LC Paper No. CB(2)2759/98-99
(These minutes have been
seen by the Administration)
Ref : CB2/PL/HS
LegCo Panel on Health Services
Minutes of meeting
held on Monday, 9 August 1999 at 8:30 am
in Conference Room A of the Legislative Council Building
Members Present :
Hon Michael HO Mun-ka (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon Cyd HO Sau-lan
Hon CHAN Yuen-han
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Hon LAW Chi-kwong, JP
Dr Hon TANG Siu-tong, JP
Members Absent :
Hon HO Sai-chu, SBS, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung
Members Attending :
Hon Bernard CHAN
Hon Emily LAU Wai-hing, JP
Public Officers Attending :
Mr Gregory LEUNG, JP
Acting Secretary for Health and Welfare
Miss Kinnie WONG
Assistant Secretary for Health and Welfare (Medical) 7
Dr Constance CHAN
Assistant Director (Health Administration & Planning)
Dr W M KO
Deputy Director of Operations,
Clerk in Attendance :
Ms Doris CHAN
Chief Assistant Secretary (2) 4
Staff in Attendance :
Miss Betty MA
Senior Assistant Secretary (2) 1
I. Confirmation of minutes of meeting
(LC Paper No. CB(2)2656/98-99)
The minutes of meeting held on 28 June 1999 were confirmed.
II. Date of next meeting and items for discussion
(LC Paper No. CB(2)2663/98-99(01))
Items for discussion at the meeting scheduled for 13 September 1999
2. Members agreed to discuss the following items at the meeting to be
held on 13 September 1999 -
- Registration of ancillary dental personnel;
- Manpower requirements in respect of health care grades in the Hospital
Authority and the Department of Health;
- Monitoring of pharmacies; and
- Report on matters considered by the Health and Medical Development Advisory Committee.
Items for discussion at future meetings -
- Control on the use of health care laser systems;
- Progress of the proposal to centralize the slaughtering of chickens;
- Registration and patent rights of drugs; and
- Proposed 24-hour out-patient service and its relationship with the accidents and emergency departments of public hospitals.
3. The Chairman requested and the Administration agreed to provide information
papers on items (a), (b) and (d) of the items for discussion at future
meetings before the next meeting.
III. Proposed amendments to the Human Organ Transplant Ordinance
(LC Paper No. CB(2)2663/98-99(02))
4. Acting Secretary for Health and Welfare (Atg. SHW) briefed members
on the background of the proposed amendments which were made in response
to the views and comments expressed by concerned parties during the deliberations
of the Human Organ Transplant (Amendment) Ordinance. The salient points
of the proposed amendments were as follows -
- Under the existing Ordinance, transplant operations were required
to be preceded by some stipulated procedures. There were practical difficulties
in complying with these required procedures in cases of operations using
organs, such as bone fragments, already removed from another person for
therapeutic purposes on a previous occasion, which was unconnected with
the potential transplant operation. The Administration proposed to add
a schedule to the Ordinance setting out circumstances under which exemptions
from certain stipulated procedures would be allowed and also to provide
a clearer definition of "organ";
- To cater for temporary absence of members of the Human Organ Transplant
Board (the Board), the Administration proposed to set up panels of alternative
members to serve as temporary members where needed. Consideration was also
being given to appointing a substantive member as the deputy chairman who
would automatically replace the chairman when he/she could not exercise
- The Administration also proposed to -
- stipulate clearly in the Ordinance that there should be a legal
advisor and secretary appointed to assist the Board in pursuit of its duties;
- stipulate clearly in the Ordinance that no member of the Board
and its secretariat should be personally liable for any act done or default
made by the Board when they were acting in good faith in the exercise of
the powers conferred on the Board by the Ordinance;
- amend the Ordinance with a view to allowing either the same or
two different medical practitioners to interview the donor and the recipient;
- review the drafting and structure of the Ordinance with a view
to streamlining it to make it more user-friendly to the Board and medical
Atg. SHW said that the Administration was still considering whether
the criteria under which the Board would make a decision should be stipulated
in the Ordinance.
