PLC Paper No. CB(2) 283
(These minutes have been
seen by the Administration
and cleared with the Chairman)
Ref : CB2/PL/HS
LegCo Panel on Health Services
Minutes of Meeting held on Tuesday, 10 June 1997 at 8:30 am
in Conference Room B of the Legislative Council Building
Members present :
Public officers attending :
- For all items
- Health and Welfare Branch
- Mr Gregory LEUNG, JP
- Deputy Secretary for Health & Welfare
- Mrs Maureen CHAN
- Principal Assistant Secretary for Health & Welfare (1)
- Mr Derek B GOULD
- Principal Assistant Secretary for Health & Welfare (3)
- Miss Joyce HO
- Assistant Secretary for Health & Welfare
- Department of Health
- Dr P Y LAM
- Deputy Director of Health
- Mr M S TSE
- Head, Boards & Councils Office
Clerk in attendance:
- Mrs Mary TANG
- Chief Assistant Secretary (2) 4 (Atg)
Staff in attendance :
- Mr Stanley MA
- Senior Assistant Secretary (2) 9
Members discussed and agreed on the major issues to be discussed in respect of each agenda item. In addition, members also agreed to enquire about the work progress of the Health and Medical Development Advisory Committee (HMDAC).
I.Confirmation of minutes of meeting and matters arising
(LegCo Paper Nos. CB(2)2445 and 2558/96-97)
2.The minutes of meetings held on 28 February and 12 April 1997 were confirmed.
Work progress of the Health and Medical Development Advisory Committee
3.In response to members enquiries, Deputy Secretary for Health & Welfare (DS/H&W) replied that HMDAC would be holding its next meeting in July 1997. It would discuss the report of the Preparatory Committee on Chinese Medicine which recommended the setting up of a framework to regulate, promote and develop the use of traditional Chinese Medicine (CM) and the on-going training and development programmes for existing CM practitioners and dispensers. At members request, he undertook to liaise with members of HMDAC to arrange more meetings for discussion on major upcoming health and medical issues and developments in Hong Kong. At the Chairmans request, he also agreed to provide the Panel with an up-to-date membership list of HMDAC and its term of office as soon as practicable.
II.Regulation on Traditional Chinese Medicine
(Paper No. CB(2)2557/96-97(01))
4.DS/H&W said the report prepared by the Preparatory Committee on Chinese Medicine (the Committee) had been circulated to Branches and Departments concerned for comments. Barring unforeseen circumstances, public consultation on the recommendations of the Committee would be arranged in the last quarter of 1997. He added that a public consultation process would normally take about three months to complete. Deputy Director of Health (DDH) supplemented that the Committee had planned to invite representatives of CM associations to participate in its discussions on the establishment of a regulatory framework to control the practice, use and trading of traditional CM. It was expected that through these representatives, the Committees recommendations would be conveyed to members of CM associations. In addition, the Committee had forwarded its report to CM associations and planned to complete the consultation process by the end of 1997. He stressed that the Committee would also welcome comments from CM practitioners and members of the public.
5.Dr LEONG Che-hung declared interest as a member of the Committee and enquired about the planned legislative schedule for statutory registration of CM practitioners and the control of traditional CM. DDH replied that subject to the outcome of public consultation, the Administration planned to introduce the relevant Bill within the 1998/99 session. As it was likely that the community would support the regulatory framework to control the practices, use and trading of CM in Hong Kong, Dr LEONG pointed out that it would facilitate the legislation process if the Administration could start the related legal drafting work now.
6.In parallel with the public consultation process, Dr LEONG suggested the Administration to commence the preparation and planning work for the following-
- the long-term education policies and programmes to ensure the optimal supply of qualified CM practitioners and dispensers in Hong Kong and their professional standards etc; and
- a registration system for proprietary CM available in market.
7.While agreeing that preparation work for the above should commence as early as possible, DS/H&W pointed out that the training of existing CM practitioners and dispensers should be given priority consideration. This would be followed by the categorization of proprietary CM and Chinese herbs.
8.Mr Howard YOUNG pointed out that the term of the first Legislative Council of the Special Administrative Region was two years. In order to enable some 7000 existing CM practitioners to register for election of LegCo members which would be conducted within May to August 2000, he urged the Administration to monitor the work schedule for registration of CM practitioners closely. As regards the accreditation of CM practitioners for registration purposes, he suggested that assistance be sought from experts in Asian countries which had a well-developed registration system for CM practitioners. DS/H&W responded that the Administrations general policy was that the profession should self-regulate its professional standards and practices.
