Provisional Legislative Council

PLC Paper No. CB(2)1464
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

Provisional Legislative Council
Panel on Health Services

Minutes of meeting held on Monday, 9 March 1998
at 8:30 am in Conference Room A of the Legislative Council Building

Members present :

Dr Hon TANG Siu-tong, JP (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon Henry WU
Hon MOK Ying-fan
Hon CHAN Yuen-han
Hon Howard YOUNG, JP

Members absent :

Hon WONG Siu-yee
Hon CHEUNG Hon-chung

Member attending :

Hon CHAN Choi-hi

Public officers attending :

Mr Gregory LEUNG, JP

Deputy Secretary for Health and Welfare

Mr Derek GOULD

Principal Assistant Secretary for Health and Welfare

(Medical) 3

Miss Eliza YAU

Principal Assistant Secretary for Health and Welfare

(Medical) 1

Ms Manda CHAN

Assistant Secretary for Health and Welfare (Medical) 2

Dr P Y LAM, JP

Deputy Director of Health

Dr Thomas TSANG

Principal Medical & Health Officer

Clerk in attendance :

Ms Doris CHAN

Chief Assistant Secretary (2) 4

Staff in attendance :

Mr LAW Kam-sang

Deputy Secretary General

Ms S Y YUE

Research Officer 2

Mr Stanley MA

Senior Assistant Secretary (2) 7

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As both the Chairman and the Deputy Chairman were delayed by traffic, in the presence of a quorum at 8:45 am, members agreed that Mr MOK Ying-fan should take the chair to start the meeting.

Closed Meeting

2. Members endorsed the draft report of the Panel [Paper No. CB(2)1140(01)] for submission to the Provisional Legislative Council on 1 April 1998.

3. Dr TANG Siu-tong arrived and took the chair at 8:50 am.

Open Meeting

I. Confirmation of minutes of special meeting held on 31 December 1997

4. The minutes were confirmed.

II Health Care Expenditure and Financing in Hong Kong
(Research Report RP06/PLC)

5. Deputy Secretary General (DSG) thanked the Administration for its feedback on the research report as detailed in PLC Paper No. CB(2)1140(02). In response, the Research and Library Services Division (RLSD) had prepared a supplementary information paper (PLC Paper No. R16) for members' reference.

6. DSG drew members' attention to the following points which were highlighted in the research report for discussion -

1. The Government had allocated about 84.1% ($21,074.8 million - revised estimate) and 10.2% ($2,559.7 million) of the total public health care expenditure ($25,051 million) respectively to the Hospital Authority (HA) and the Department of Health (DH) in 1996-97. Only a total of $1,919.2 million (around 7.7% of the total public health care expenditure) was spent on primary health care services provided by the DH. Since primary health care services which were comprehensive and effective would reduce the demand for secondary and tertiary health care services and consequently the overall expenditure on public health care services, the Administration should review its resources allocation for provision of primary health care services in the light of changing circumstances and expectations of the community;

2. As a result of a shortage of infirmary beds, some of the more costly general beds in public hospitals were occupied by patients who should be provided with infirmary beds. In 1996-97, the estimated daily costs of infirmary and general beds in public hospitals were $1,611 and $3,370 respectively. To ensure cost-effective use of general beds, the HA should monitor the provision of beds in the different categories in public hospitals on a continuous basis;

3. About 74.8% and 21.8% of the HA's budget were respectively spent on providing acute and extended care services and ambulatory care services including general out-patient (GOP) and specialist out-patient (SOP) services in 1996-97. As demand for SOP services had been increasing rapidly and since the emphasis of health care provision had switched from hospital in-patient care to ambulatory care services nowadays, a review on an optimal allocation of resources between in-patient services and ambulatory care services would help ensure that the needs of the patients were satisfied in the most cost-effective way;

4. In order to satisfy the increasing demand for public hospital services, the Administration should consider ways to make use of services in private hospitals so as to maximize the utilization of both public and private health care resources in the community; and

5. Faced with ever increasing public health care expenditure, of which more than 90% was financed by public fund, the Administration should consider ways to widen the source of income to ensure the continuous provision of quality public health care services in the long run, particularly during a period of economic downturn. In this connection, the RLSD was conducting researches on the health care financing models adopted in the USA, Britain, Taiwan and Australia. Reports of these researches would be completed in April 1998.

