Replies to LegCo questions

LCQ18: Elderly Health Care Voucher Scheme

Following is a question by the Hon Frederick Fung and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 17):

Question:

Quite a number of elderly persons have relayed to me their hope that the Government lowers the eligibility age for the Elderly Health Care Voucher Scheme (EHCVS). Besides, I have recently received quite a number of complaints from elderly persons who alleged that some private clinics had employed various means to charge patients using Health Care Vouchers (HCV patients) consultation fees higher than those for other patients, e.g. charging the former administrative fees or offering concessions to the latter. They considered that this practice was tantamount to gnawing the healthcare subsidies provided by the Government for the elderly, thus reducing the actual healthcare services they could receive. Regarding the implementation of EHCVS, will the Government inform this Council:

(1) of the current number of elderly persons eligible for using health care vouchers in Hong Kong and, among them, the percentage of those who have never used any health care voucher; whether the authorities will consider lowering the eligibility age for EHCVS to 65; if they will not, of the reasons for that;

(2) of the number and the main contents of the complaints about EHCVS received by the authorities in the past three years; whether such complaints involved overcharging or collection of medical fees higher than those for other patients; if so, how the authorities followed up such complaints and what measures are currently in place to curb such practices;

(3) whether the authorities have provided any guidelines or imposed any regulation regarding the items and levels of medical fees charged by healthcare service providers under EHCVS; if so, of the details; if not, the reasons for that; and

(4) whether it has conducted any detailed analyses, comparisons and studies concerning the data on the reimbursements under EHCVS and healthcare expenditure in the past; if so, (i) whether healthcare expenditure has increased due to the implementation of EHCVS, (ii) whether there is any evidence showing that some healthcare service providers have charged, for the same disease, HCV patients medical fees higher than those for other patients, and (iii) whether it has found any elderly persons using their health care vouchers without the medical needs to do so, thus increasing public expenditure; how the authorities tackle the issues of moral risks arising from EHCVS?

Reply:

President,

My reply to the question raised by the Hon Frederick Fung is as follows:

(1) The Government launched the pilot Elderly Health Care Voucher Scheme (EHV Scheme) in 2009 to provide subsidies for local residents aged 70 or above to use primary care services provided by the private sector, including preventive care. The EHV Scheme was converted from a pilot project into a regular programme in 2014. The annual voucher amount has increased progressively from the initial sum of $250 to the current total of $2,000 for an eligible elder. Besides, the face value of each voucher has been lowered from $50 to $1 with effect from July 2014 to provide elders with greater flexibility in using the vouchers.

According to the Hong Kong Population Projections 2012-2041, there are about 750 800 elders aged 70 or above in 2015. As at end-May 2015, more than 578 000 eligible elders (around 77 per cent) had made use of the health care vouchers.

As regards requests for increasing the voucher amount and lowering the eligible age for EHV Scheme, we need to carefully examine the effectiveness of subsidising primary care service in the form of health care vouchers and assess in detail the long-term financial implications to the Government.

(2) The Department of Health (DH) received a total of 34 complaints about the EHV Scheme in the past three years, involving scheme coverage, operational procedures, administrative procedures, technical issues, staff performance and suspected deception or improper voucher claims by service providers. In one of these cases, the service provider was alleged to have collected higher medical fees from an elder who used health care vouchers. The DH is following up the case.

A service provider suspected of defraud or professional misconduct will be referred by the DH to the Police and relevant statutory organisations, such as the Medical Council of Hong Kong, for follow-up, which may lead to disqualification from participating in the scheme. Depending on the situation, the DH may consider recovering any payment made from the service provider concerned.

(3) and (4) At present, health care vouchers can be used for private primary care services provided by 10 categories of locally registered healthcare professionals, including medical practitioners, Chinese medicine practitioners, dentists, occupational therapists, physiotherapists, medical laboratory technologists, radiographers, nurses, chiropractors and optometrists. As such, it may not be feasible to regulate the items of fees included and levels of fees charged by private service providers under the scheme.

To protect the interests of elders, it is stipulated under the terms and conditions of the EHV Scheme Agreement that participating service providers shall ensure that the voucher amount used by an elder does not exceed the fee for the healthcare service received. They shall not charge the elderly any fees for creating a voucher account or using voucher. If any participating service provider fails to comply with the terms and conditions of the EHV Scheme Agreement, the voucher claims will not be reimbursed by the Government. In case the reimbursement has been made, the Government will recover the amount from the service provider concerned.

From 2012 onwards, service providers are required to input in each voucher claim the voucher amount used by an elder and any extra fees charged during the same visit. Taking doctors as an example, the average healthcare service fee in each voucher claim was $277 in 2014. The doctors fees survey conducted by the Hong Kong Medical Association in the same year indicates that the median fee charged by general practitioners and family medicine practitioners ranges from $240 to $325.

Besides, registered healthcare professionals have to strictly abide by their codes of professional conduct and ethics and to fulfil their professional obligations. For example, the Code of Professional Conduct for medical practitioners provides the general guidelines on fees collection. It stipulates that consultation fees should be made known to the patients on request and a doctor should not charge or collect an excessive fee.

If necessary, elders could ask first the service providers to advise on the fees.

