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Following is a question by the Dr Hon Joseph Lee and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (July 17):
Question:
One of the features of the Health Protection Scheme (HPS) being studied by the Government is the vision of encouraging more people to buy private health insurance products, thereby indirectly relieving the pressure on the public healthcare system. It has been reported that, according to the latest proposal submitted by the authorities some time ago, the private health insurance policies to be regulated under HPS will come mainly in the form of "packages" to cover surgeries and treatments frequently performed in private hospitals (e.g. examinations such as endoscopy, Magnetic Resonance Imaging and Computed Tomography scans, as well as surgeries such as appendicetomy, atherectomy, hysterectomy, oophorectomy, haemorrhoidectomy and otorhinolaryngological surgeries) at the early stage of implementation of HPS. In addition, the authorities have proposed to set up a High-risk Pool (HRP) to underwrite the policies of the HPS Standard Plans for high-risk individuals. In this connection, will the Government inform this Council:
(a) whether it knows the following information on each type of the aforesaid surgeries and treatments performed by public hospitals on their patients in the past three years: (i) the number of patients receiving the surgeries/treatments, (ii) the average unit cost and (iii) the average waiting time;
(b) whether it knows the following information on the 20 types of most frequently performed surgeries in public hospitals in the past three years: (i) the number of patients receiving the surgeries, (ii) the average unit cost and (iii) the average waiting time (broken down by surgery type);
(c) whether it knows the following information on the 10 types of surgeries with the longest waiting time among those performed by public hospitals on their patients in the past three years: (i) the number of patients receiving the surgeries, (ii) the average unit cost and (iii) the average waiting time (broken down by surgery type); and
(d) whether it has assessed the approximate length of time for which the $50 billion, set aside from the fiscal reserves for the implementation of the healthcare reform, can support the operation of HRP; if it has, of the details; if not, the reasons for that; whether the authorities will impose a cap on the amount of co-payment for each subscriber in HRP; if they will, of the details; if not, the reasons for that?
Reply:
President,
The Health Protection Scheme (HPS) aims to complement the public healthcare system by providing better protection to those who are able and willing to pay for private health insurance and use private healthcare services. By providing value-for-money choices to the community, the HPS could indirectly provide relief to the public system by better enabling the latter to focus on serving its target areas, thereby enhancing the long term sustainability of our healthcare system. We have set up a Working Group and a Consultative Group on the HPS under the Health and Medical Development Advisory Committee to formulate detailed proposals for the HPS. The Consultant appointed to conduct a consultancy study on the HPS has also tendered preliminary recommendations on various matters related to the HPS, including setting up an High-risk Pool (HRP) to accept health insurance applications from high-risk individuals, and the adoption of "no-gap/known-gap" arrangements to enhance upfront payment certainty for consumers. In addition, we will also encourage private healthcare service providers to provide packaged pricing for common procedures in order to enhance payment certainty and transparency.
My reply to the various parts of the question is as follows:
(a) and (b) The waiting time, number of cases and reference cost of common elective surgeries and investigations conducted in public hospitals are set out in Table 1 and Table 2. Emergency procedures such as appendicetomy would be performed as soon as possible in accordance with protocols having regard to the relevant medical conditions of the patients.
(c) The Hospital Authority has not surveyed the waiting time for all common elective surgeries performed in public hospitals due to the wide range of procedures. Please refer to Table 1 and Table 2 for the waiting time, number of cases and reference cost of some common elective surgeries and investigations conducted in public hospitals.
(d) In order to enable high-risk individuals to have access to health insurance protection at affordable premiums, we have proposed to set up an HRP to accept policies of the HPS Standard Plans of high-risk individuals. Where the premium loading of such policies, at the opinion of the insurer providing coverage, is assessed to equal or exceed 200% of standard premium charged by the insurer for providing HPS Standard Plan coverage, the insurer may transfer these policies to the HRP by surrendering the premium collected for these policies after deducting a nominal handling fee to be prescribed by the HPS agency. Thereafter, the insurer will continue to be responsible for the administration of the policies, but the premium income (net of expense), claim liabilities and profit/loss of these policies would be accrued to the HRP instead of the insurer concerned. The Consultant is working on an estimation of the financial support required for the HRP, and will provide the estimated figures in its final report to be submitted by end of 2013. Where necessary, the Government would consider injecting funding to the HRP directly to ensure the Pool's sustainability by making use part of the $50 billion fiscal reserve earmarked for assisting the implementation of healthcare reform.
"Co-payment" is a cost-sharing arrangement between insurers and insured persons. It is designed to combat moral hazard and to bring healthcare costs under better control. On the other hand, in designing cost-sharing arrangements, due regard should be given to possible adverse impact on consumer interests, particularly concerning the ability of lower-income persons in paying the shared cost, which might affect their desire to seek necessary treatments. With the above in mind, the Consultant proposes to impose an annual cap on the amount of "co-payment" for HPS Standard Plans for the sake of consumer protection. We will consult insurers and relevant stakeholders in setting a reasonable level of annual cap on the "co-payment" amount.
Ends/Wednesday, July 17, 2013
Issued at HKT 15:17
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