under review to include a new section on patients' medical records, setting out what information was required to be documented. According to information from the Council, the CoP has not been revised yet.
As regards the report of the Working Group, since it contains views given by individual organisations and persons for internal reference by the Working Group, the full report will not be released. However, the key findings of the study have been presented in the Information Paper of the Legislative Council Panel on Manpower (Paper No.: CB(2)2044/10-11(03)).
(b) The main responsibility of the Working Group is to study whether the medical certificates issued by chiropractors should be recognised under labour legislation. Thus, it had not explored whether there was any correlation between the prevalence of chiropractic treatment and the availability of chiropractic service in the public healthcare system. However, the Working Group noted that chiropractic lacked ethnic root in the local Chinese community. Even though injured employees can claim reimbursement for the cost of chiropractic treatment under the Employees' Compensation Ordinance, only a small number of citizens have sought such treatment. LD undertook two surveys of injured employees who called on the department for sick leave clearance in October 2007 and November 2010. The respective results indicated that 0.5% and 2.9% of the injured employees had sought chiropractic treatment. In a similar survey conducted by LD in 2003 to ascertain the prevalence of Chinese medicine among injured employees, 32.1% of the respondents replied that they had sought Chinese medicine treatment. At that time, the medical functions performed by registered Chinese medicine practitioners had yet to be recognised under labour legislation and Chinese medicine treatment was not available in the public healthcare system.
In addition, existing services provided by public hospitals and health issues handled by relevant allied health professionals already cover those handled by chiropractors. Therefore the Hospital Authority (HA) has no plan to introduce chiropractor service at the moment. HA will consider new services and facilities in response to the demand of the public for different healthcare services.
(c) and (d) In order to gain a more updated and thorough understanding of the community's knowledge and utilisation of chiropractic treatment and gauge the prevalence of chiropractic treatment in Hong Kong, LD will commission the Census and Statistics Department (C&SD) to conduct a comprehensive survey. It is tentatively scheduled to be conducted in the latter half of 2012. LD will commence the preparatory work with C&SD shortly. Views from the chiropractic sector in respect of the survey are welcome. At the same time, the Administration will continue to communicate with the stakeholders and closely monitor the latest development of chiropractic in Hong Kong and other regions.
Ends/Wednesday, June 29, 2011
Issued at HKT 12:52
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