Question by Hon KP Chan on Non-eligible Persons Receiving Public Healthcare Service:
At present, the public charges for public healthcare services in Hong Kong are divided into two categories based on Eligible Persons and Non-eligible Persons (NEPs). As the local public healthcare system mainly serves Hong Kong residents, it is currently stipulated that only holders of Hong Kong Identity Cards or children under 11 years of age who are Hong Kong residents are entitled to use healthcare services at heavily government-subsidised rates. NEPs (including mainland residents) receiving public healthcare services are required to pay for service charges which are determined on a cost-recovery basis. According to the 2012-2013 Budget, in public hospitals, the cost per accident and emergency (A&E) attendance is about $930 and the cost per specialist outpatient attendance is about $1,090, and the cost per patient day for general inpatient services is about $4,250. However, at present, the Hospital Authority (HA) only charges NEPs $570 per attendance, $700 per attendance, and $3,300 per day respectively for A&E services, specialist outpatient services and general inpatient services received in public hospitals, which are much lower than their service costs. In 2010-2011, the respective numbers of attendance of NEPs for A&E services and specialist outpatient services in public hospitals were 25 161 and 32 678, while the number of bed days for general inpatient services in public hospitals received by NEPs was 49 316. On the basis of the aforesaid differences, the annual amount of subsidy on these three kinds of public hospital services for NEPs paid by the Government is nearly $70 million, or $700 million if calculated on a 10-year basis. The service charges paid by NEPs were last adjusted in 2003 and local taxpayers have in effect been subsidising NEPs heavily over the years in receiving public healthcare services in Hong Kong. In this connection, will the Government inform this Council:
(a) of the aggregate amount of subsidies paid by local taxpayers for NEPs receiving public healthcare services in each of the past 10 years;
(b) given that while it is clearly shown in the government budget every year that the annual cost of services of public hospitals has been rising, public hospitals are required to collect charges in accordance with the List of Charges published in the Gazette and it has been nearly 10 years since the charges for NEPs were last published in the Gazette, of the reasons why so far such charges have not been updated to comply with the principle of cost recovery; whether the authorities will establish a regular mechanism to review the charges annually; and
(c) for the purpose of relieving the pressure on the public healthcare system in Hong Kong (including the problem of excessively long waiting time for patients), apart from recovering service costs from NEPs for using public hospital services, whether the authorities will consider introducing a quota system for certain specialist services that register a very long waiting time for patients, in a way similar to the quota system for provision of obstetric services to non-local residents, in order to ensure that Hong Kong residents can be accorded priority in receiving proper and adequate healthcare services?
Written Reply by the Secretary for Food and Health, Dr York Chow:
(a) Public healthcare services provided by the Hospital Authority (HA) are primarily targeted at Hong Kong residents. The provision of healthcare services for Non-eligible Persons (NEPs), including non-local residents, should be limited to a level that can be supported by our healthcare system. According to the statistical data of 2011-12 (as at December 2011), healthcare services provided to NEPs only account for a small fraction of the total services provided by HA, representing 0.6% of the total in-patient bed-days utilised, 1.3% of accident and emergency (A&E) attendances and 0.3% of specialist outpatient (clinical) attendances. For obstetric services, the number of deliveries by NEPs accounts for about 21% of HA overall figure.
NEPs are provided with public healthcare services in emergency situations and they may seek non-emergency public healthcare services when there is spare service capacity. However, NEPs will need to pay the charges applicable to them. These charges are generally set on a cost recovery basis. The table below sets out the NEP charges of HA’s major services, which were last revised in April 2003 based on the then prevailing costs of the services.
Services Charge for NEPs
Inpatient service (General) $3,300 per day
Accident and Emergency service $570 per attendance
Specialist Outpatient service $700 per attendance
General Outpatient service $215 per attendance
HA has also implemented a package charge for obstetric services for NEPs since 2005. The existing obstetric services package charge for NEPs is $39,000 (for booked case) and $48,000 (for non-booked case).
(b) HA will review of the cost of various public healthcare services every year. Currently, the charges of services for NEPs are mainly set on a cost recovery basis. HA will also make reference to the market prices of the private sector in setting the charges for specific services, having regard to the individual circumstances of these services, such as the obstetric services package charge for NEPs. HA will report to the Food and Health Bureau from time to time the outcome of the review on the charges for public healthcare services. The Administration will consider adjusting the service charges at appropriate time.
(c) As mentioned above, Hong Kong residents are always the primary targets of public healthcare services. Apart from emergency services, HA will provide non-emergency services to NEPs only when there is spare service capacity. At present, healthcare services provided to NEPs only account for a small fraction of the total services provided by HA. HA has no plan to introduce service quota for NEPs for using other services besides obstetric services. In addition, for those NEPs who default on payment of medical fees to HA, HA will suspend the provision of non-emergency medical services to them before they have settled the outstanding payments.