5. Dr LEONG Che-hung supported the proposed amendments. He pointed out
that the most important decision of the Board had to make was whether there
was any commercial dealing. Such an assessment sometimes had to be made
within a very tight time-frame. He enquired whether there had been any
difficulty in making such an assessment and whether there was a need for
stipulating clearly in the Ordinance the criteria to be adopted by the
Board. In addition, he was concerned that due to the lack of written guidelines,
the appointment of temporary members might give rise to inconsistent decisions.
6. In response, Atg. SHW said that he appreciated the difficulties faced
by the Board when an important decision had to be made within a few hours.
The Board might have internal guidelines for its members as to how to make
an assessment on commercial dealing. Consideration had been given to providing
written guidelines in the legislation but there was worry that it would
result in inflexibility for the Board in making a decision. The Administration
therefore preferred to rely on the experience of the nine members to make
an assessment based on the information available to them. Nevertheless,
the Administration would further discuss the matter with the Board.
7. As regards the concern about the possibility of inconsistent decisions,
Atg. SHW said that the proposal to set up panels of alternative members
to serve as temporary members where needed would be an improvement on the
present arrangement. The continuity and cooperation amongst alternative
members of the panels would be enhanced as the appointment to the panels
would last for some time.
|8. As to the operation of the panels of alternative members, Mr
LAW Chi-kwong suggested that alternative members might be requested to
serve as temporary members on case-by-case rotation basis instead of being
rotated periodically so as to even out their workload. Atg. SHW explained
that members of the Board were responsible for the formulation of subsidiary
legislation and making decisions on various applications. As the making
of subsidiary legislation was not subject to a very tight schedule, the
work could be undertaken by the nine substantive members. Alternative members
would only be involved in making decisions in respect of applications during
the temporary absence of substantive members. Atg. SHW agreed to consider
Mr LAW's suggestion.||Adm|
9. Referring to the proposal to add a schedule to the Ordinance setting
out circumstances under which exemptions from certain stipulated procedures
could be allowed, Mr LAW Chi-kwong asked whether the schedule in question
would be subsidiary legislation. Atg. SHW said that it would be part of
the principal Ordinance.
|10. Mr LAW Chi-kwong suggested that the Administration might consider
publicizing the working procedures of the Board by way of Gazette notice
which would not be subject to the scrutiny of the Legislative Council.
Atg. SHW said that the Administration would take note of Mr LAW's suggestion.||Adm|
11. In response to Dr LEONG Che-hung and Miss Cyd HO's enquiries about
the legislative timetable, Atg. SHW said that the Administration would
proceed with the drafting of the amendment bill should members support
the proposed amendments in principle. The Panel would be further consulted
on the draft amendments before they were finalized. The Administration
intended to introduce the amendment bill to the Legislative Council for
first reading in late 1999 or early 2000.
12. Mr LAW Chi-kwong asked how the Ordinance would be re-structured.
Miss Cyd HO enquired about the plan for reviewing the drafting of the Ordinance.
Atg. SHW said that the Administration would liaise with the Law Drafting
Division of the Department of Justice on this issue with a view to making
the Ordinance more user-friendly to the Board and medical practitioners.
13. Responding to Dr TANG Siu-tong's enquiry about the meaning of "good
faith" as stated in paragraph 7 of the information paper, Atg. SHW said
that generally speaking, the term would be interpreted as having no personal
pecuniary interest in the exercise of powers.
IV. Members' discussion on the Harvard Report
14. The Chairman said that the purpose of the discussion at this meeting
was for members to draw the Administration's attention to special areas
of concern after five earlier meetings which had been held to meet deputations
to listen to and to discuss with them their views on the Harvard Report.
15. Dr LEONG Che-hung enquired about the Administration's plan on the
way forward and the timetable for the consultation document. Atg. SHW said
that the public consultation period had been extended to mid-August 1999.
The Administration would issue a consultation paper at the end of 1999
upon the completion of analysis of the views received during the current
consultation exercise. The paper would set out the direction that the Administration
proposed to pursue in respect of the development of Hong Kong's health
|16. Dr LEONG Che-hung commented that the Harvard Report did not
cover dental health and Chinese medicine services. He asked whether the
Administration would address the issues in its consultation paper. Atg.
