LCQ20: Shortfall in public dental services

     Following is a question by the Hon Paul Tse and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (July 13):
     It has been reported that the Department of Health had a cumulative number of wastage of dentists at 64 in the past three years, and the latest vacancy rate is as high as 16 per cent. Some veteran dentists have pointed out that in recent years, some private dental clinics have recruited dentists with a monthly salary of $200,000 which, coupled with other causes such as retirement and emigration of quite a number of government dentists, has led to a high wastage rate of government dentists. The latest figures indicate that members of the public have to wait for 12 to 18 months for a general examination at government dental clinics, and the longest waiting time for treatments such as root canal treatment and fillings even reaches 39 months. Some members of the public have criticised that the waiting time is too long and unacceptable, especially for those underprivileged grass-roots elderly persons who have limited financial ability to afford the services of private dental clinics which charge exorbitant fees, even such elderly persons have the subsidy of health care vouchers. This, in effect, deprives such elderly persons of their right to receiving treatment. In this connection, will the Government inform this Council:
(1) of the new measures in place, under the circumstances of a continued drop in the number of government dentists, to increase the manpower of government dentists and shorten the waiting time of members of the public for public dental services;
(2) in view of the excessively long waiting time of members of the public for public dental services, whether it will consider subsidising patients to receive treatments at private dental clinics through a "public-private partnership" model; if so, of the details; if not, the reasons for that;
(3) in view of the strong demand of members of the public for dental services, whether it has studied the introduction of a policy on mobile dental vans for various districts; if it has studied, of the outcome, and the annual number of members of the public expected to be benefitted from such service; if not, whether it will immediately conduct such a study; and

(4) as some members of the public have criticised that the current amount under the Elderly Health Care Voucher Scheme is insufficient for supporting elderly persons to receive private dental services, and elderly persons are forced to wait often for years for receiving government dental services, whether the authorities will study the feasibility of introducing elderly dental care vouchers, or the provision of other subsidies, so as to encourage elderly persons to use private dental services, thereby alleviating the pressure on public dental services?

     The reply to the question raised by the Member is as follows:

(1) To cope with the surge in demand for dental services, the Government will further increase the annual intake of University Grants Committee (UGC)-funded first-year-first-degree training places in dentistry from 80 to 90 in the 2022/23 to 2024/25 triennium. It is expected that there will be around 400 dental graduates becoming registered dentists in the coming five years. 

     Furthermore, the Government will provide ten UGC-funded taught postgraduate places in dentistry per year in the 2022/23 to 2024/25 triennium to ensure a stable supply of dental specialists. For admission of non-locally trained dentists, the Dental Council of Hong Kong has increased the Licensing Examination for non-locally trained dentists to two sittings a year starting from 2015, and has further improved the arrangement of certain parts of the Licensing Examination and updated its result retention policy and examination admission arrangement, so as to attract more qualified non-locally trained dentists to practise in Hong Kong and contribute to the diversity of the local dentistry workforce.

     As regards the reduced manpower of Dental Officers in the Government, the Department of Health (DH) will adopt a multi-pronged approach to recruit and retain Dental Officers, including:

(a) continuing all-year-round recruitment of Dental Officers to fill vacancies arising from natural wastage or the creation of new posts; and accepting applications for non-civil service contract positions in individual dental specialties throughout the year;

(b) adjusting the starting salaries by granting incremental credits based on the experience of candidates, and relaxing the language proficiency requirements for some posts, so as to encourage more professionally qualified applicants to apply for Dental Officer posts in the DH;

(c) subject to applicable arrangements and relevant criteria, extending the employment of Dental Officers beyond normal retirement age so as to retain experienced staff such that they can pass on their professional expertise and skills;

(d) conducting recruitment seminars for dental students; and

(e) providing suitable training for incumbent Dental Officers, including professional training and subsidising their postgraduate studies, so as to increase the attractiveness of the post of Dental Officer.
(2) and (4) Proper oral health habits are important to the effective prevention of dental diseases. As such, the Government's policy on dental care seeks to raise public awareness of oral health and encourage proper oral health habits, through promotion and education, thereby improving oral health and preventing dental diseases. Dental care services in Hong Kong are mainly provided by the private sector and non-governmental organisations (NGOs). Under the prevailing policy, the Government mainly undertakes publicity, education (including the School Dental Care Service), promotion of oral health and provision of emergency dental services for the public (including General Public Sessions to provide treatment of acute dental diseases, prescription for pain relief, treatment of oral abscess and teeth extraction); and takes forward initiatives targeting persons with special dental care needs, in particular elderly persons with financial difficulties and persons with difficulties in accessing general dental services.