Ends/Wednesday, June 17, 2015
Issued at HKT 17:36

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Following is a question by the Hon Frederick Fung and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 17):

Question:

Quite a number of elderly persons have relayed to me their hope that the Government lowers the eligibility age for the Elderly Health Care Voucher Scheme (EHCVS). Besides, I have recently received quite a number of complaints from elderly persons who alleged that some private clinics had employed various means to charge patients using Health Care Vouchers (HCV patients) consultation fees higher than those for other patients, e.g. charging the former administrative fees or offering concessions to the latter. They considered that this practice was tantamount to gnawing the healthcare subsidies provided by the Government for the elderly, thus reducing the actual healthcare services they could receive. Regarding the implementation of EHCVS, will the Government inform this Council:

(1) of the current number of elderly persons eligible for using health care vouchers in Hong Kong and, among them, the percentage of those who have never used any health care voucher; whether the authorities will consider lowering the eligibility age for EHCVS to 65; if they will not, of the reasons for that;

(2) of the number and the main contents of the complaints about EHCVS received by the authorities in the past three years; whether such complaints involved overcharging or collection of medical fees higher than those for other patients; if so, how the authorities followed up such complaints and what measures are currently in place to curb such practices;

(3) whether the authorities have provided any guidelines or imposed any regulation regarding the items and levels of medical fees charged by healthcare service providers under EHCVS; if so, of the details; if not, the reasons for that; and

(4) whether it has conducted any detailed analyses, comparisons and studies concerning the data on the reimbursements under EHCVS and healthcare expenditure in the past; if so, (i) whether healthcare expenditure has increased due to the implementation of EHCVS, (ii) whether there is any evidence showing that some healthcare service providers have charged, for the same disease, HCV patients medical fees higher than those for other patients, and (iii) whether it has found any elderly persons using their health care vouchers without the medical needs to do so, thus increasing public expenditure; how the authorities tackle the issues of moral risks arising from EHCVS?

Reply:

President,

My reply to the question raised by the Hon Frederick Fung is as follows:

(1) The Government launched the pilot Elderly Health Care Voucher Scheme (EHV Scheme) in 2009 to provide subsidies for local residents aged 70 or above to use primary care services provided by the private sector, including preventive care. The EHV Scheme was converted from a pilot project into a regular programme in 2014. The annual voucher amount has increased progressively from the initial sum of $250 to the current total of $2,000 for an eligible elder. Besides, the face value of each voucher has been lowered from $50 to $1 with effect from July 2014 to provide elders with greater flexibility in using the vouchers.

According to the Hong Kong Population Projections 2012-2041, there are about 750 800 elders aged 70 or above in 2015. As at end-May 2015, more than 578 000 eligible elders (around 77 per cent) had made use of the health care vouchers.

As regards requests for increasing the voucher amount and lowering the eligible age for EHV Scheme, we need to carefully examine the effectiveness of subsidising primary care service in the form of health care vouchers and assess in detail the long-term financial implications to the Government.

(2) The Department of Health (DH) received a total of 34 complaints about the EHV Scheme in the past three years, involving scheme coverage, operational procedures, administrative procedures, technical issues, staff performance and suspected deception or improper voucher claims by service providers. In one of these cases, the service provider was alleged to have collected higher medical fees from an elder who used health care vouchers. The DH is following up the case.

A service provider suspected of defraud or professional misconduct will be referred by the DH to the Police and relevant statutory organisations, such as the Medical Council of Hong Kong, for follow-up, which may lead to disqualification from participating in the scheme. Depending on the situation, the DH may consider recovering any payment made from the service provider concerned.

(3) and (4) At present, health care vouchers can be used for private primary care services provided by 10 categories of locally registered healthcare professionals, including medical practitioners, Chinese medicine practitioners, dentists, occupational therapists, physiotherapists, medical laboratory technologists, radiographers, nurses, chiropractors and optometrists. As such, it may not be feasible to regulate the items of fees included and levels of fees charged by private service providers under the scheme.

To protect the interests of elders, it is stipulated under the terms and conditions of the EHV Scheme Agreement that participating service providers shall ensure that the voucher amount used by an elder does not exceed the fee for the healthcare service received. They shall not charge the elderly any fees for creating a voucher account or using voucher. If any participating service provider fails to comply with the terms and conditions of the EHV Scheme Agreement, the voucher claims will not be reimbursed by the Government. In case the reimbursement has been made, the Government will recover the amount from the service provider concerned.

From 2012 onwards, service providers are required to input in each voucher claim the voucher amount used by an elder and any extra fees charged during the same visit. Taking doctors as an example, the average healthcare service fee in each voucher claim was $277 in 2014. The doctors fees survey conducted by the Hong Kong Medical Association in the same year indicates that the median fee charged by general practitioners and family medicine practitioners ranges from $240 to $325.

Besides, registered healthcare professionals have to strictly abide by their codes of professional conduct and ethics and to fulfil their professional obligations. For example, the Code of Professional Conduct for medical practitioners provides the general guidelines on fees collection. It stipulates that consultation fees should be made known to the patients on request and a doctor should not charge or collect an excessive fee.

If necessary, elders could ask first the service providers to advise on the fees.

Ends/Wednesday, June 17, 2015
Issued at HKT 17:36

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