Replies to LegCo questions
LCQ2: Private patient services at public hospitals
Following is a question by the Dr Hon Pierre Chan and a reply by the Secretary
for Food and Health, Professor Sophia Chan, in the Legislative Council today
(November 22):
Question:
Recently, some members of the medical sector have expressed to me their concerns
about the engagement in private clinical practice (PCP) by teaching staff of the
faculties of medicine of the two universities. In this connection, will the
Government inform this Council:
(1) whether it can comprehensively set out the details of the rules and
guidelines made by the two faculties of medicine on the engagement in PCP by
their teaching staff, including the qualifications for engagement, the maximum
number of hours allowed, the systems for reporting and auditing the figures of
consultations, and the additional restrictions on the engagement in PCP by
part-time teaching staff and doctors with limited registration, and provide
copies of the relevant documents; whether it knows the number of cases of
violations of such rules and guidelines uncovered by each faculty of medicine in
the past five years, and the number of teaching staff involved; whether the two
faculties of medicine have established a mechanism for handling complaints about
PCP; if so, of the details;
(2) whether it can comprehensively set out the mechanisms adopted by the two
faculties of medicine for sharing the income generated from PCP, as well as
provide the relevant documents, and set out in a table the PCP data of each
faculty of medicine in each of the past five years, including the number of
doctors engaging in PCP, the number of patient attendances, the total amount of
income generated, the amount of income apportioned to the Hospital Authority,
the amount of income apportioned to the teaching staff, and the amount of
relevant income received by each of the five teaching staff members who received
the largest amounts of income generated from PCP; and
(3) if it knows how the Hospital Authority and the two faculties of medicine
verify the number of hours of engagement in PCP as reported by the teaching
staff, and whether the time they spend on conducting ward rounds, providing
consultation services at outpatient clinics, performing operations and handling
administrative work in respect of PCP will be counted?
Reply:
President,
The main rationale for providing private patient services at public hospitals is
that certain specialised expertise and facilities in the public medical sector
(especially the two teaching hospitals, namely the Queen Mary Hospital
affiliated with the University of Hong Kong (HKU) and the Prince of Wales
Hospital affiliated with the Chinese University of Hong Kong (CUHK) are not
generally available in the private sector. The public can be offered an access
to these specialised services by means of private services of the Hospital
Authority (HA).
My reply to the various parts of the question raised by the Dr Hon Pierre Chan
is as follows.
(1) The HA requires clinical professors from the two universities to be
appointed as honorary staff before they can practise medicine on public patients
in the teaching hospitals. Besides, as honorary staff of the HA, these clinical
professors have to abide by the relevant guidelines and management procedures of
the HA in the provision of private patient services.
According to the HA's guidelines on the provision of private patient services,
both honorary staff from the universities and doctors of the HA must obtain the
formal approval of the head of clinical department and the chief executive of
the hospital concerned before engaging in the provision of private patient
services. The HA also requires that all doctors providing private patient
services must be specialists registered with the Medical Council of Hong Kong.
The HA also requires specialists to appropriately record their engagement in
private clinical practice in writing during the process, so as to monitor and
audit the provision of private services. To ensure that the provision of private
services will not affect the public services received by Hong Kong residents,
the HA has established guidelines to restrict the time that each HA doctor can
be engaged in the provision of private specialist outpatient service to an
average of only one session (i.e. three to four hours) per week. Currently
private patient services account for less than 1 per cent of the overall service
capacity of the HA.
We understand that the HKU and the CUHK have respectively implemented stringent
internal control measures to govern the engagement in private patient services
by clinical professors.
According to the information provided by the Faculty of Medicine of HKU, there
are comprehensive regulations and guidelines regarding teaching staff of HKU
engaging in outside practice. Applications for outside practice submitted by the
teaching staff of the Faculty of Medicine have to be approved by the head of
teaching department and the Outside Practice Committee of the faculty. The
amount of time spent on outside practice and the distribution of revenue are
also stringently regulated and monitored. Annual reports on outside practice
must be audited by the Outside Practice Committee of the faculty and submitted
by the Finance and Enterprises Office to the Council of HKU.
The Faculty of Medicine of CUHK also set stringent requirements for its teaching
staff on private clinical practice (PCP). These include, for example, those
engaged in PCP must be full time professoriate staff of the Faculty of Medicine
having obtained the approval of the respective head of teaching department and
Dean of the Faculty of Medicine, etc. There are restrictions on the time spent
on private consultation service provided by each clinical teaching staff member.
The service charges are set according to the List of Private Charges as per the
Gazette and handled by the medical centre under the Prince of Wales Hospital.
There is an established sharing mechanism in CUHK to share the revenue among the
university, Faculty of Medicine, clinical department and professors, and the
CUHK professors are not allowed to accept any payment directly from the
patients. CUHK staff providing private consultation are required to report to
the university and the Faculty of Medicine the number of hours of private
consultation provided, and the Faculty of Medicine audits the records on a
quarterly and a yearly basis according to the regulations concerned.
(2) and (3) Private patient services offered in HA hospitals are HA services.
The HA has set up a standardised system to process relevant clinical
documentation, billing and revenue collection of private services, etc. pursuant
to the HA's procedures and requirements.
In view of the contribution of the two universities in private patient services,
a fee sharing arrangement between the HA and the universities is in place. In
general, revenue generated from consultations and procedures is shared in the
ratio of 75 (university): 25 (HA), whereas that from supporting services (like
radiology investigation and laboratory tests) is shared in the ratio of 75 (HA):
25 (university) in view of the higher contribution from the HA in the provision
of such services. The way that the two universities handle their shares of
revenue from private services is an internal matter of the universities and is
outside the jurisdiction of the HA.
To step up monitoring, the HA has developed a common set of guidelines for
public hospitals on the use of income generated from private patient services.
The HA has also issued internal guidelines to assist doctors providing private
patient services in determining the charges according to the complexity of each
case.
The statistics on the use of the HA's private services, and the revenue so
generated and apportioned to the universities in the past five years are at
Annex.
To help the chief executives and heads of clinical departments of the hospitals
concerned keep abreast of the service volume, HA has included private patient
services in its formal statistical work starting from 2017-18. This helps ensure
that the public medical services received by Hong Kong residents will not be
affected by the provision of private patient services. Recently, the HA has
conducted a review on the implementation of the guidelines on private patient
services, and noted that the guidelines had been implemented smoothly in public
hospitals (including the two teaching hospitals).
Ends/Wednesday, November 22, 2017
Issued at HKT 16:40
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LCQ2 Annex