Replies to LegCo questions
LCQ3: General out-patient clinic services
Following is a question by the Hon Li Kwok-ying and a reply by the Secretary for
Health, Welfare and Food, Dr York Chow, in the Legislative Council today
(November 16):
Question:
It is learnt that the Hospital Authority (HA) has been trying out a new
chip-distribution arrangement at the general out-patient clinics on Hong Kong
Island since October this year. Under the new arrangement, members of the public
have to collect the consultation chips on a first-come-first-served basis in the
afternoon prior to the day of consultation. As the demand for general
out-patient services is large, very few consultation chips are still available
for distribution on the day of consultation. In this connection, will the
Government inform this Council whether it knows:
(a) the respective numbers of attendance quotas for the morning, afternoon and
evening sessions at each of the clinics on each day of consultation, and the
respective numbers of attendance quotas for the morning and afternoon sessions
available for distribution on a queuing basis on each day of consultation when
the new arrangement was being tried out between October 4 and November 3 this
year;
(b) whether HA has reviewed the above arrangement; if it has, of the review
results, and whether it will consider reserving some consultation chips for
distribution on the day of consultation for the benefit of those who need to
seek consultation on that day or those who cannot spare the time to queue for
collecting consultation chips on the previous afternoon; and
(c) whether HA will gradually implement the new arrangement at clinics in other
districts; if so, of the specific timetable, and whether additional resources
will be allocated to improve the queuing problem with general out-patient
services?
Reply:
Madam President,
(a) General outpatients can be grouped into two categories, namely patients with
stable chronic diseases and those with episodic illnesses. To address the
problem of long queuing time for general outpatient services, the Hospital
Authority (HA) has adopted a series of improvement measures since August this
year. Measures for chronic patients include:
* Arranging follow-up appointments for patients with chronic diseases requiring
regular follow-up subject to their consent. Patients are encouraged to take up
such appointments in less busy sessions, such as afternoon or evening sessions
or sessions on public holidays.
* Where appropriate, prescribing medication for 12 weeks or more for patients
with chronic diseases according to attending doctors' clinical judgment.
The above two measures have already been implemented, for instance, in the
general outpatient clinics (GOPCs) on Hong Kong Island earlier on, and have
significantly reduced the need for patients to queue at the clinics in the early
morning for a place in the day's quota.
Measures for patients with episodic illnesses include:
* Posting up in the clinics the utilisation information of other clinics in the
same district to facilitate patients' choice of clinics/consultation sessions.
* Rolling out a pilot next-day appointment scheme in 12 GOPCs on Hong Kong
Island to allow patients who line up at the clinics in the afternoon to have
clinical consultation on the same day (if slots are available) or the following
day (in morning, afternoon or evening session). The objective of the scheme is
to allow patients to obtain a consultation slot one day in advance without
having to queue at the clinic in the early morning on the day of consultation.
This will also facilitate the patient to make better plans for his personal
schedule on the day of consultation.
The daily allocation of consultation slots under the new arrangement at the 12
GOPCs on Hong Kong Island from October 10, 2005 to November 8, 2005 is shown at
the Appendix for Members' reference. The distribution of the daily quota among
different types of patients varied from clinic to clinic, but generally
speaking, at least 40% of the slots were allocated to patients with episodic
illnesses daily, with a significant higher percentage recorded by some clinics
on certain dates.
(b) The "next-day appointment" scheme for patients with episodic illnesses was
introduced in October. The HA conducted a survey two weeks after commencement of
the scheme. Among the 7,635 respondents out of 17,012 questionnaires distributed
to the patients, over 90% of the respondents expressed approval of the concept
and arrangement of the pre-booking scheme. In other words, patients' initial
response was positive. They held that the scheme could dispense with the need
for them to queue up for a place in the day's consultation quota in the early
morning. The HA will continue to monitor the operation of the scheme closely.
After the allocation of places in the quota to patients with chronic diseases
through the appointment system and other patients through the "next-day
appointment" system, the remaining places in the daily quota in each clinic, if
any, is reserved for "walk-in" patients on the same day. In situations where
quota places are used up, clinic staff will still ensure the provision of most
appropriate service to patients with emergency symptoms, such as making
arrangement for them to be attended to by doctors of the GOPC, despite the using
up of all quota places or sending them to the accident and emergency (A&E)
department of a hospital if they were considered to be better taken care of in
that manner in view of their symptoms.
(c) Apart from Hong Kong Island, the HA has arranged to try out this pilot
scheme in some smaller clinics in Kowloon and the trial run is still underway.
The HA will consider whether to extend the arrangement to other districts in the
light of the effectiveness of the trial scheme and the circumstances in other
districts, such as the number of stable chronic patients in need of follow-up
appointments in their respsective districts.
The "next-day appointment system" is only a transitional arrangement. In the
longer run, the HA will introduce a phone appointment system which will be tried
out in Hong Kong East Cluster by the end of this year. The practice that the
next follow-up appointment will be arranged during the consultation for patients
with chronic diseases requiring regular follow-up is to be retained. For
patients with episodic illnesses, the phone appointment system will allow them
to make their next-day appointment by phone without having to attend the clinic
in person the previous day. The automated phone appointment system can monitor
the slots available in different sessions of different clinics in a district
automatically. It can also search and arrange the next available slot for a
number of patients simultaneously if all the slots of a certain session have
been allocated. The system is linked up to the patients' database of various
clinics. Through fine-tuned and human-error free procedures, it aims at enabling
general patients, including the elderly, to make their consultation appointments
by going through the least possible number of steps. The HA will extend this
pilot system to other districts by the end of next year if it proves to be
effective.
I would like to reiterate that our public health care services, particularly
general outpatient services, are primarily targeted at the low income and
underprivileged groups, such as the chronically ill with low income or frail and
vulnerable elders. Public and private general outpatient services have all along
accounted for about 15% and 85% of the market share respectively. Substantial
input of resources is required for our public health care system to develop and
sustain other key services, such as geriatric services, psychiatric services, as
well as services for chronic illnesses and various kinds of severe or emergency
cases. At this stage, we do not think there is a need to substantially increase
the resources devoted to public general outpatient services to achieve a larger
market share, particularly when the supply of such services in the private
market in recent years has been on the rise which has in turn led to price
adjustments and greater transparency in the fees charged by private
practitioners. Furthermore, increasing input of resources is not the only option
available to improve our general outpatient services. We can address patients'
needs through service restructuring and improvement. As for the problem of
patients having to queue for a long time for consultation slots, the HA has
responded positively by initiating a series of improvement measures. We will
keep the situation under review and make flexible arrangements so that resources
are effectively deployed to those who are most in need.
Ends/Wednesday, November 16, 2005
Issued at HKT 12:41
NNNN
Annex to LCQ3