7. Dr LEONG Che-hung expressed appreciation of the quality of the research report and briefly commented on the issues highlighted by DSG. He stressed that these issues should be further elaborated in the Administration's current review on health care financing. Deputy Secretary for Health and Welfare (DS/HW) responded that the cost of in-patient care services was in general higher than that of ambulatory services. He agreed that improvements in the delivery of primary health care services to the community could help reduce the demand for in-patient services in the long term. He stressed that the Administration would continuously review the optimal level of resources allocation for primary, secondary and tertiary health care services in the light of prevailing circumstances such as advances in medical science and technologies to determine the best way forward. As regards the shortage of infirmary beds, the provision of additional care-and-attention homes and nursing homes, as well as the preventive and promotive health care services to be provided by the visiting health teams which would be progressively established within 1998 to 2000, for elderly living in the community would assist in reducing the demand for infirmary beds in public hospitals. In respect of health care financing systems in overseas countries, he pointed out that most Asian countries, not including Hong Kong and Malaysia, had adopted some forms of non-government central health care funding system, such as the Medisave Scheme of Singapore in which working citizens were required to contribute a certain percentage of their monthly income to provide for future health care needs. He anticipated that by making references to those models and having regard to local circumstances, the Consultant appointed to conduct the comprehensive review would be able to recommend a list of workable health care financing options for the community to consider.

8. The Chairman enquired about the feasibility of using public funds to subsidize selective private medical services to supplement the delivery of public health care services to the community. DS/HW said that he was in support of the advocacy that the public and private health care sectors should further co-operate and supplement each other in the provision of health care services. He highlighted that the use of additional public funds to enhance the delivery of public health care services would have to be supported by the community.

9. Mr MOK Ying-fan commented that policies and implementation measures for enhancing co-operation between the public and the private health care sectors should be developed as early as possible. He urged the Administration to review the current allocation of health care resources with the aim of ensuring the fair and adequate provision of primary, secondary and tertiary public health care services to the community. He opined that private medical practitioners should consider donating some of their time and efforts to serve the community in return for the public money which had been spent on their education and training in local universities and hospitals. Regarding the Administration's policy of encouraging the elderly to stay in the community, he pointed out that members of families might for various reasons not be able to look after their senior family members on a full time basis. Mr MOK also requested the Administration to follow up the establishment of a central health care fund and asked about the future role of traditional Chinese medicine (TCM) and TCM practitioners in the health care system of Hong Kong. DS/HW responded that the Administration reviewed the existing co-operation and relationship between the public and private health care sectors on a continuous basis and would thoroughly consider the views of the community before formulating any new policies in this respect. He opined that subject to individual circumstances, most elderly would prefer to live with their families. He highlighted that the Administration would continue to encourage family support for the elderly and improve the various out-reach services extended to elderly living in the community. As regards the promotion, development and regulation of TCM in Hong Kong, he said that preparation of the legislation for the regulation of TCM was in progress. Along with the establishment of the proposed TCM regulatory framework which would provide a foundation for the future development of TCM, the role of TCM and TCM practitioners in the health care system of Hong Kong would become increasingly important. In reply to Mr Howard YOUNG's follow-up enquiry, Principal Assistant Secretary for Health and Welfare (Medical 3) said that the mandatory Medisave Scheme, under which six to eight percent of the taxed income of a working citizen in Singapore was reserved for his/her future health care needs, provided financial protection against expenses arising out of basic health care needs. In addition, Singapore citizens might join additional health insurance schemes to meet the costs for higher levels of health care protection.

