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Following is a question by the Dr Hon Leung Ka-lau and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 29):
Question:
The costs for public hospital services have continued to rise in the past decade and the increase has outpaced that in the number of attendances and the local economic growth. According to the latest figures of the Government's estimates of expenditure for the year 2011-2012, the cost per patient day for general inpatient services, as well as the costs per accident and emergency attendance and specialist outpatient attendance will rise to $3,830, $830 and $950 and the percentages of increase will be 4.6%, 3.8% and 5.6% respectively. In this connection, will the Government inform this Council:
(a) of the parameters and formulas adopted by the Government in calculating the cost per patient day for general inpatient services, as well as the costs per accident and emergency attendance and specialist outpatient attendance respectively;
(b) of the actual value of each relevant parameter in (a) in the past five years;
(c) whether it knows if the public hospitals have independently calculated the aforesaid unit costs; if they have, of the detailed figures for the past five years; if not, the reasons for that; and
(d) given that the Hospital Authority (HA) has also calculated the specialty costs of various services such as liver and bone marrow transplantation, etc., whether it knows the service items which had been included for calculating the specialty costs by HA as well as the specialty costs of and numbers of attendances for such services in the past five years?
Reply:
President,
(a) The Hospital Authority (HA) adopts a "total cost" accounting approach in calculating its relevant service costs. Broadly speaking, the service costs of HA include not only the direct service costs of various clinical specialties and expenses of various clinical support services (e.g. anaesthesia service, pharmacy, pathology, diagnostic radiology and allied health services), but also the costs of various non-clinical support services and daily expenses of hospitals (e.g. meals for patients, utility expenses, repair and maintenance of medical equipment and machinery), some institutional items (e.g. insurance costs and information technology support for clinical computer systems), the administrative costs of HA Head Office, as well as some charges for services provided by government departments to HA (e.g. building maintenance services provided by the Architectural Services Department). The cost of clinical services related to teaching that are provided by staff of universities is not included in the abovementioned service cost of HA.
The average unit cost of a particular type of service is calculated with reference to the total costs of provision of such service and the corresponding volume of activities.
(b) The attendances of HA's general inpatient services, accident and emergency (A&E) services and specialist outpatient services in the past five years (2006-07 to 2010-11) and their corresponding unit costs are set out in Annex A.
(c) The costs of general inpatient services per bed day and the costs of A&E services and specialist outpatient services per attendance of various hospital clusters under HA in the past five years (2006-07 to 2010-11) are set out in Annex B.
Given the varying complexity of conditions of patients and the different diagnostic services, treatments and prescriptions required, the average service costs of general inpatient services, A&E services and specialist outpatient services vary between different hospital clusters. In addition, the case-mix (i.e. the mix of patients of different conditions in the cluster) may vary among different hospital clusters due to demographic profile and other factors, including services provided by the cluster. Therefore the service costs will vary between different hospital clusters. For instance, clusters with more patients with more complicated conditions or requiring costly treatment would incur a higher average cost of service. Hence, the average service costs cannot be compared directly between different clusters.
(d) HA provides various healthcare services for patients through a multidisciplinary integrated service approach. Organ transplant is an example which requires treatment by different specialties. For instance, liver transplant involves integrated healthcare services provided by different specialties such as medicine, surgery, intensive care and immunology, and the medical cost of each case is about $1 million.
The numbers of inpatient and day patient discharges and deaths of the major clinical specialties in the past five years (2006-07 to 2010-11) and their corresponding average costs are set out in Annex C.
Ends/Wednesday, June 29, 2011
Issued at HKT 15:12
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