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Following is a question by the Hon Ip Wai-ming and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (December 15):
Question:
In March this year, the Government introduced the Shared Care Programme (the Programme) through the Hospital Authority (HA). The Programme is piloted in Sha Tin and Tai Po to subsidise eligible patients with diabetes mellitus and hypertension to receive care from private doctors, with a maximum subsidy of $1,400 per patient per year. In this connection, will the Government inform this Council:
(a) of the number of patients participating in the New Territories East Cluster of HA since the Programme was implemented; whether the authorities have looked into and compiled statistics on the extra consultation and medical fees private doctors charged the patients after deduction of the aforesaid subsidy; if they have, of the details; if not, the reasons for that; of the number of patients who had been successfully referred by the authorities to private doctors to receive care; whether it knows if there is any change in the average waiting time for patients of specialist out-patient clinics of public hospitals after implementation of the Programme; if there is, of the details;
(b) as I have learnt that the Programme offers subsidies as an incentive to attract participation of patients with economic capability, but the grassroots who lack financial means have refrained from participating as the subsidy is not sufficient to cover the fees charged by private doctors, whether the authorities have considered if patients who lack financial means are given the same right to choose in a fair manner; whether subsidising patients with economic capability to receive care from private healthcare institutions is the future policy direction of the authorities;
(c) whether the authorities will consider expanding the Programme for all patients to participate and increasing the subsidy under the Programme to attract participation of more doctors and patients; and
(d) given that HA has indicated that the Programme will soon be introduced in its Hong Kong East Clusters, whether the authorities have reviewed the effectiveness of the Programme before deciding on the expansion; if they have, of the outcome of the review; if not, the reasons for that?
Reply:
President,
The Public-Private Chronic Disease Management Shared Care Programme (Shared Care Programme) is one of the pilot projects to enhance primary care services under the healthcare service reform taken forward by the Government. Implemented by the Hospital Authority (HA), it aims to test a model of public-private partnership (PPP) for enhancing the provision of continuous and comprehensive care and support for chronic disease patients based on the care frameworks for diabetes mellitus (DM) and hypertension (HT) developed by the Working Group on Primary Care in order to assess the feasibility and effectiveness of the PPP model and care frameworks.
Under the Shared Care Programme, participating chronic disease patients can choose participating private doctors as the main healthcare providers to follow up on their conditions according to the care frameworks, while the public system will continue to provide support services for chronic disease patients and private doctors. Such support services include comprehensive health risk assessments for patients at least once a year, the required diagnostic and laboratory services and allied health services, as well as referral of patients by private doctors back to the specialist out-patient clinics (SOPCs) of public hospitals for treating more complicated conditions where necessary.
Under this pilot project, the Government provides each patient with a direct subsidy of $1,600 per year, which comprises a subsidy of $1,200 for chronic disease management, an incentive of up to $200 to each patient and a quality incentive of up to $200 to each doctor. The Government will also bear all the expenses arising from the provision of support services to patients and doctors. Individual participating private doctors may decide on their own the additional fees to be charged on top of the subsidy provided by the Government under the Shared Care Programme. Information on the fees charged is made available to patients to facilitate their choice of private doctors.
The Shared Care Programme is not a replacement for existing public healthcare services. The services provided by HA's SOPCs or general out-patient clinics (GOPCs) will not be reduced as a result of its implementation. For chronic disease patients currently being followed up in the public healthcare system, the pilot project is an additional choice which allows them to have a private doctor to follow up on their conditions and establish long-term patient-doctor relationship in order to achieve the objective of continuous and holistic care. The public healthcare system will continue to take care of chronic disease patients who have not opted for the pilot project.
The Shared Care Programme has been implemented in Sha Tin and Tai Po in HA's New Territories East Cluster (NTEC) since March 2010 and in Wan Chai and Eastern District in the Hong Kong East Cluster (HKEC) since September 2010.
The reply to various parts of the question is as follows:
(a) and (b) As at November 2010, 36 private doctors in Sha Tin and Tai Po have enrolled in the Shared Care Programme. A list of participating private doctors and additional fees to be charged by them for the management of DM and HT (including consultation/case management and drugs) on top of the Government subsidy is sent to eligible patients together with the invitation letters for patients' reference. The list has also been uploaded onto HA's dedicated webpage on PPP programmes (www3.ha.org.hk/ppp/sopcscp.aspx) for public access. Patients can choose a private doctor and a service plan as appropriate according to their individual needs.
The NTEC is issuing invitation letters by batches to about 1,000 eligible patients in Sha Tin and Tai Po in the first round of invitation. It is also arranging group briefing sessions to explain the details of the programme to patients. The programme has just been launched for about four months and so far 33 patients have enrolled in the pilot project. Some of the participating patients have started to receive treatment from their selected private doctors. The process of inviting patients to join the programme is still in progress and it is expected that more eligible patients will join the programme later. For the private doctors selected by patients, their additional fess charged for the basic plan (four consultations a year) range from $800 to $3,000 per year, with the median being $1,600.
As mentioned above, the Shared Care Programme aims to enhance primary care services, particularly chronic disease management, through a PPP model on a pilot basis. It is not a replacement for public healthcare services. As such, the Government has not made any assessment on the effect of the pilot project on the waiting time for public out-patient services. Patients who have not yet participated in the programme will continue to be taken care of by HA's existing public healthcare services to ensure that no one would be denied adequate healthcare through lack of means.
(c) and (d) According to our original schedule, we have first implemented the programme in Sha Tin, Tai Po, Wan Chai and Eastern District with a view to evaluating the pilot project. HA has engaged the University of Hong Kong and the Chinese University of Hong Kong as independent assessment bodies to collect data on the services provided by private doctors to patients on an on-going basis during the pilot period. We expect that evaluation of the arrangements and effectiveness of the programme will be available by the end of next year. The Government and HA will make appropriate adjustments to the direction and detailed arrangements of the programme where necessary having regard to the results of evaluation and experience gained from the programme.
Ends/Wednesday, December 15, 2010
Issued at HKT 13:00
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