10. Referring to the philosophy that no one should be prevented, through lack of means, from obtaining adequate medical treatment, Dr LEONG Che-hung pointed out that the Administration had already committed to take care of the health care needs of the community. As regards the operation of the Medisave Scheme which was tailor-made and found feasible for the unique social environment of Singapore, he commented that similar mechanisms could be considered for incorporation under the proposed mandatory provident fund scheme in Hong Kong. Referring to the 1974 White Paper on "Further development of Medical and Health Services in Hong Kong" which placed greater emphasis on hospital services than on primary health care services, Dr LEONG said that after adoption of this policy for more than two decades, a review of relative resources allocation for primary health care and hospital services with respect to the health care needs of the community was necessary. Lastly, Dr LEONG commented that the Administration should continue to publicize that patients shared a responsibility in taking care of their own health. He requested the Administration to ensure the early completion of its comprehensive review on health care financing, so that the Chief Executive would be able to elaborate the Administration's policies on improving public health care services in his 1998 Policy Address. In response, DS/HW said that the Administration would consider the various issues raised for discussion in the research report as well as members' valuable feedback expressed at the meeting. Responding to Mr CHAN Choi-hi's follow-up question, DS/HW pointed out that the total expenditure of the HA as quoted in the research report included provisions for staff provident fund, housing allowances, services rendered by other government departments, etc., whereas the quoted total expenditure of the DH did not cover these expenses.

11. In reply to Mr CHAN Choi-hi' enquiries, DS/HW briefed members on the latest development of the Administration's comprehensive review on health care financing. Barring unforeseen circumstances, the review would be completed by the end of 1998. As regards the use of public funds for treatment of drug addicts, Deputy Director of Health (DDH) said that the use of methadone for treatment of drug addicts started in the seventies when prices of drugs rose rapidly, resulting in a significant increase of robberies which caused public concerns. He added that apart from the DH, the Security Bureau played an active role in monitoring the provision of other treatment and assistance to drug addicts.

12. Miss CHAN Yuen-han enquired about the basis for determination of daily maintenance charge of public hospitals and the large difference of share in the HA's 1996/97 annual expenditure ($21,865.8 million - revised estimate) between staff cost (around 80.5 %) and medical supplies and equipment (around 8.5%). DS/HW replied that the Administration would review the basis for determination of hospital maintenance charges in its review on health care financing. While deliveries of various health care services in a hospital setting involved intensive labour work which was costly in general, he assured members that the Administration would by way of the above review explore alternatives to reduce hospital staff costs. Given the circumstances and subject to advances in medical science and technologies in the future, the existing pattern of high staff and low medical supplies and equipment costs in hospital operation would most likely continue. As regards the work of medical consultants in public hospitals, DS/HW said that the HA was also reviewing their duties and responsibilities with the aim of ensuring cost-effective uses of their medical expertise in clinical management. He pointed out that some seemingly administrative tasks such as making decisions on procurement of medical equipment required professional knowledge and judgement and were best taken up by medical consultants specialized in the field concerned. Miss CHAN responded that there might be some administrative and operational arrangements within hospital settings which could be modified or improved to enhance patient's safety and work efficiency. In this connection, she urged the Administration to consider the views of laymen in its review of operational and management efficiencies in hospital operation.

13. Dr LEONG Che-hung added the following comments -

1. depending on circumstances and developments of medical science, the percentages of in-patients and out-patients to total number of patients receiving hospital services in a country would vary from time to time;

2. the allocation of public funds for DH to carry out its assigned range of primary and non-primary health care services had remained more or less stationary in the past five years and was insufficient on the whole;

3. staff cost was always the largest expenditure item in hospital operations. It also accounted for 70% to 80% of the total costs of hospitals in overseas countries. However, HA should continue to explore ways to further reduce the establishment of the head office;

4. the studies on hospital operation and health insurance schemes conducted by the two working groups under the DH in 1992 might be useful references for the current comprehensive review on health care financing;

5. the Administration should start the process of public consultation on the findings of the review on health care financing as soon as practicable; and

6. the report of the review on health care financing should, apart from providing a list of policy alternatives, recommend policy directions for development and provision of public health care services in the future.

