Speech on motion debate “Stepping up the promotion of primary healthcare development and improving healthcare services for elderly people” (Translation)

I thank Miss Alice MAK and other five Members for proposing this motion and various amendments, and most of their proposals are pretty good. Although I have some reservations about certain proposals, I will support the motion and all the amendments, and I also hope that Members will support my amendment.

I would like to bring out some concepts for discussion, and let us start with a simple one. Miss Alice MAK just now said that the increasing hospitalization rate of elderly people is attributable to a lack of primary healthcare services. Is that true? While I think the hospitalization rate is affected by many factors, I do agree that community support is lacking. But is primary healthcare service also lacking? I would like to first correct Members' understanding by highlighting that 85% of Hong Kong's primary healthcare services is provided by the private sector, and only 15% is provided by the public sector. Given that the private sector has taken up such a large market share, the quantity and quality of services are pretty satisfactory. Cases would not be arbitrarily transferred to the specialist departments unless necessary. We sometimes jokingly said that many family doctors and general practitioners are "diplomatosis". What does this mean? It means that they study hard to obtain diplomas in various disciplines, such as dermatology, ophthalmology and psychiatry, with a view to providing comprehensive support for patients.

Furthermore, I think one of the most important reasons for the rising hospitalization rate for the elderly is the long lifespan of Hong Kong people. Longer lifespan naturally means a higher chance of hospitalization. Why do the elderly have a long lifespan? Can we place all the credits on the Hospital Authority (HA)? As Members may be aware, primary healthcare is more important than the third or fourth layer, this is why I think primary healthcare in Hong Kong is pretty good on the whole. What has gone wrong then? The problem lies in the HA. What has happened to the HA?

People have an impression that, under the governance of the HA, the waiting time is very long, especially specialist services. How come the waiting time for specialist services is so long? Because there are some problems with the HA's primary healthcare system, resulting in more than 30% of the HA's specialist cases being internal transfer cases. In other words, patients are being transferred from one department to another. I estimate that 50% of the cases referred to the specialist out-patient clinics actually do not need specialist services as most of them (I would say 70% to 80%) do not involve complicated complaints from patients. The illness can be handled by family doctors. But in the absence of a screening system, HA patients have been transferred from one specialist out-patient clinic to another.

I have once cited an example. When I was still serving in a public hospital as a surgeon, a haemorrhoid patient came to seek colorectal out-patient services. Let me put it this way. If a haemorrhoid patient complained about the pain and was diagnosed to have gallstones as well, what would a doctor of the HA's specialist out-patient clinic do even though he is not the patient's attending doctor? Given the division of work, the patient was then referred to the division of gastro-intestinal for treatment and had to wait for 12 to 18 months, probably because his condition was not urgent. I have come across some even more interesting cases. A patient was not treated by me in the first place, but by an intern, who has to work in different surgical departments under various specialist divisions. It turned out that 18 months later, the intern was transferred to the division of gastro-intestinal and met the haemorrhoid patient again. Both of them felt very sad on this occasion. Why should the patient have to wait for another year for no reason? Why should the doctor handle an additional case for no reason instead of treating the patient in one go?

There is another saddening case recently which only involves the division of gastro-intestinal. This is a real case of a haemorrhoid patient who could have undergone ligation immediately in an out-patient clinic. Ligation of haemorrhoid could have been done right away if such a need arises, but given the authentication requirement of the HA and the occupational health hazard arising from the need to sterilize the equipment for the ligation of haemorrhoid immediately afterwards, coupled with the need to authenticate the name of the patient who has used certain equipment, it was proposed that an out-patient clinic should be set up to specialize in the ligation of haemorrhoid. It therefore took him another three months' wait. To save the trouble of sterilizing the equipment and marking the name of the patients who have used certain equipment, a simpler way is to use disposable equipment costing about $100. This is simple and easy. Thus, I have no idea what administrative problem the HA has encountered that makes the waiting time longer and longer.

After all, the biggest problem lies in the HA. Looking at the figure of the previous year, it shows that the number of attendances of specialist out-patient services was 6.8 million, and about 5.7 million for general and integrated out-patient services, which are out-patient services that have a wider coverage and may make referrals to specialist services. As a matter of fact, a more ideal approach is to lay down service targets and restructure the specialist or the entire out-patient services, with a view to reducing the target attendances of specialist out-patient services to 4 million while allowing the number of attendances of general and integrated out-patient services to reach as high as 7 million. While enhancing the necessary services, a mechanism should be put in place to ensure that the enhanced services can really bring down the number of attendances of specialist services, thereby saving the patients' trouble to seek consultation time and again. This approach can therefore kills three birds with one stone.

Why would I make this comment? For patients, reducing the number of attendances would mean shortening of the waiting time. Also, patients will receive more comprehensive services and the workload of doctors will lessen. But before making such an arrangement, the HA should consider how the interests of various divisions can be catered for from an administrative perspective. Many specialist departments are afraid that a reduction in the number of attendances may result in a cut in resources and doctors, which will definitely create great problems. Therefore, the service target of bringing down the number of attendances should not have any resource implication.

Here, I also wish to briefly respond to the proposals put forward by a number of Members. Miss Alice MAK proposes to introduce "elderly dental care voucher". However, first of all, the existing healthcare vouchers can also be used for dental services. I once asked some elderly people, if the Government is willing to increase the value of the health care voucher by $1,000, whether they prefer to have this $1,000 dedicated for dental purpose, or to have the liberty to decide on the use of this additional sum? The majority of the elderly people hope that they can have the liberty to decide on how the money should be spent as some of them do not have any dental problem.

Mr Albert HO has put forward a very interesting proposal, suggesting that the Government should provide half-free concessions to all elderly people using public healthcare services. In fact, 97% of public healthcare services are subsidized, and elderly people are only required to pay 3% of the service fee. Although the required payment is 3%, I am aware that 50% of the users do not need to pay a penny for the public healthcare services. In other words, it is completely free of charge. I trust that the Government does not mind as this 3% fee serves a similar environmental purpose as the waste charges, aiming merely to ensure that people will not abuse the services.

Dr Priscilla LEUNG proposes to provide tax concessions for children who pay for medical insurance contributions for their parents. Unfortunately, some elderly people are too old to secure coverage from insurance companies. In other countries, tax concessions are provided to children who pay for medical expenses for their parents, which I think is a more encouraging approach.

I have also put forward a proposal about health care vouchers earlier on. It is good to lower the eligible age to 65, but in order to avoid abuse, I proposed to subsidize 80% of the actual expense. A ceiling can actually be imposed in this regard. Perhaps I am too conservative to think that subsidy should not be provided to LI Ka-shing, I have therefore proposed to establish a lenient means test system.

That is all I need to say. Deputy President, I so submit.