9.Mr MOK Ying-fan declared interest as a CM practitioner. He was concerned about the availability of training courses in local institutions for in-service traditional CM dispensers. On the registration of CM practitioners, he asked whether the Administration had obtained the necessary financial and manpower resources for the implementation of the registration programme. DS/H&W replied that the Administration would follow up with local tertiary institutions and vocational training schools for further training of traditional CM dispensers. He pointed out that the registration of CM practitioners would involve a number of practical issues which needed to be resolved by the profession. As soon as the profession had agreed on the major principles and a proposed course of action, the Administration would proceed with the necessary legislative procedures. As regards the required funding, he said that the Department of Health (DH) would make appropriate bids to the Administration in the next resources allocation exercise. DDH supplemented that members of the Committee had been re-appointed by the Secretary for Health and Welfare for a further period of two years. As the profession had all along been involved in the Committees work, it was most likely that CM practitioners would support the Committees recommendations. Mr MOK supplemented that most CM practitioners were in support of the Committees proposals and urged the Administration to make arrangements for the registration of CM practitioners as soon as practicable. He added that the registration systems which had been adopted by China (since 1949) and Taiwan for a long time were valuable references for the Administration to consider.
10.Dr LEONG reiterated that the registration of proprietary CM should be proceeded in parallel with the registration of CM practitioners. He opined that the registration system for the former could follow the regulations and procedures of the existing registration system for western medicine. He was also concerned about the future role of CM practitioners in Hong Kongs overall medical and health care system. DS/H&W replied that the Administration would like to implement the Committees proposals as soon as possible. He opined that CM practitioners had a long history in Hong Kong and their contribution to the community had been well recognized. As for the incorporation of proprietary CM into the health care system in Hong Kong, DS/H&W said that this would depend on public confidence on the quality and reliability of proprietary CM. The Administration so far did not have a plan to use proprietary CM for patients at public hospitals and clinics. DDH supplemented that the Department of Health (DH) had increased the number of chemical analyses and toxicity tests for proprietary CM from 400 to 600 items a year. Initially DH would concentrate on the safety aspects of proprietary CM under test i.e., whether the medicine contained ingredients of western medicine and elements of heavy metals. In response to members further enquiries, DDH pointed out that some proprietary CM were made of compound formularies and as a result of processing, they might contain ingredients not indicated in the CM labels concerned. According to past records, about two percent of proprietary CM imported from China contained western medicine. Preparations containing western medicine were required to be registered under the Pharmacy and Poisons Ordinance (Cap 138). He anticipated that the implementation of a comprehensive and reliable system of control for CM would depend on the advancement of medical technologies involved in performing chemical analyses and toxicity tests for proprietary CM and Chinese herbs.
11.Mr MOK opined that formal recognition of the position of traditional CM and status of CM practitioners in Hong Kong could only be attained when they were accepted by the medical community and incorporated into the public health care system. He urged the Administration to work towards the incorporation of traditional CM into the public health care system and the formal recognition of CM practitioners. In response, DS/H&W said that the Administration would continue to keep in view the latest developments of the profession and review the situation from time to time.
III. Registration of Medical and Health Care Professionals/Personnel
(Paper No. CB(2)2557/96-97(02))
12.Dr YEUNG Sum enquired about the progress of implementation of the Chiropractors Registration Ordinance which was enacted in February 1993. Principal Assistant Secretary for Health and Welfare (1) (PAS/H&W1) replied that the profession had recently agreed on the set of qualifications and requirements for registration purposes. The legal drafting work was in progress and the subsidiary legislation would be introduced to LegCo shortly.
13.In reply to Dr LEONGs enquiry on the progress of the proposed registration of ancillary dental personnel (ADP), PAS/H&W1 said that the profession had yet to agree on a course of action. The Dental Sub-committee of the Health and Medical Development Advisory Committee had commissioned a Working Group on the registration of ADP to reconcile the divided views and concerns among the ADP and the dental profession. The Working Group would complete a report in July 1997. Members opined that the different views within the profession arising out of the conflicting interests between employers and employees should not be an obstacle to the setting up of a legislative framework. In the interest of public health, the registration of ADP should start as early as possible. PAS/H&W1 pointed out that most ADP received no formal training for the profession and a set of criteria for statutory registration of ADP was being examined. The Chairman responded that as long as the livelihood of in-service ADP was not affected by the legislation, the Administration should proceed with the preparatory work for registration.
|14. In view that a formal registration system for the profession should be established. PAS/H&W1 agreed to study the issue and would provide the Panel with an information paper as soon as practicable.||Adm
|15.In response to the Chairmans concern about the professional standard of dietitians in private sector, PAS/H&W1 informed that the profession had approached H&W Branch to explore the feasibility of introducing statutory registration for dietitians. He also agreed to update members with a list of health care professions which had not yet been subject to statutory registration. ||Admin
|16.Dr HUANG Chen-ya reminded the Administration that in setting entrance requirements for statutory registration of health care professions which were in relative minority, the actual manpower situation and the historical background of the professions concerned should be considered thoroughly. A member added that for some special health care professions, the requirement of statutory registration might not be beneficial to the community as a whole. PAS/H&W1 agreed to report on the issue.||Admin
IV. Review of the health care System
(Paper No. CB(2)2557/96-97(03))
17.DS/H&W confirmed that the Chinese translation of National Health Account (NHA) should be"
instead of as used in the Chinese version of Paper No. CB(2)2557/96-97(03). He explained that the revised translation incorporated health care expenditure in both public and private sectors.