14. Referring to the current utilization rates of primary, secondary and tertiary health care services provided by the public and private health care sectors and the percentage of population insured with some form of medical insurance, the Chairman requested the Administration to work out a set of strategies and policies which would ensure efficient deliveries and effective co-ordination of public and private health care services in the long run. He also urged the Administration to complete the comprehensive review on health care financing on schedule so that policy directions in relation to the Administration's strategies in financing the existing and new public health care services would be available for open discussion in mid-1998. Noting that the HA took up an overwhelming percentage (currently at around 93%) of the total secondary health care expenditure, Miss CHAN Yuen-han requested the Administration to review the policy of operating B-Class beds in public hospitals which, in her opinion, provided an environment and a quality of service exceeding that provided in private hospitals.

III Process of Legislation of Traditional Chinese Medicine
(PLC Paper No. CB(2)1140(03))

15. DS/HW briefed members on the salient points of the Administration's paper on the subject.

16. Dr LEONG Che-hung declared interest as a member of the Preparatory Committee on Chinese Medicine (the Committee) set up in March 1995. He enquired about the progress of legislation for the Committee's recommendations. In response, DS/HW said that he expected that legislation for the establishment of the TCM Council would be introduced to the LegCo in the 1998-99 session, followed by the enactment of the subsidiary legislation for registration of TCM practitioners. Barring unforeseen circumstances, the registration of TCM practitioners could be started in 2000. As for registration of Chinese medicines, he said that since it consisted of proprietary Chinese medicines and Chinese herbs of which some were toxic and potent, the Administration was now consulting the views of the profession in proposing a system of control which would include setting requirements for the packaging, labelling, storage and sale of these medicines. In response to Dr LEONG's follow-up comments that drafting of the subsidiary legislation for registration of TCM practitioners and proprietary Chinese medicines should be proceeded in parallel with the drafting of the principal legislation, DS/HW said that drafting of the Bill was underway, and the future TCM Council could only be set up after the approval of the Bill by the LegCo. As the preparation of the relevant subsidiary legislation would be subject to the advice or approval of the TCM Council, as appropriate, before they were introduced to the LegCo for negative vetting, the drafting of the subsidiary legislation could only be completed in slower time. DDH supplemented that all new proprietary Chinese medicines imported into Hong Kong were now subject to chemical analysis conducted by the Government Laboratory. As for the statutory registration of proprietary Chinese medicines, the DH was now seeking the views of the profession with the purpose of ensuring the safety standard, quality and efficacy of these medicines registered under the future registration system. In reply to the Chairman's follow-up question, DDH confirmed that the adulteration of proprietary Chinese medicine with western medicine was not allowed under the current legal framework. Proprietary medicines containing both Chinese and western medicine would continue to be subject to licensing control in the future.

17. Mr MOK Ying-fan declared interest as a serving TCM practitioner. He asked whether registered TCM practitioners in the future would be allowed to operate western medical tools and equipment such as X-ray for their patients. DS/HW replied that the Administration was carefully considering the related issues and would seek the views of the relevant medical professions in due course Regarding Mr MOK's concerns about the community's divided views on the proposed transitional arrangements for the registration of currently practising TCM practitioners and the high tuition fees of TCM courses offered by local tertiary institutions, DS/HW said that the Administration was devising some feasible transitional arrangements to ensure that practising TCM practitioners could continue to provide service to the community and would convey Mr MOK's opinions on tuition fee of TCM courses to the tertiary institutions concerned.

