Replies to LegCo questions
LCQ20: Health Protection Scheme
Following is a question by the Dr Hon Joseph Lee and a written reply by
the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative
Council today (July 17):
Question:
One of the features of the Health Protection Scheme (HPS) being studied
by the Government is the vision of encouraging more people to buy
private health insurance products, thereby indirectly relieving the
pressure on the public healthcare system. It has been reported that,
according to the latest proposal submitted by the authorities some time
ago, the private health insurance policies to be regulated under HPS
will come mainly in the form of "packages" to cover surgeries and
treatments frequently performed in private hospitals (e.g. examinations
such as endoscopy, Magnetic Resonance Imaging and Computed Tomography
scans, as well as surgeries such as appendicetomy, atherectomy,
hysterectomy, oophorectomy, haemorrhoidectomy and otorhinolaryngological
surgeries) at the early stage of implementation of HPS. In addition, the
authorities have proposed to set up a High-risk Pool (HRP) to underwrite
the policies of the HPS Standard Plans for high-risk individuals. In
this connection, will the Government inform this Council:
(a) whether it knows the following information on each type of the
aforesaid surgeries and treatments performed by public hospitals on
their patients in the past three years: (i) the number of patients
receiving the surgeries/treatments, (ii) the average unit cost and (iii)
the average waiting time;
(b) whether it knows the following information on the 20 types of most
frequently performed surgeries in public hospitals in the past three
years: (i) the number of patients receiving the surgeries, (ii) the
average unit cost and (iii) the average waiting time (broken down by
surgery type);
(c) whether it knows the following information on the 10 types of
surgeries with the longest waiting time among those performed by public
hospitals on their patients in the past three years: (i) the number of
patients receiving the surgeries, (ii) the average unit cost and (iii)
the average waiting time (broken down by surgery type); and
(d) whether it has assessed the approximate length of time for which the
$50 billion, set aside from the fiscal reserves for the implementation
of the healthcare reform, can support the operation of HRP; if it has,
of the details; if not, the reasons for that; whether the authorities
will impose a cap on the amount of co-payment for each subscriber in
HRP; if they will, of the details; if not, the reasons for that?
Reply:
President,
The Health Protection Scheme (HPS) aims to complement the public
healthcare system by providing better protection to those who are able
and willing to pay for private health insurance and use private
healthcare services. By providing value-for-money choices to the
community, the HPS could indirectly provide relief to the public system
by better enabling the latter to focus on serving its target areas,
thereby enhancing the long term sustainability of our healthcare system.
We have set up a Working Group and a Consultative Group on the HPS under
the Health and Medical Development Advisory Committee to formulate
detailed proposals for the HPS. The Consultant appointed to conduct a
consultancy study on the HPS has also tendered preliminary
recommendations on various matters related to the HPS, including setting
up an High-risk Pool (HRP) to accept health insurance applications from
high-risk individuals, and the adoption of "no-gap/known-gap"
arrangements to enhance upfront payment certainty for consumers. In
addition, we will also encourage private healthcare service providers to
provide packaged pricing for common procedures in order to enhance
payment certainty and transparency.
My reply to the various parts of the question is as follows:
(a) and (b) The waiting time, number of cases and reference cost of
common elective surgeries and investigations conducted in public
hospitals are set out in Table 1 and Table 2. Emergency procedures such
as appendicetomy would be performed as soon as possible in accordance
with protocols having regard to the relevant medical conditions of the
patients.
(c) The Hospital Authority has not surveyed the waiting time for all
common elective surgeries performed in public hospitals due to the wide
range of procedures. Please refer to Table 1 and Table 2 for the waiting
time, number of cases and reference cost of some common elective
surgeries and investigations conducted in public hospitals.
(d) In order to enable high-risk individuals to have access to health
insurance protection at affordable premiums, we have proposed to set up
an HRP to accept policies of the HPS Standard Plans of high-risk
individuals. Where the premium loading of such policies, at the opinion
of the insurer providing coverage, is assessed to equal or exceed 200%
of standard premium charged by the insurer for providing HPS Standard
Plan coverage, the insurer may transfer these policies to the HRP by
surrendering the premium collected for these policies after deducting a
nominal handling fee to be prescribed by the HPS agency. Thereafter, the
insurer will continue to be responsible for the administration of the
policies, but the premium income (net of expense), claim liabilities and
profit/loss of these policies would be accrued to the HRP instead of the
insurer concerned. The Consultant is working on an estimation of the
financial support required for the HRP, and will provide the estimated
figures in its final report to be submitted by end of 2013. Where
necessary, the Government would consider injecting funding to the HRP
directly to ensure the Pool's sustainability by making use part of the
$50 billion fiscal reserve earmarked for assisting the implementation of
healthcare reform.
"Co-payment" is a cost-sharing arrangement between insurers and insured
persons. It is designed to combat moral hazard and to bring healthcare
costs under better control. On the other hand, in designing cost-sharing
arrangements, due regard should be given to possible adverse impact on
consumer interests, particularly concerning the ability of lower-income
persons in paying the shared cost, which might affect their desire to
seek necessary treatments. With the above in mind, the Consultant
proposes to impose an annual cap on the amount of "co-payment" for HPS
Standard Plans for the sake of consumer protection. We will consult
insurers and relevant stakeholders in setting a reasonable level of
annual cap on the "co-payment" amount.
Ends/Wednesday, July 17, 2013
Issued at HKT 15:17
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LCQ20 Table 1
LCQ20 Table 2