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Following is a question by the Hon Ip Wai-ming and a reply by the Acting Secretary for Food and Health, Professor Gabriel Leung, in the Legislative Council today (May 11):
Question:
It has been reported that a deficit of $30 million in the expenditure on drugs was incurred by the New Territories East Cluster of the Hospital Authority (HA) in 2009-2010. I have recently received complaints from members of the public that the New Territories East Cluster has reduced the quantity of drugs prescribed to patients and also switched to use generic drugs, causing people to worry that the quality of the medical services and drugs received by patients has no safeguard. In this connection, will the Government inform this Council whether it knows:
(a) the overall balance of income and expenditure of various clusters under HA in the past five years, and their expenditure on drugs in 2010-2011;
(b) the quantity of generic drugs purchased by the various clusters under HA and the percentage of such drugs in the total quantity of drugs in the past five years; whether HA has laid down guidelines on whether the clusters should purchase brand name drugs or generic drugs; if it has, of the details; if not, the reasons for that; and
(c) how HA monitors the procurement of drugs and drug treatment on patients by its various clusters at present; whether HA knows if individual clusters have substantially reduced the quantity of drugs prescribed to patients because of deficits, and allows them to do so; if so, of the details?
Reply:
President,
The Hospital Authority (HA) has put in place an established mechanism on the procurement of pharmaceutical products. In compliance with the requirements of the World Health Organisation and the World Trade Organisation, HA procures drug items of high volume or in large value with market alternatives through open tenders. All products of the suppliers must comply with all quality requirements, including pharmaceutical product registration with the Department of Health; accreditation of Good Manufacturing Practice of the manufacturing site; detailed product specific information, such as product master formula, method of assay, finished product specifications and stability data, as well as the bioequivalence data of generic drugs in comparison with the proprietary drugs to prove the generic drugs' efficacy, before the consideration of tender prices. In other words, the prices will only be considered after the quality of the products is confirmed in order to protect the safety of patients. This mechanism ensures that the efficacy of generic drugs selected and procured by HA from the market is comparable to that of the proprietary drugs.
The HA Drug Formulary (the Formulary) has included drugs for the treatment of various diseases. Currently, the vast majority of drugs have been centrally procured, and hospitals cannot decide on their own to purchase drugs outside the Formulary.
The reply to various parts of the question is as follows:
(a) Every year, clusters and hospitals under HA will, in light of HA's strategic planning and service development needs, draw up annual plans to specify the strategies, major initiatives and service targets to meet district demands. HA will provide a block allocation to various hospital clusters, which may flexibly deploy the funding and adjust their expenditures, including the expenditure on drugs, having regard to actual service demands. HA reviews the financial position of various clusters, including their expenditure on drugs, every three months through an established mechanism. In case of a possible deficit in the overall budget of individual cluster, HA will discuss with the cluster the measures to address the situation under the existing mechanism.
In the past five years, various clusters could achieve an overall balanced budget. The expenditures on the procurement of drugs of various HA clusters are set out in Annex A.
(b) When the patent of a proprietary drug has expired and generic drugs are available in the market, the decision as to whether HA will purchase the generic drugs or not will be made centrally and individual hospitals cannot decide on their own whether to purchase new generic drugs. As mentioned above, drugs currently selected and procured by HA have met all the quality requirements. For generic drugs, their bioequivalence data in comparison with the proprietary drugs must be submitted to prove their equivalence of efficacy with the proprietary drugs. At present, HA procures more than 3,000 items of drugs in different formulations such as ampoule, tablet, pill, capsule, granular, oral solution and injection fluid. Under such circumstances, HA does not have detailed statistics on the quantity of different types of generic drugs procured by various clusters and their respective proportions to the total drugs procured. The annual percentage of expenditure on generic drugs procured through tenders by HA (accounting for more than 80% of the total expenditure on drugs) in the past five years is set out in Annex B.
(c) As mentioned above, HA reviews the financial position of various clusters, including their expenditure on drugs, every three months through an established mechanism. In case of a possible deficit in the overall budget of individual cluster, HA will discuss with the cluster the measures to address the situation through the existing mechanism. The consideration for the type and quantity of drugs prescribed to patients is based on the judgment of doctors having regard to individual patients' clinical needs and treatment outcome, and will not be affected by the overall financial position of the clusters.
Ends/Wednesday, May 11, 2011
Issued at HKT 15:33
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