Replies to LegCo questions
LCQ7: Determination of fees for public hospital services
Following is a question by the Dr Hon Yeung Sum and a written reply by the
Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council
today (May 16):
Question:
Under the Hospital Authority (HA) Ordinance (Cap.113), the Hospital Governing
Committee (HGC) of an individual HA hospital or HA (if there is no HGC
established for a public hospital) may, without subject to the approval by the
Legislative Council (LegCo), determine on its own the fees for hospital services
provided by the hospital concerned. Regarding the powers and procedures for
determining and revising medical services-related fees and charges, will the
Government inform this Council:
(a) of the medical services-related fee items and the number of people affected
last year, broken down by the powers and procedures for fee determination and
revision (subject to LegCo's approval, or may be decided and implemented,
without subject to LegCo's approval, by the executive authorities, HA or the
HGCs concerned on their own);
(b) of the rationale and principle for conferring on individual HGC the power to
determine the fees for hospital services; how the Government addresses the
problems of additional fees charged by individual public hospitals (for example,
Tuen Mun Hospital charges additional fees for acute wards) and the inconsistency
in the fee-charging policies adopted by different public hospitals; and
(c) whether it will consider amending the legislation to abolish the arrangement
for individual HGCs to determine on their own the fees for hospital services
provided by the hospital concerned, and to enhance the monitoring of fee
determination by HA (for example, requiring that such determination shall be
subject to LegCo's approval)?
Reply:
Madam President,
The Hospital Authority (HA) is a statutory body established under the Hospital
Authority Ordinance (Cap. 113). The functions and powers of the HA, including
the power to determine the fees payable for hospital services provided by public
hospitals, are clearly stipulated in the Ordinance.
Pursuant to section 18 of the Hospital Authority Ordinance, a Hospital Governing
Committee (HGC) of a public hospital may determine the fees payable for hospital
services provided by the public hospital(s) under its charge. For hospitals
without an HGC (only two of the 41 hospitals under the HA, namely the Wong Chuk
Hang Hospital and St. John Hospital, are operating without an HGC), the power
for determining fees is exercised by the HA. Any determination so made by an HGC
or the HA should be published in the Gazette. Section 18 also stipulates that
the Secretary for Health, Welfare and Food (SHWF) may give directions to the HA
over the determination of fees for hospital services; and the HA may also,
subject to SHWF's directions, give directions to an HGC over the determination
of fees for hospital services. The above arrangement provides the HA, as an
independent statutory body, the necessary power to standardise the fees charged
for various hospital services, thus able to avoid irregular fee-charging
practices among different public hospitals. The arrangement also enables the
Administration to participate in the determination of fees for hospital services
through the issue of directions.
(a) The fees for the main services of the HA and the number of patients served
in 2006 are set out in the Annex.
(b)&(c) The rationale for conferring upon individual HGCs the power to determine
the fees payable for hospital services was based on the fact that prior to the
establishment of the HA, the fees for hospital services charged by some of the
subvented hospitals were not entirely the same as those charged by Government
hospitals. In the process of drafting the Hospital Authority Ordinance, the
Administration considered that subvented hospitals should be allowed to retain a
certain degree of flexibility in the determination of hospital service fees, so
as to enable their parent organisations to provide some free medical services to
the community with their own resources. For example, members of the public can
still enjoy free general out-patient and specialist out-patient services at the
Tung Wah Eastern Hospital, Tung Wah Hospital and Kwong Wah Hospital today.
However, there are only a handful of hospitals left within the public healthcare
system with such arrangements for free hospital services or for the provision of
hospital services at reduced rates. After its establishment, the HA has already
put in place an overall medical fee waiver mechanism in public hospitals to
assist patients with financial difficulties. It has also standardised the fees
for public services in 1996 and then the fees for private patient services in
2003.
While the legislation confers upon individual HGCs and the HA the power to
determine the fees payable for hospital services, as a matter of actual practice
whenever there are new policies on or major changes in the charging of public
hospital fees (e.g. the introduction of charges for accident and emergency
service in 2003), the Administration and the HA have always consulted the
Legislative Council Panel on Health Services and explained the policy and fees
involved.
Since the mechanism for determining the fees charged by public hospitals has
been working well for many years, the Administration does not have any plan to
amend the relevant legislative provisions and abolish the arrangement for
individual HGCs and HA to determine the fees payable for hospital services.
Emergency Medicine Wards are a new type of wards in public hospitals. The
services provided in this type of wards are inpatient services by nature, and
are different from the services provided by Accident and Emergency Departments.
The objective of establishing this new type of wards is to provide patients in
acute clinical conditions with multi-disciplinary healthcare services. The
Emergency Medicine Wards are under the charge of specialists in emergency
medicine, who employ a more pro-active "treatment and review" approach. In
addition to conducting rapid examination and tests, the doctors in Emergency
Medicine Wards will administer emergency treatment in accordance with patients'
conditions, where necessary, and devise longer-term treatment plans. Generally
speaking, a determination will be made within 24 hours as to whether the
patients can be discharged or need to remain hospitalised. Moreover, Emergency
Medicine Wards adopt an integrated and multi-disciplinary treatment approach to
provide specialist consultation to patients in need and facilitate their early
recovery. Apart from Tuen Mun Hospital, Emergency Medicine Wards have also been
set up in the Queen Elizabeth Hospital. Since the services provided by Emergency
Medicine Wards form part of the inpatient services (acute beds) of public
hospitals, patients in such wards are charged $100 per day, which is the
standard maintenance fee applicable to all acute beds in public hospitals as
published in the Gazette.
Ends/Wednesday, May 16, 2007
Issued at HKT 13:25
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