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A spokesman for the Social Welfare Department (SWD) said today (April 6) that the department generally accepted the recommendations made by Ombudsman on the medical fee waiver system.
The spokesman, however, stressed that in processing waiver applications, consideration must be given to the non-financial factors of a case to ensure vulnerable groups in the community have access to proper medical care.
The SWD and the Hospital Authority (HA) agreed with the principle that public resources should be prudently managed and used for those genuinely in need. The authorities had implemented most of the recommended improvement measures in the Ombudsman's report, including:
1. Strengthening the checking mechanism. All waivers approved on non-financial grounds would have to be checked by the supervisor.
2. Medical Social Workers (MSWs) must submit all new cases, including medical fee waiver applications, to their supervisors for endorsement within five working days from the date of receipt.
3. All service units must select 1% of the medical fee waiver cases for random checks each six months.
4. MSWs will be reminded to cross-check the information provided by the applicants on their applications.
The SWD will further examine the other recommendations of the Ombudsman in the investigation report with the HA and consider the feasibility of their implementation.
The SWD and the HA have closely monitored and regularly reviewed their operations as well as updated the operational guidelines for frontline medical social workers whenever necessary. For instance, the latest version of the operational guidelines, which has incorporated most of the recommended improvements, was issued on March 29, 2006.
The spokesman stressed that the SWD and the HA were not complacent and attached importance to the need for vigilance and improvement under the medical fee waiver system.
The spokesman also said the medical fee waiver system would ensure that the vulnerable groups could access adequate medical care, therefore the system should strike a balance between patients' access to medical services and effective use of public funds, so that needy patients were not deterred from seeking necessary medical treatment by complicated and over-stringent administrative procedures.
"In order to ensure that the vulnerable groups in the community would not be denied proper medical care, social workers will consider both the financial factors as well as social (non-financial) factors in processing wavier applications," the spokesman said.
"Under special circumstances, some applications may not meet the financial criterion; social workers, based on individual case merit and difficulties, will consider granting a wavier on social grounds. These applications include disabled, chronically ill, the elderly and psychiatric patients."
Regarding the cases highlighted in the investigation report, the spokesman did not agree with the comment that SWD had "dismissed the matter so readily" and was "covering up mistakes". The department provided the following explanation:
Granting of medical fee waiver on non-financial grounds
The case quoted by the Ombudsman in the report involved a chronic psychiatric patient who needed to receive long-term psychiatric treatment. In handling this case, MSW A admitted that due to her oversight, she wrongly interpreted the patient's monthly income, and waived the patient's medical charges for three months on financial grounds. The total value of the waiver involved was $124.
After the mistake was discovered by MSW B, the case was reviewed by the supervisor and the Assistant District Social Welfare Officer, who considered that MSW A had committed an oversight in documenting the patient's financial condition, and duly advised her to make necessary improvements. However, considering the patient's circumstances and his mental condition, there were adequate non-financial factors to justify the granting of a medical waiver, as an incentive to encourage the patient to receive treatment. However, MSW B filed a complaint on producing false information by the patient and suggested the case be referred to the Police for investigation.
Upon receiving the complaint, the concerned supervisor and district management investigated the case by referring to existing guidelines. The management concluded that it was not a fraud case and concurred that the medical waiver was granted under the professional judgment of the MSW with due consideration to the patient's mental condition.
The SWD had not covered up any mistake in this case. Headquarters and district management had conducted an assessment and investigation into the case in accordance with the existing departmental guidelines, and the MSW who had committed the mistake had been reprimanded.
Handling of medical waiver over $7,000
The investigation report mentioned the possibility on an MSW issuing two waiver certificates to waive medical charges over $7,000, so as to get around the waiver limit of MSWs, which was below $7,000. As details of the case was not available, the SWD could not establish whether such a case existed or not. Nevertheless, under the existing waiver system, there are related guidelines governing MSWs processing of applications for waiving of medical charges over $7,000. The HA also has a Patient Billing and Revenue Collection System to check against cases of which the total waiver amount is greater than $7,000.
Lack of signed applications
The investigation report mentioned that MSWs would issue medical waivers even when the applicant had not signed the Assessment Form of Medical Fee Waiver. It is stressed that the scenario is only applicable to some exceptional cases when a mentally disturbed patient required immediate medical attention. These patients could not and would not sign the application. However, MSWs needed to take the initiative to grant medical waivers to them in order to encourage them to receive necessary treatment to prevent them from harming themselves or others. For other psychiatric patients who are willing to receive treatment, MSWs will assess their financial and non-financial circumstances to determine their eligibility for medical fee waiver.
The spokesman reiterated that the department supported the general direction of Ombudsman's recommendations to improve the medical fee waiver system and would work hand in hand with the HA to prevent abuse of the system.
Ends/Thursday, April 6, 2006
Issued at HKT 11:35
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