Ref : CB2/PL/HS

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,
Hospital Authority

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 -

1. Registration of ancillary dental personnel;

2. Manpower requirements in respect of health care grades in the Hospital Authority and the Department of Health;

3. Monitoring of pharmacies; and

4. Report on matters considered by the Health and Medical Development Advisory Committee.

Items for discussion at future meetings -

1. Control on the use of health care laser systems;

2. Progress of the proposal to centralize the slaughtering of chickens;

3. Registration and patent rights of drugs; and

4. 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 -

1. 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";

2. 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 his/her functions;

3. The Administration also proposed to -
   1. stipulate clearly in the Ordinance that there should be a legal advisor and secretary appointed to assist the Board in pursuit of its duties;

   2. 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;

   3. amend the Ordinance with a view to allowing either the same or two different medical practitioners to interview the donor and the recipient; and

   4. 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 practitioners.

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 care system.

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 care.

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 consultation paper.

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 exercise.

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 providers.

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 stance.

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 Report.	Adm

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