SHW assured members that the Administration recognized the importance of
all health care professionals in the health care system and would take
note of the concerns in drawing up its future direction.||Adm|
17. Mr LAW Chi-kwong pointed out that under the existing health care
system, resources allocated for curing and treatment of diseases outweighed
those for disease prevention and health promotion/education significantly.
He considered that the Administration should first enhance disease prevention
before cutting back resources for curative care. In order to do so, the
only way was for the Administration to inject new money for introducing
changes to the health care system. In addition, the Administration should
take into account the affordability of members of the public on health
care expenses within the next three to five years bearing in mind that
the coming into force of the Mandatory Provident Fund in the coming year.
Mr LAW considered that the timetable for introducing changes to the health
care system should not be too hasty. Dr LEONG Che-hung also expressed concern
whether the Administration had any plan to improve primary health care
first before implementing the other changes in the health care review.
18. In response, Atg. SHW said that given the present economic condition,
the Administration might not have additional resources for implementing
new proposals in connection with health care service delivery. The Administration
would probably focus on areas where there had been consensus on the need
to change in the first instance.
19. Dr LEONG Che-hung urged the Administration not to set aside those
areas where no consensus was reached at the moment. Atg. SHW said that
the Administration was aware that time was a critical factor for introducing
changes to the health care system.
20. Mr Bernard CHAN said that the Hong Kong Federation of Insurers would
make a submission to the Health and Welfare Bureau before the deadline
of 15 August 1999. He pointed out that the Harvard Report did not mention
the future of some 2.3 million existing medical insurance policies. He
said that the insurance sector was concerned about the future operation
of private medical insurance should the proposed mandatory Health Security
Plan (HSP) come into effect. The existing insurance policy holders would
also need to know whether the future benefit under HSP would be better
or worse than their existing coverage. Atg. SHW responded that it was considered
that HSP should be better than private medical insurance as the scheme
would not be profit making. As to whether private insurance could continue,
Atg. SHW said that private insurance schemes would still be allowed to
supplement the compulsory scheme if implemented. He appealed to the insurance
sector to give more views to the Administration. He reiterated that the
Administration was open-minded over the Harvard proposal and would welcome
other views or alternative proposals.
21. Noting from paragraph 8 of the research report entitled "A Comparison
Between the Harvard Proposal and other Health Care Financing Models" (RP14/98-99)
that savings accounts represented 8.4% of the health care financing in
Singapore in 1995, Mr Bernard CHAN enquired whether such proportion was
considered significant. In response, Atg. SHW said that, as far as he could
recall, savings accounts represented 11% of the health care financing in
Singapore in 1998. Government funding and other private financing sources
were also available in Singapore.
22. In respect of the Administration's consultation paper, Miss Cyd
HO asked whether it would cover review of the health care system given
that the public's views on the Harvard proposal were not only confined
to health care financing. Atg. SHW explained that the Administration's
consultation paper would cover the delivery system of health care and its
financing. Miss Cyd HO remarked that the Administration should give due
emphasis on ways to achieve an effective delivery system of health care
in preparing its consultation paper.
23. The Chairman asked for more details on the consultation paper to
be issued at the end of the year. He said that the public could not make
a decision on the options put forward by the Administration in its consultation
paper if it failed to provide specific implementation details and supporting
statistics. In particular, the public would need to know what they could
get for making 1% contribution for HSP. In response, Atg. SHW said that
a three-pronged approach would be adopted in the consultation paper having
regard to the views and comments on the Harvard Report collected during
the present consultation period. Firstly, the consultation paper would
list areas with broad consensus for adoption, e.g. setting up an Institute
for Health Policy and Economics to conduct objective and rational analyses
and to monitor the system's performance. Secondly, the consultation paper
would outline health areas which attracted divergent views, such as ways
to improve the accountability of medical practices, and would make recommendations.