Adm

18. Mr Henry WU enquired about the target date for completion of the necessary legislative and registration work as proposed by the Administration in its consultation document on the development of TCM in the HKSAR. DS/HW replied that in view of the complexities of the work involved, the Administration had retained some flexibility in time management for completion of the registration of TCM practitioners and TCM and Chinese herbs. He explained that it would take five years for students to complete their undergraduate studies in local universities, and added that it was difficult to fix a period of time to complete the registration of some 7 000 currently practising TCM practitioners who came from different backgrounds and had different qualifications. Depending on their years of continuous practising experience and professional qualifications, these practising TCM practitioners would have to undergo a vetting process or a registration assessment or examination conducted by the future TCM Council as well as to satisfy other general conditions. For those who were not qualified for registration initially, there would be a specified period for them to meet the necessary registration standard. On the other hand, the controls over Chinese medicines, including Chinese herbs and proprietary Chinese medicines, would be introduced by phases. In view of the serious consequence of misuse of toxi/potent herbs, the Administration had proposed, as the first step, to compile a list of such herbs for statutory control. The next step would be to regulate, through a licensing system, the manufacturers, exporters/importers, wholesalers/retailers and processors of Chinese medicines in Hong Kong. A registration system similar to that for western medicines would be introduced for proprietary Chinese medicines. The DH would arrange sample testing for these registered medicines on a regular basis. In response, Mr WU stressed the need for the Administration to set a target date for completing the registration of currently practising TCM practitioners.

19. Mr MOK Ying-fan enquired about the incorporation of TCM out-patient service in the public health care sector. DS/HW said that the health care system in Hong Kong had all along been operating on the basis of western medical science and medicines. At present, the priority task was to establish a TCM regulatory framework and to facilitate the registration of currently practising TCM practitioners. Consideration of the role of TCM in the public health care system should be left to a later stage. Miss CHAN Yuen-han opined that due to historical reason, the Administration had traditionally placed TCM and TCM practitioners in an inferior position insofar as its policies on provision of public health care services were concerned. She urged the Administration to allocate more resources to facilitate early incorporation of TCM and TCM practitioners into the public health care system. Mr MOK added that the provision of TCM out-patient services in parallel with the existing out-patient services could alleviate the work pressure in the public health care sector in the long run. He urged the Administration and the medical professions concerned to take this into account in their consideration whether to support the request of TCM profession to play a part in serving the community's increasing demand for better public health care services in the years to come.

IV. Any other business

Commencement of Smoking (Public Health) (Amendment) Ordinance 1997
(PLC Paper No. CB(2)1140(04))

20. DS/HW informed the Panel that the Secretary for Health and Welfare had published a gazette notice on 20 February 1998 to assign 1 April 1998 and 1 July 1998 as the commencement dates for some of the provisions in the Smoking (Public Health) (Amendment) Ordinance 1997 (93 of 1997).

21. In reply to Mr Howard YOUNG's enquiry, DS/HW replied that in setting the commencement dates for different provisions of the Amendment Ordinance, the Administration had considered the need to allow sufficient time for the trade and related parties to make preparations for adaptation to the new requirements.

22. Noting that smoking was permitted in restaurants located within department stores and shopping malls, Miss CHAN Yuen-han enquired about the feasibility of requiring the owners concerned to re-design and modify the central air-conditioning system of these premises to prevent the circulation of cigarette smoke from these restaurants to other areas. DS/HW said that the Administration would consider the suggestion but pointed out that it was in practice difficult to require owners of these premises to do so. He added that the Smoking (Public Health) (Amendment) Ordinance 1997, to be commenced later, would require operators of restaurants having an indoor seating capacity of more than 200 (including those inside department stores and shopping malls) to designate no-smoking areas within the restaurant premises.

23. Dr LEONG Che-hung asked about the Administration's approach in ensuring no tobacco advertisement on the Internet. DS/HW responded that the Administration would follow up all reported complaints on such offence.

Special meeting of the Panel

24. Members agreed to hold a special meeting on 19 March 1998 to discuss the following issues -

1. the Hospital Authority budget for 1998/99; and

2. the prevention and control of cholera as well as possible influenza epidemic.

(Post meeting note : At the Administration's request, the Chairman agreed to change the date of the special meeting to Monday, 30 March 1998 at 8:30 am.)

25. The meeting ended at 11:05 am.

Provisional Legislative Council Secretariat
1 June 1998