Replies to LegCo questions

LCQ4: General out-patient services

Following is a question by the Hon Andrew Cheng and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (June 1):


Question :


Regarding the general out-patient clinics (GOPCs) under the Hospital Authority (HA), will the Government inform this Council whether it knows:


(a) the annual attendances at public GOPCs in the year preceding the HA's taking over 59 GOPCs from the Department of Health in July 2003 and thereafter;


(b) the daily consultation quotas of various types per GOPC in the past three years; and given that HA will refer patients of its specialist out-patient clinics whose conditions have become stable to GOPCs for follow-up consultations, the percentage of attendances by such patients at GOPCs last year, and whether the authorities have correspondingly increased the quotas for consultation at GOPCs; and


(c) whether the current average unit cost of HA's GOPC service is higher than that of private clinics; if so, the reasons for that, and whether it will look into ways to reduce costs?


Reply :


Madam President,


(a) The overall annual attendances at all of the 59 GOPCs for the periods from 1 July 2002 to 30 June 2003 and from 1 July 2003 to 30 June 2004 are 5,086,024 and 4,190,314 respectively. It should be noted that in 2003, there was a notable reduction in public medical service activities because of the impact of the SARS(Severe Acute Respiratory Syndrome) epidemic. The number of patients attending GOPCs also dropped and only gradually returned to normal towards the end of 2003. In addition, the implementation of the Visiting Medical Officer Scheme successfully managed many patients at elderly homes. This also reduced their need to visit the GOPCs.


(b) Before the transfer of GOPCs from the Department of Health (DH) to HA, it had already been a practice for Specialist Outpatient Clinics (SOPCs) to refer patients whose conditions had become stable to GOPCs for follow-up consultations. In the past, these patients were required to book their consultation at the GOPC personally. For patients' convenience, they may now book their GOPC follow-up consultations at the SOPCs direct. The Hospital Authority (HA) has not noticed any marked change in the number of overall referrals of such patients to GOPCs before and after the transfer of GOPCs to HA. The exact percentage of GOPC patients who were previously followed up at SOPCs is not readily available because the computerisation of patients' records in GOPCs has not yet been completed. Because of the same reason, the daily consultation quotas per GOPC broken down by types for the past three years are not readily available either.


As it has long been a standing arrangement for SOPC patients who no longer require specialist care to be followed up at GOPCs if they choose to remain under the public sector's care, there does not appear to be a need to increase the quota of GOPCs at this particular point in time.


(c) The average unit cost per attendance at HA's GOPCs does not lend itself to direct comparison with costs at private clinics for a number of reasons.


* First, there are major differences in the cost structure between public and private clinics. For instance, doctors and other healthcare staff in public clinics are under the remunerated employment of the HA and enjoy a package of benefits. The running of HA's network of GOPCs requires a sizable administrative set up. In addition, the HA is setting up an integrated computer system for patient registration, consultation, prescription and dispensing at all GOPCs. The system is also linked with the HA-wide Clinical Management System. This is in contrast with most of the private clinics which are operated by doctors in solo practise, most of whom take up the administrative work as well. The level of computerisation of their clinics is still limited to the use of standalone computers, if any.


* Secondly, the cost of HA's GOPC service contains some elements which are normally not a part of the service provided by the private sector. These include medical services provided by professionally qualified nurses and pharmacists, laboratory tests and the provision of drugs. In respect of the provision of drugs, it should be pointed out that public clinics have a much higher proportion of chronic patients who require the prescription of several drugs over long time periods. In comparison, private clinics usually only provide patients with drugs for a short time period (1 week or less) as a part of their standard charge.


* Thirdly, HA's GOPCs also serve as one of the training grounds for Hong Kong's healthcare professionals, while the private medical sector does not have the responsibility to train new entrants to the field. Therefore, the cost of HA's GOPCs contains a training element, which is not a part of the cost of private clinics.


Currently, the average unit cost per attendance at HA's GOPCs is $256. However, if the training element and the cost of pharmacists and drugs are excluded, the unit cost per attendance is $112, which is comparable to charges at private clinics.



Ends/Wednesday, June 1, 2005

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