Thirdly, the consultation paper might include alternative financing proposals
suggested by the community during the current consultation exercise. Atg.
SHW assured members that apart from outlining the concept of each proposal,
the paper would also provide some supporting statistics that would be easily
understood by the public.
24. Referring to the scope of the consultation paper, Dr LEONG Che-hung
was of the view that the Administration should not put forward too many
options. Otherwise, the consultation process would be unduly prolonged.
Atg. SHW replied that the Administration aimed at putting forward two to
three options, including the Harvard proposal, in its consultation paper.
25. Dr TANG Siu-tong wished to know whether the Administration already
had a plan in respect of the development of Hong Kong's health care now
or when it commissioned the Harvard team to conduct a study on Hong Kong's
health care system. Atg. SHW said that the Harvard study included a comprehensive
assessment of the current system and a proposal for alternative options
to improve financing and delivery of health care. He stressed that the
Administration had not yet concluded on which option to be adopted. Apart
from the Harvard proposal, at least two other major proposals had been
put forward by the community, namely, a medical saving scheme and voluntary
private medical insurance. The Administration would try to outline the
pros and cons of various options in the forthcoming consultation paper.
26. Miss Emily LAU was of the view that the Administration already had
some plans in mind when it commissioned the Harvard team to conduct the
study on Hong Kong's health care system. Atg. SHW said that the Harvard
team was asked to examine three major areas when it was commissioned to
conduct the study, namely, a) whether the current arrangement for financing
health care (i.e. relying on tax revenue) could be sustained; b) whether
the existing distribution of workload between public and private sectors
was in need of adjustment having regard to the fact that each sector had
some 4 000 medical practitioners but the former was providing services
to meet 92% of the community's inpatient needs; and c) whether there was
an overlapping of services among primary, secondary and inpatient health
27. The Chairman asked the Administration to provide specific cost estimation
for implementing each option outlined in its forthcoming consultation paper
in order to facilitate the public to make a decision. Atg. SHW said that
apart from putting forward some conceptual ideas for health care review,
the Administration would hopefully be able to provide supporting figures
in its consultation paper which could be understood and mastered by the
general public by the end of 1999.
28. Miss Emily LAU urged the Administration to provide the latest statistic
on the projection of population profile and the demand for health care
services in its consultation paper. Atg. SHW said that with the assistance
from the Hospital Authority (HA), more concrete figures would be incorporated
in the Administration's consultation paper.
29. Dr LEONG Che-hung referred to the guiding principles stated in paragraph
1.5.1 of the Harvard Report and asked whether there was consensus on the
guiding principles. Atg. SHW said that no dissenting views had been
received so far. The thrust of the question was on how to achieve the objective
of the guiding principles.
30. Miss CHAN Yuen-han enquired about the timetable for the forthcoming
consultation paper and consultation exercise. Atg. SHW said that there
might be two to three options put forward for consultation at the end of
1999. The length of the consultation period would depend on the complexity
of the areas requiring consultation.
31. Noting that the Medical Council of Hong Kong (MCHK) had already
made some proposals to improve medical practices, Miss Emily LAU asked
whether MCHK's proposals could be regarded as introducing changes to those
health areas where consensus had been reached between MCHK and the Administration
as a result of the Harvard proposal. Atg. SHW said that the Administration
had not yet received MCHK's formal submission. The MCHK's view was an indicator
of whether consensus had been reached within the medical profession on
areas of change. He reiterated that the Administration would have all the
views, including consensus views, collated and presented in its forthcoming
32. Miss Emily LAU further asked whether changes to health areas where
consensus had been reached would be implemented ahead of the publication
of the Administration's consultation paper. Atg. SHW said that the Administration
could start doing some ground work on these items, but their implementation
should await further endorsement by the public through the subsequent consultation
33. Miss CHAN Yuen-han said that it seemed that the Administration
was inclined to taking the opportunity to introduce an overall reform of
the health care policy and system. She pointed out that to adopt the Harvard
proposal would be a fundamental change to Hong Kong's health care system.
