In 2003, the Department of Health (DH) issued the Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes (the Code), which sets out the standards of good practice for healthcare institutions to adopt. The Code provides that private hospitals must keep a schedule of charges in respect of wards, investigative and treatment procedures and medical supplies, at the admission office and other appropriate places for reference by patients. During its inspections of private hospitals, DH checks the latter’s compliance with the requirements set out in the Code. In this connection, will the Government inform this Council:
(1) of the number of complaints received in the past five years by DH from members of the public about the charges levied by private hospitals, with a breakdown by type of complaints (such as sudden charge increases, unreasonable charges, failure to provide information on charges to patients beforehand, etc.) and the outcome of investigation; whether DH has taken any follow-up action against private hospitals for alleged breaches of the relevant requirements in the Code; if it has, of the details; if not, the reasons for that;
(2) of the number of inspections of private hospitals conducted by the authorities in each of the past five years, and the number of such inspections in which private hospitals were found to have failed to make available complete information on charges at suitable places for reference by patients in accordance with the Code;
(3) given that the Code is not part of the law and hence DH can only advise or remind private hospitals to provide patients with complete information on charges in accordance with the Code, whether the authorities will consider giving legal effect to the Code and setting penalties for breaches of the Code (such as subjecting private hospitals with serious breaches to revocation of their licences); if they will, of the details; if not, what measures the authorities have in place at present to ensure that private hospitals will provide complete information on charges to their patients;
(4) given that the Government requires the private hospitals to be developed on the two reserved sites at Wong Chuk Hang and Tai Po to provide at least 51% of their in-patient bed days taken up in a year for services to local residents through standard beds at packaged charge and to provide the public with comprehensive information on charges, whether the authorities will explore requiring existing private hospitals to abide by the same requirements; if they will, of the details; if not, the justifications for that; and
(5) given the recommendations in the Director of Audit’s Report No. 59 that the authorities should explore ways to enhance the transparency of charges levied by private hospitals taking into account the good practices adopted locally and overseas (such as requiring private hospitals to ensure that every patient is informed, prior to or upon his admission to the hospital, of the estimated total charges which are likely to be incurred, and enacting laws on the transparency in medical charges), and that the authorities have agreed to the recommendations of the Audit Commission, whether the authorities have commenced studies on the relevant recommendations; if they have, of the progress and the latest findings; if not, the reasons for that?
Under the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (Cap. 165) (the Ordinance), the Department of Health (DH) registers private hospitals, nursing homes and maternity homes, subject to their conditions relating to accommodation, staffing and equipment. The DH has also promulgated a Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes (COP), which sets out the standards of good practice for compliance by registered healthcare facilities, with a view to enhancing the safety of patients and quality of services. The COP covers requirements on areas including organisation and management, accommodation and equipment, patient care, risk management and rights of patients. To ensure that private hospitals, nursing homes and maternity homes comply with the requirements stipulated in the Ordinance and the COP, the DH conducts inspections of these establishments and investigates sentinel events and complaints.
My reply to the five-part question raised by the Hon Chan is as follows:
(1) On charges, the COP requires private hospitals to prepare a schedule of charges with respect to room charges, investigative and treatment procedures, medical supplies, medicines and any charges that will be levied. The schedule of charges should be made available for reference by patients at the admission office, cashier and wherever appropriate. When there is a change in the charges, the schedule must be updated and published for general information before the new charges take effect. Hospitals are also required to inform patients of any applicable charges as soon as practicable.
When inspecting a private hospital, the DH would check whether the hospital has provided and displayed the schedule of charges, and explained to patients admitted to the hospital the procedures of charging, etc. according to the requirements of the COP. The DH has also reminded private hospitals to take the initiative in providing patients with detailed information on charges so as to enhance price transparency. If a private hospital is found to have violated the requirements on charges as stipulated in the COP, the DH will issue regulatory letters to the private hospital concerned asking them to make improvements.
In the past five years (from 2009 to 2013), the DH received a total of 43 complaints about the charges of private hospitals, which can be categorised into three types. The first type, involving 20 cases, was related to disagreements to the service charges. None of these cases were found to be in contravention of the COP upon investigation. The second type, involving 15 cases, was about patients not being informed of the charges in advance. After investigation, two of these cases were further followed up by the DH which has subsequently requested the private hospitals concerned to make improvements in order to comply with the requirements of the COP. The third type, involving 8 cases, was related to other complaints about fees and charges (for example, complaints about the bills and the level of charges). After investigation, one of these cases was further followed up by the DH which has subsequently requested the private hospital concerned to make improvements in order to comply with the requirements of the COP.
(2) In the past five years (from 2009 to 2013), the DH conducted a total of 537 inspections of private hospitals (including maternity homes). The number of inspections conducted in each of the five years was 75, 96, 134, 106 and 126 respectively. For the above 537 inspections, none of the private hospitals concerned were found to have contravened the requirement of the COP in making available information on charges at suitable places.
(3) and (5) The Food and Health Bureau set up a Steering Committee on Review of the Regulation of Private Healthcare Facilities (Steering Committee) in October 2012. Having examined relevant legislation and regulatory practices of various countries (including the United Kingdom, Australia and Singapore), and taking into account the public aspirations as well as factors and circumstances unique to Hong Kong, the Working Group on Regulation of Private Hospitals under the auspices of the Steering Committee has developed a number of recommendations to improve the corporate governance, clinical quality, price transparency and complaint handling procedures of private hospitals. The recommendations include a substantial increase in penalties, mandatory provision of comprehensive fee schedules by private hospitals, implementation of a price quotation mechanism, publication of historical statistics on bill sizes and offer of service packages for common procedures, etc.
The Government is now reviewing the findings and recommendations of the working groups under the Steering Committee, and plans to conduct a public consultation exercise in the second half of 2014 on these results and recommendations as well as other proposals relating to the regulation of private healthcare facilities. The Legislative Council Panel on Health Services will be briefed on the results of the review in due course.
(4) Regarding certain requirements which involve the regulation of service provision and charging mode of private hospitals that have to be implemented by virtue of land grant conditions, the Government will consider including these terms in the land grant document concerned when the grantee applies for lease renewal, lot extension or lease modification to cope with any hospital expansion or redevelopment.