Replies to LegCo questions

LEGCO QUESTION NO.9 (Written Reply)

Asked by:	Dr Hon LUI Ming-wah	Date of meeting :	7 July 1999
		Replied by :		Secretary for Health and Welfare

 

Question :

Will the Government inform this Council :

(a) whether it knows the basis on which the Hospital Authority determines the amount of financial resources allocated to each hospital cluster;

(b) how the average respective ratios of population to beds in public hospitals with Accident and Emergency Departments and other public hospitals compare with those in advanced countries in America and Europe; and

(c) of the average ratio of public hospitals in-patients to doctors in the past year, and how this figure compares with those in advanced countries in America and Europe; and whether it plans to take measures to reduce the ratio; if so, of the specific timetable; if not, the reasons for that?

 

Reply :

Madam President,

(a) The resource allocation mechanism of the Hospital Authority (HA) is to allocate funding to individual hospitals according to their needs. HA has currently established a mechanism which links resource allocation to annual planning. With a hospital’s budget of previous year as baseline, HA will request each hospital to formulate an annual plan, setting out the major scope and volume of services, as well as the performance and quality targets, for the coming year. HA will determine the amount of funding for the hospital, including whether to provide new resources for introducing or strengthening services, with reference to the hospital’s annual plan. Moreover, HA will coordinate the service plans of different hospitals of the same cluster, and also of different clusters, to ensure that there will be no duplication of services and that resources will be well utilised.

(b) At present, HA has divided the territory into eight hospital clusters. In each cluster, there are hospitals with Accident and Emergency (A&E) Departments and also those without such Departments to cater for different needs of the residents within the cluster. Apart from providing urgent treatment for patients, public hospitals with A&E departments usually have more acute beds and more different clinical specialties to provide acute and general medical services. Hospitals without A&E departments usually have more non-acute beds and focus on providing other services, such as infirmary and rehabilitation services. There are currently about 4.1 public hospital beds per 1,000 population in Hong Kong. To take into account the total number of hospital beds in Hong Kong, that is to include private hospital beds, there are about 4.7 hospital beds per 1,000 population. In UK and US, the corresponding ratio is 4.5 and 4.1 hospital beds per 1,000 population respectively. Since there are hospitals with A&E departments and also other public hospitals in every cluster, and these hospitals serve all residents within the cluster, the number of hospital beds of each hospital should not be linked to the population to derive a bed-to-population ratio.

(c) Since the health care systems of different countries vary, for example, there is no clear distinction between public and private medical institutions in countries implementing medical insurance system, HA does not have information on the ratio of public hospitals inpatients to doctors of other countries. To take into account the total number of doctors in Hong Kong, in 1997, each doctor managed about 127 discharged patients. In UK, the corresponding figure for 1994 was 135 discharged patients per doctor per year, while in US, each doctor managed 47.7 discharged patients per year in 1995. The ratio of inpatients to doctors is not a reliable indicator to assess the quality of health care services. The higher ratio of inpatients to doctors i.e. each doctor manages more patients, could be due to different disease profiles and occurrence rates of different countries’ population, which gives rise to different needs for hospital services; or could be due to higher population density and different modes of doctor consultation. HA has already implemented various measures, such as introducing clinical audit and risk management systems; strengthening clinical supervision and professional training of health care professionals etc to continuously enhance the quality of health care services. HA will continue to review its medical manpower planning and to adjust the medical staffing level according to changes in service needs.