She asked how the Administration would deal with the public views collected
in the present consultation on the Harvard Report. In reply, Atg. SHW said
that all the views received in the recent public consultation would be
taken into consideration regardless of whether the views were in support
of the Harvard Report. As far as he was aware, it was quite clear that
members of the public were in support of that there was a need to introduce
some changes to the existing health care system. As regards whether there
would be a structural change to HA, Atg. SHW said that it was premature
to comment on the issue at the moment.
34. In response to Miss Emily LAU's enquiry, Deputy Director of Operations/
Hospital Authority said that HA had set up a select committee to study
the Harvard proposal and the committee was finalizing its views and comments
for the endorsement of its members before submission to the Government
before the end of the consultation period. In drawing up its views, the
select committee had interviewed patients' associations, members of the
Provisional District Boards, health care professionals and academics from
the universities. Of the views collected, it was noted that the majority
of the members of the public wished the Government to continue to provide
basic health care service. The proposal of a system of shared responsibility
between the Government and residents was generally accepted. It was noted
that the final decision of the public would, however, depend very much
on the proposed fees for various health care services. Hence, HA would
incorporate supporting statistics as far as practicable in its report.
He saw no reasons why HA's report could not be made public after it was
submitted to the Administration.
35. Mrs Sophie LEUNG added that HA had collected views from patients
and front-line health care staff on the existing health care system well
before the launching of the consultation on the Harvard Report. Thus HA,
in drawing up its submission, had taken into account its experience in
the delivery of health care as well as feedback from both users and service
36. Noting that the incumbent of the post of SHW would be retiring from
the civil service shortly, Dr TANG Siu-tong expressed concern whether the
Government's stance in respect of the development of Hong Kong's health
care might be revised as a result of the staff change. Miss Emily LAU also
wondered if a change in the incumbent of the post would have any impact
on the health care policy and hence the timetable for implementing changes
to the health care system. Atg. SHW said that the staff change would not
affect the Administration's undertaking to continue with the review. Dr
LEONG Che-hung was of the view that a change in the incumbent of a public
post should not have any impact on the respective organization's policy
37. Miss Cyd HO asked whether the Legislative Council would be consulted
on the health care reform in the event that no additional resources would
need to be sought from the Finance Committee and no amendment to existing
legislation would be required. Atg. SHW assured members that should there
be any substantial change to the existing health care policy, members would
be consulted before introducing the changes.
38. The Chairman enquired whether there was sufficient manpower in the
Health and Welfare Bureau to cope with workload in connection with the
health care proposals. Atg. SHW said that with the assistance from HA,
the Bureau would be able to cope with the workload.
|39. Miss Emily LAU suggested and the Chairman shared the view that
the Panel should be provided with a copy of HA's submission on the Harvard
40. In addition, Miss Emily LAU suggested to hold another meeting to
discuss HA's submission. Miss CHAN Yuen-han supported Miss LAU's suggestion.
Mr LAW Chi-kwong was of the view that it was unnecessary for the Panel
to discuss individual submissions to the Administration given that the
Administration would consult the Panel on the consolidated views at a later
stage. The Chairman suggested that if members had interests in individual
submissions, a list of such organizations could be drawn up so that the
Clerk could approach the respective organizations to obtain the relevant
submissions. Interested members should liaise with the Clerk for follow-up
actions if they so wished.
41. Mrs Sophie LEUNG enquired whether it was possible for the Panel
to be provided with an executive summary of the submissions received by
the Administration while awaiting the publication of the Administration's
consultation paper. Noting that some 430 submissions had already been received
by the Administration so far, Mr LAW Chi-kwong pointed out that the request
would result in additional workload for the Administration and he did not
see the need for such a summary.
42. In response to Miss Emily LAU and the Chairman, Atg. SHW said that
the Administration had not spelt out explicitly to the respective organizations
that their submissions on the Harvard Report would be made available to
the public. However, should there be such need, he could approach respective
organizations to obtain their agreement. Miss Emily LAU opined that as
a matter of principle, the Administration should ensure an open access
to the submissions.
43. There being no other business, the meeting ended at 10:40 am.
Legislative Council Secretariat
7 September 1999