     For elderly persons, the Elderly Health Care Voucher Scheme (the Scheme) currently subsidises eligible Hong Kong elders aged 65 or above with an annual voucher amount of $2,000 to use private primary healthcare services provided by ten types of healthcare professionals, including dentists. Under the existing arrangement, the elderly can flexibly use the vouchers to receive private healthcare services that best suit their health needs. In 2019, the accumulation limit of the voucher amount was raised to $8,000. This enhancement provides the elderly with more flexibility and room in using dental services. In 2021, the voucher amount claimed by the elderly for private dental services represented 14 per cent of the total voucher amount claimed, which was the third highest among the ten types of healthcare services under the Scheme. Further to the Elderly Health Care Voucher, the Government has also launched a series of initiatives for elders with special needs to receive dental care support services in recent years. The measures include the Outreach Dental Care Programme for the Elderly (ODCP) and the Community Care Fund (CCF) Elderly Dental Assistance Programme (details set out below). The Government does not have any plan to introduce an elderly care voucher for dental services at this stage.

     The Government launched a three-year pilot project in 2011 to provide subsidies for NGOs to set up outreach dental teams to provide basic dental services (covering oral examination, scaling and polishing, and emergency dental treatments) for elders residing in residential care homes for the elderly (RCHEs) or receiving services in day care centres for the elderly (DEs). With the experience gained, the Government regularised the pilot project (renamed as ODCP) in October 2014 to continue the provision of outreach dental services for relevant elders with expanded scope of dental treatments covering fillings, extractions and dentures, etc. The scope of beneficiaries was also expanded to cover those residing in similar facilities (e.g. nursing homes for the elderly registered under the DH). Under the ODCP, ten NGOs have set up a total of 23 outreach dental teams to provide free outreach dental services for elders in RCHEs, DEs and similar facilities in the city.

     The Elderly Dental Assistance Programme, funded by the CCF and launched in September 2012, provides free removable dentures and related dental services (including oral examination, scaling and polishing, fillings, tooth extractions and X-ray examinations) to low-income elders who are users of the home care services subvented by the Social Welfare Department (SWD). To allow more elders in need to benefit, the programme was expanded by phases in September 2015, October 2016, July 2017 and February 2019 to cover elders who are recipients of the Old Age Living Allowance and aged 65 or above. The scope of subsidy under the Programme has been further expanded since July 2021 to cover more subsidised dental treatment items so that eligible elders in need can receive more targeted dental services related to the fitting of removable dentures and related dental services. The newly included treatment items cover the removal of bridges or crowns and the provision of root canal treatment, while elders aged 75 or above who received dental services under the programme at least five years ago can receive free removable dentures and related dental services for a second time.

     Furthermore, for persons with financial difficulties, the Comprehensive Social Security Assistance (CSSA) Scheme provides a dental grant for its recipients to pay for dental services (including extraction, dentures, crowns, bridges, post, post and core, scaling and polishing, fillings and root canal treatment). Eligible CSSA recipients may go to one of the 73 dental clinics designated by the SWD for dental examination and cost estimation of the needed services, and then choose to receive the relevant dental treatments from any registered dentist in Hong Kong, including any of those in the SWD designated dental clinics. The amount of grant payable will be based on the exact fee charged by the clinic, the cost estimated by the designated clinic or the ceiling amount set by the SWD, whichever is the less.

     For planning and evaluation of oral health programmes, and to plan for future oral health care development, it is necessary for the Government to collect information on the oral health conditions and related behaviour of the people in Hong Kong. The DH conducts a territory-wide oral health survey (OHS) every ten years. Following the OHS 2001 and 2011, the DH commenced the OHS 2021 in November 2021 to collect information about the prevailing oral health conditions of the local population. The expert group of the DH will review and advise on the setting of appropriate oral health goals taking into account the age groups (including the elderly) set in the OHS 2001 and 2011, the local situation, and the findings of the OHS 2021.

     The Government is well aware of the public's keen demand for dental services, and will continue to communicate with relevant stakeholders, listen to different views and formulate relevant measures after fully considering all recommendations, with a view to achieving oral health goals set, promoting oral health of the public, and continuing to take care of persons with special needs, including elderly persons with financial difficulties. To this end, the Government will review and consider regularisation of dental services under different schemes (including the Scheme, the CCF Elderly Dental Assistance Programme, etc.) with a view to ensuring the provision of more effective dental services for the elderly and needy. The Government will also examine dental services as part of primary healthcare services under the framework of the Primary Healthcare Blueprint.
(3) The concept of mobile dental clinics is to provide dental services by means of well-equipped vehicles for people who have difficulties in accessing such services (e.g. people living in remote and rural areas). In Hong Kong, public transportation is relatively more convenient, and dental clinics are easily accessible. On the other hand, the scope of service that can be provided in mobile dental clinics has its limitation. The Government will consider appropriate arrangement for the provision of the relevant service in the course of examining the dental services as mentioned above.

Ends/Wednesday, July 13, 2022
Issued at HKT 16:18