LCQ2: Private patient services at public hospitals
Recently, some members of the medical sector have expressed to me their concerns about the engagement in private clinical practice (PCP) by teaching staff of the faculties of medicine of the two universities. In this connection, will the Government inform this Council:
(1) whether it can comprehensively set out the details of the rules and guidelines made by the two faculties of medicine on the engagement in PCP by their teaching staff, including the qualifications for engagement, the maximum number of hours allowed, the systems for reporting and auditing the figures of consultations, and the additional restrictions on the engagement in PCP by part-time teaching staff and doctors with limited registration, and provide copies of the relevant documents; whether it knows the number of cases of violations of such rules and guidelines uncovered by each faculty of medicine in the past five years, and the number of teaching staff involved; whether the two faculties of medicine have established a mechanism for handling complaints about PCP; if so, of the details;
(2) whether it can comprehensively set out the mechanisms adopted by the two faculties of medicine for sharing the income generated from PCP, as well as provide the relevant documents, and set out in a table the PCP data of each faculty of medicine in each of the past five years, including the number of doctors engaging in PCP, the number of patient attendances, the total amount of income generated, the amount of income apportioned to the Hospital Authority, the amount of income apportioned to the teaching staff, and the amount of relevant income received by each of the five teaching staff members who received the largest amounts of income generated from PCP; and
(3) if it knows how the Hospital Authority and the two faculties of medicine verify the number of hours of engagement in PCP as reported by the teaching staff, and whether the time they spend on conducting ward rounds, providing consultation services at outpatient clinics, performing operations and handling administrative work in respect of PCP will be counted?
The main rationale for providing private patient services at public hospitals is that certain specialised expertise and facilities in the public medical sector (especially the two teaching hospitals, namely the Queen Mary Hospital affiliated with the University of Hong Kong (HKU) and the Prince of Wales Hospital affiliated with the Chinese University of Hong Kong (CUHK) are not generally available in the private sector. The public can be offered an access to these specialised services by means of private services of the Hospital Authority (HA).
My reply to the various parts of the question raised by the Dr Hon Pierre Chan is as follows.
(1) The HA requires clinical professors from the two universities to be appointed as honorary staff before they can practise medicine on public patients in the teaching hospitals. Besides, as honorary staff of the HA, these clinical professors have to abide by the relevant guidelines and management procedures of the HA in the provision of private patient services.
According to the HA's guidelines on the provision of private patient services, both honorary staff from the universities and doctors of the HA must obtain the formal approval of the head of clinical department and the chief executive of the hospital concerned before engaging in the provision of private patient services. The HA also requires that all doctors providing private patient services must be specialists registered with the Medical Council of Hong Kong.
The HA also requires specialists to appropriately record their engagement in private clinical practice in writing during the process, so as to monitor and audit the provision of private services. To ensure that the provision of private services will not affect the public services received by Hong Kong residents, the HA has established guidelines to restrict the time that each HA doctor can be engaged in the provision of private specialist outpatient service to an average of only one session (i.e. three to four hours) per week. Currently private patient services account for less than 1 per cent of the overall service capacity of the HA.
We understand that the HKU and the CUHK have respectively implemented stringent internal control measures to govern the engagement in private patient services by clinical professors.
According to the information provided by the Faculty of Medicine of HKU, there are comprehensive regulations and guidelines regarding teaching staff of HKU engaging in outside practice. Applications for outside practice submitted by the teaching staff of the Faculty of Medicine have to be approved by the head of teaching department and the Outside Practice Committee of the faculty. The amount of time spent on outside practice and the distribution of revenue are also stringently regulated and monitored. Annual reports on outside practice must be audited by the Outside Practice Committee of the faculty and submitted by the Finance and Enterprises Office to the Council of HKU.
The Faculty of Medicine of CUHK also set stringent requirements for its teaching staff on private clinical practice (PCP). These include, for example, those engaged in PCP must be full time professoriate staff of the Faculty of Medicine having obtained the approval of the respective head of teaching department and Dean of the Faculty of Medicine, etc. There are restrictions on the time spent on private consultation service provided by each clinical teaching staff member. The service charges are set according to the List of Private Charges as per the Gazette and handled by the medical centre under the Prince of Wales Hospital. There is an established sharing mechanism in CUHK to share the revenue among the university, Faculty of Medicine, clinical department and professors, and the CUHK professors are not allowed to accept any payment directly from the patients. CUHK staff providing private consultation are required to report to the university and the Faculty of Medicine the number of hours of private consultation provided, and the Faculty of Medicine audits the records on a quarterly and a yearly basis according to the regulations concerned.
(2) and (3) Private patient services offered in HA hospitals are HA services. The HA has set up a standardised system to process relevant clinical documentation, billing and revenue collection of private services, etc. pursuant to the HA's procedures and requirements.
In view of the contribution of the two universities in private patient services, a fee sharing arrangement between the HA and the universities is in place. In general, revenue generated from consultations and procedures is shared in the ratio of 75 (university): 25 (HA), whereas that from supporting services (like radiology investigation and laboratory tests) is shared in the ratio of 75 (HA): 25 (university) in view of the higher contribution from the HA in the provision of such services. The way that the two universities handle their shares of revenue from private services is an internal matter of the universities and is outside the jurisdiction of the HA.
To step up monitoring, the HA has developed a common set of guidelines for public hospitals on the use of income generated from private patient services. The HA has also issued internal guidelines to assist doctors providing private patient services in determining the charges according to the complexity of each case.
The statistics on the use of the HA's private services, and the revenue so generated and apportioned to the universities in the past five years are at Annex.
To help the chief executives and heads of clinical departments of the hospitals concerned keep abreast of the service volume, HA has included private patient services in its formal statistical work starting from 2017-18. This helps ensure that the public medical services received by Hong Kong residents will not be affected by the provision of private patient services. Recently, the HA has conducted a review on the implementation of the guidelines on private patient services, and noted that the guidelines had been implemented smoothly in public hospitals (including the two teaching hospitals).
Ends/Wednesday, November 22, 2017
Issued at HKT 16:40
Issued at HKT 16:40