Replies to LegCo questions
LCQ5: Patients' Choice Items Scheme
Following is a question by the Hon Michael Mak Kwok-fung and a reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (October 9):
Question:
In August this year, the Hospital Authority (HA) implemented the Patients' Choice Items Scheme in the seven hospitals of the New Territories East Cluster. Under the Scheme, only drugs classified as "clinically essential" will be provided to patients free of charge whereas patients may choose to purchase, at their own expense, drugs classified as "non-essential". In this connection, will the Government inform this Council whether:
(a) it knows which of the drugs now classified as "non-essential" used to be provided to patients free of charge before implementation of the above Scheme, and the diseases to be treated with these drugs;
(b) the Administration has stepped up its supervision on the sale of drugs classified as "non-essential" at drugstores after the implementation of the Scheme; and
(c) it knows if HA intends to extend the Scheme to all public hospitals; if so, of the implementation timetable, and the estimated annual savings in expenditure on drugs?
Reply:
Madam President,
(a) Rapid advance in medical technology results in new drugs constantly being launched in the market. It is essential for the Hospital Authority (HA) to fully evaluate these new drugs before they are introduced into public hospitals. In this connection, HA has been carrying out regular and systematic reviews to ensure that its clinical and therapeutic practices on the usage of new drugs are safe, efficacious, cost effective and according to best available scientific evidence, and that public resources are appropriately targeted to patients in need.
The HA New Territories East (NTE) Cluster conducted a comprehensive review on the usage of drugs in various clinical specialties earlier this year and developed a set of drug utilisation guidelines to systematically classify drugs into "essential" and "non-essential" items. The classification of drugs as "essential" or "non-essential" items is primarily based on the clinical conditions of the patients and the therapeutic indications of the drugs concerned. Broadly speaking, the NTE Cluster adopts the following basic principles when classifying "non-essential" drugs:
i) Drugs which lack comprehensive scientific evidence on clinical efficacy;
ii) Drugs with comparatively fewer side effects or marginally better efficacy, but disproportionately higher cost when compared with available alternatives; and
iii) Lifestyle drugs or drugs for primary prevention in low risk patients.
In addition, whether a drug is an "essential" item would depend on the clinical conditions of individual patients. A drug can be essential for one patient but not for another because of their different clinical conditions. It is therefore not a question of whether certain drugs are classified as "essential" or "non-essential" drugs before and after the implementation of the Patients' Choice Items (PCI) Pilot Scheme.
The implementation of the PCI Pilot Scheme aims to provide a mechanism to facilitate patients to make an informed choice on alternative and "non-essential" drugs that are outside the scope of provision of public hospitals in the NTE Cluster. Hospitals in the NTE Cluster will continue to prescribe essential drugs to all medically indicated patients irrespective of the cost of these drugs.
(b) HA will ensure that all public hospital patients receive appropriate medical care, irrespective of whether the patients choose to use PCI drugs or not. While PCI drugs should normally be supplied by community pharmacies, there are certain infrequently prescribed drugs which community pharmacies could encounter temporary difficulties in supplying them. HA has made temporary arrangements to provide these drugs to patients on a cost recovery basis. HA will maintain continuous dialogues with the pharmacy industry to ensure that public hospital patients are able to purchase the PCI drugs in the community pharmacies.
(c) The PCI is a Pilot Scheme implemented by the NTE Cluster. The objective of the Pilot Scheme is to ensure public resources are appropriately targeted to patients in need, and to offer alternative choices to patients for drugs that are outside the scope of provision of public hospitals in the NTE Cluster. HA will review the effectiveness of the Pilot Scheme before deciding on the most appropriate approach to be adopted across all public hospitals.
End/Wednesday, October 9, 2002
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