Press Releases

SHWF's remarks on target subsidy

Following is a transcript of the remarks on target subsidy made by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, at a media session after the "Men's Health Conference" today (November 8):

Reporter: Can you repeat the target subsidy again?

Secretary for Health, Welfare and Food: We are already doing it. If you remember the consultation document, it said that we need to target our subsidies. Targetting subsidies is from two perspectives. One is which service do we target more subsidies. The other is people, to whom do we target more subsidies. So to whom do you target more subsidies obviously involve the lower income, the chronically ill, and the elderly with limited resources. That is where in the initial change of the fee restructuring, when the whole fee restructuring starts to kick in, we need to have a fee assistance scheme so that people with low incomes and the chronically ill and the elderly with limited resources will pay part or at least less than the charges. So that will be the target, so it was really what Dr Leong was saying that for people with very low incomes, below the ten or twenty whatever percentage, there should be some mechanism thereby they are paying less. So this is what we talk about which in the document we call the second safety net. But because there is some confusion about the safety net, the definition of terms, it was thought better not to use that terminology, so we then use more generally accepted and understood term because we already have all those in various sectors. In schools we have a fee assistance scheme. So in the future we shall also have a medical assistance scheme to cater for the lower income and that will be built on the present system. That is target subsidising because you are targetting for very low incomes, for people of frequent uses of service, for the elders with limited resources, then you target subsidies so that they pay less. Come back to the question of population. It is a matter how you far up you go. How far up you go really depends on how high the charges go. If the charges remain to be affordable, then obviously you don't have to go very high up. As far as we see we have no intention for the charges to go up very high. If we don't go up very high, then we don't need to have so many layers. If you have very high charges, obviously you need to go up very high. But how practical it is to have all these layers because in Hong Kong we don't have a mechanism to know what people's incomes are, and it is all going to be on the system? So all these are issues. The target subsidy approach is the right one but it is a matter of how far we go. For which levels that we reach so it depends on how far charges go up. The second target charge perspective is which services do we target more subsidies. I was explaining that when we had this new fee structure. We can see that for a lot of rehabilitation beds, psychiatric beds, the day services for geriatric and psychiatric, we are not increasing charges, not a single cent. Why do we do that? Because these are services although the cost of operating a bed in rehabilitation services is less expensive than acute hospitals but the duration of stay tends to be very long, so on the average people stay two or three months. If you charge the full rate, we talk about over a hundred thousand dollars. For these services, even the middle income cannot afford. So these services we need to target more subsidies, and not only is it expensive to receive treatment but also in these rehabilitation services because of the chronic illness, most of the patients will have lost their earning capacity. Because most of them have stroke, some of them have chronic lung disease and they are in and out of hospitals, they can't even cater for their own needs or find a job. So these services need to be subsidised more. So the target subsidy is two things. One is to target which group of individuals that we need to give more subsidies. And the second is which services should the general revenue subsidise more.

Reporter: ... upper and middle class ...they won't be overburdened?

Secretary for Health, Welfare and Food: When we look at the impact, we look at the impact on each level in the community, how much of the services for general usage, how much of their incomes would be committed to health services. With our present charges, for most of the high income groups, even middle income groups, the impact is not a great deal. We had looked at the figures. With the new fees and charges, generally in Hong Kong, people will not have to more than 10 per cent of their incomes for health services. So this is a very acceptable level. But for some individuals who need to see doctors very frequently because of their chronic illnesses, their incomes will be marginal. So these have got to be dealt with differently. These are the people in the extremes. That will be dealt with in the new fee assistance scheme. That's why we say in the new fee assistance scheme we will look at factors such as the income level of the individual, the nature of the illness. A lot of the chronically ill are likely to have limited resources. The elderly people with limited assets because they do not have an earning capacity. So they will be affected. They need to be dealt with differently. These are the factors that we will look at in the future. When we have the medical assistance scheme, all these factors will kick in. We will continue to make our services affordable for different levels and different needs.

Reporter: Dr Yeoh, I just want to ask you one question, now that the A&E fee has been implemented and they are going to be taken into effect at the end of November, how are you going to encourage patients to go to the private sector? Is the Government in some sort of negotiations with the private sector or how to encourage them to go to private clinics instead of misusing A&E facilities?

Secretary for Health, Welfare and Food: I just want to emphasise the Government is not trying to get patients to go to the private sector. I think we need to look at how the public and private sectors can work better so that patients can make a choice. It is really an individual choice. When there are charges of emergency care, some individuals will then make a choice on whether they would want to pay a hundred dollars in emergency or they wish to go to a primary care clinic or to a private doctor. Our role is to facilitate that. It is not our objective to push patients to private sector but to give patients a choice.

(Please also refer to the Chinese portion)

End/Friday, November 8, 2002