18.Mr Howard YOUNG enquired about the purpose of constructing a NHA for Hong Kong and the significance of "facilitating international comparisons" in the context of the future development of the health care system in Hong Kong. Principal Assistant Secretary for Health & Welfare (3) (PAS/H&W3) replied that NHA provided policy decision makers with a holistic picture which indicated the sources and destinations of health care expenditure and the roles of different payers in both public and private health care sectors. A regularly updated NHA could serve as a powerful tool for policy analysis and a monitoring mechanism for the allocation of public funds. In practice, NHA was both an accounting system and an econometric model which could help policy makers ascertain the flow of funds into primary, secondary and tertiary health care within the public and private sectors, evaluate policy proposals and options, assess and monitor the effectiveness of reform measures adopted within the health care system. NHA systems varied from country to country and some of them might serve as valuable references for the Administration to predict the general and possible consequences of a change in health care policies as well as a variation in some social and economic factors having direct or indirect effects on individual cost items of health care expenditure.
|19.In response to Dr LEONGs enquiries, DS/H&W said that the construction and the on-going updating of NHA would enable the Administration to analyze the various factors contributing to the utilization of public and private expenditure in health care items. While it appeared that Government had provided for most of the health care services to the community, the private sector in monetary terms did constitute about 55 percent of the total health care expenditure. The Administration would use the service of an external consultant to assist in the construction of NHA and, having regard to the operational merits and demerits of individual NHAs in overseas countries and their applicability to Hong Kong, recommend a system of NHA which would best suit the Hong Kong situation. At members request, DS/H&W agreed to provide an interim report to the Panel as soon as practicable.||Admin
20.Dr HUANG was in favour of the construction of NHA and enquired on the applicability of overseas NHA models to Hong Kong. PAS/H&W3 replied that due to the varying socio-economic structures among different countries, the Administration so far had not identified a NHA model which was considered suitable for Hong Kong. It appeared very likely that the ultimate recommendation would be to adopt a combination of features of different NHAs for the particular health care environment in Hong Kong.
21.Members in general concurred that the construction of NHA should not delay the completion of the review on health care financing policies. PAS/H&W3 responded that the Administration had conducted the review in parallel with the study on NHA which would be completed in 1998. With the supporting analysis and statistics made available in NHA, he was of the view that the Administration would be in a better position to propose policy options in respect of future developments of health care system in Hong Kong. DS/H&W supplemented that the Administration would, based on the data and findings of NHA which would be made available to members in due course, propose policy changes with the aim of improving the existing health care system. He added that these proposals would be subject to open consultation before adoption.
V. Any other business
Control on infectious disease
22.The Chairman was concerned about the recent outbreak of infectious diseases such as tuberculosis and measles in Hong Kong. DDH responded that infectious diseases would always exist and according to World Health Organization, more would emerge in the future. Under the Quarantine and Prevention of Diseases Ordinance (Cap 141), DH was empowered to carry out investigation into the source of infection, isolation of cases, contact tracing and other preventive and control measures. For this purpose, DH had established an effective and efficient surveillance programme built upon a network of health care facilities in the public and private sectors. Apart from this, DH would continue to arrange staff to attend local and overseas conferences and training on prevention of infectious diseases, to maintain a close link with World Health Organization and conduct applied research studies organized jointly with local tertiary institutions to combat infectious diseases. As a preventive measure, DH would propose the construction of a new public laboratory to cater for the demand for large scale laboratory support arising from an outbreak of infectious disease. In summary, Hong Kong had a well-developed system in place for surveillance of infectious diseases.
23.In response to members comments on the surveillance of infectious diseases, DDH explained that the epidemiological pattern of measles had shown some changes in recent years. There were increasing infections of children above ten as well as those already vaccinated against measles. In line with international standards and in pace with most developed countries such as United Kingdom, DH had arranged a second dose vaccination programme against measles for children at primary six classes since 1996. To prevent a predicted measles outbreak next year, DH would be launching the Special Measles Vaccination Compaign 1997 targetting at those under the age of 19. He stressed that DH had been proactive in both surveillance and prevention of infectious diseases. In response to Dr LEONGs further enquiry, DDH replied that the combined measles, mumps and rubella (MMR) vaccine would be given to booster the immunity of children and teenagers between one and 19 years old who had not received a measles vaccination before or those who had only received one dose of vaccine for measles. After the completion of this campaign by the end of November 1997, the future second dose vaccination against measles would be arranged for children at primary one each year.
24.Miss CHAN Yuen-han was concerned about the spread of infectious diseases in health care and education institutions. DDH replied that all health care personnel working in these institutions were encouraged to take vaccinations against infectious diseases including measles. A special working group comprising members from DH and the Education Department had been established to keep surveillance of infectious diseases in schools and to co-ordinate follow-up actions for any reported cases. Special information leaflet on the handling of infectious diseases had been prepared by medical consultants and distributed to school teachers. DH would also develop a mechanism to ensure that all children at primary school had received the required vaccination against infectious diseases, with particular attention on children of new immigrants. In response to the Chairmans request, DDH undertook to make known to the public the three vaccine contained in a MMR injection.
25.There being no other business, the meeting ended at 10:45 am.
Provisional Legislative Council Secretariat
10 September 1997
Last Updated on 19 August 1998