interim review report - ehcv final clean - hcv.gov.hk · interim review of elderly health care...

InterimReviewofElderlyHealthCareVoucherPilotScheme

FoodandHealthBureauDepartmentofHealth

February2011

GovernmentofHongKongSpecialAdministrativeRegion

ElderlyHealthCareVoucherPilotScheme:AnInterimReview

Content

EXECUTIVESUMMARY ............................................................................................................................... I

PURPOSE...................................................................................................................................................1

BACKGROUND...........................................................................................................................................1

POLICYADDRESS...................................................................................................................................1 SCHEMEOBJECTIVES ............................................................................................................................ 1

IMPLEMENTATION.....................................................................................................................................2

SCHEMEDESIGNANDFEATURES........................................................................................................... 2 ElderlypersonseligibletoparticipateintheScheme.....................................................................2 HealthcareserviceproviderseligibletoparticipateintheScheme................................................2 Restrictionsontheuseofhealthcarevouchers .............................................................................2

SCHEMEOPERATION ............................................................................................................................ 3 Mechanismforissuingandusinghealthcarevouchers .................................................................3 Arrangementforreimbursementofhealthcarevouchers .............................................................4 eHealthSystem ...............................................................................................................................4 PrivacyImpactAssessmentandPrivacyComplianceAssessment ..................................................5 SecurityRiskAssessmentandAudit................................................................................................6 Theelectronicplatformpilotingamodelforschemeadministration ............................................6

IMPROVEMENTMEASURES .................................................................................................................. 7 Datainputofclaimtransactions .....................................................................................................7 ModificationtoConsentForm ........................................................................................................7 NoneedtoarrangeVoucherAccountCreationForm.....................................................................8 UseofSmartIdentityCardReader..................................................................................................8

PUBLICITYANDPROMOTION................................................................................................................ 9 REIMBURSEMENT............................................................................................................................... 10 POSTCLAIMCHECKINGANDAUDITING.............................................................................................. 10

MeasurestopreventabuseoftheScheme ..................................................................................11 TheCorruptionPreventionDepartmentofIndependentCommissionAgainstCorruption .........12 TheAuditCommission ..................................................................................................................12

INTERIMREVIEW................................................................................................................................13 Objectivesoftheinterimreview...................................................................................................13 Methodologyandsourceoffindings ............................................................................................13


STATISTICSONPARTICIPATIONANDUTILIZATION....................................................................................15

METHODOLOGY..................................................................................................................................15 RESULTS..............................................................................................................................................15

(A) Statisticsonhealthcareserviceproviders ............................................................................15 Numberofenrolledhealthcareserviceproviders....................................................................15

Distributionofplacesofpractice .............................................................................................15

Enrolmentamonghealthcareprofessionals.............................................................................18

Participationamonghealthcareprofessionals .........................................................................20

Enrolmentandwithdrawalofhealthcareprofessionals...........................................................21

(B) Statisticsontheelderly .........................................................................................................23 NumberofelderlypeoplejoiningtheScheme ........................................................................23

(C) Voucherutilizationpattern....................................................................................................23 NumberofeHealthaccountscreated ......................................................................................23

Numberofclaimtransactionsmade ........................................................................................25

NumberofeHealthaccountswithzerobalanceofvoucher ....................................................25

Distributionofclaimtransactionsamonghealthprofessions..................................................25

Distributionofclaimtransactionsbyreasonofvisit ................................................................27

Numberofvouchersusedpertransactionbytheelderly........................................................29

Numberofvouchersclaimedbyhealthprofession..................................................................31

Medianofvouchersclaimedpertransactionbyhealthprofession .........................................33

Distributionofvouchersclaimedandtransactionsmadebymedicalpractitioners ................34

Doctorpatientrelationship......................................................................................................35

FEEDBACKFROMTHEELDERLY................................................................................................................37

OPINIONSURVEY................................................................................................................................37 METHODOLOGY............................................................................................................................. 37 RESULTS .........................................................................................................................................37

(A) Reasonsforusingvouchers .............................................................................................38

(B) Schemeawareness ..........................................................................................................40

(C) Schemescope .................................................................................................................43

a. Subsidyamount .........................................................................................................43

b. Ageeligibility..............................................................................................................44

c. Coverageofhealthservices .......................................................................................44

(D) Schemedelivery ..............................................................................................................45

(E) Schemeimpact................................................................................................................46

a. ChoiceofhealthcareservicesafterSchemelaunch...................................................46

b. ChangeinservicefeesafterSchemelaunch..............................................................47


WILLINGNESSTOPAYSTUDY .............................................................................................................. 49 METHODOLOGY............................................................................................................................. 49 RESULTS .........................................................................................................................................49

(A) Willingnesstopay ...........................................................................................................50

(B) Willingnesstocopay ......................................................................................................52

(C) Subsidy............................................................................................................................54

FEEDBACKFROMHEALTHCARESERVICEPROVIDERS...............................................................................56

METHODOLOGY..................................................................................................................................56 RESULTS..............................................................................................................................................56

(A) Reasonsforchoiceofparticipation ......................................................................................56 (B) Schemedelivery...................................................................................................................56 (C) Schemeimpact.....................................................................................................................57 (D) Suggestionsfromhealthcareserviceproviders ....................................................................57

CONCLUSIONSANDRECOMMENDATIONS ..............................................................................................58

KEYOBSERVATIONSONTHESCHEME ................................................................................................. 58 (i) Schemeawarenessandparticipation..................................................................................58 (ii) SatisfactionwiththeScheme ..............................................................................................59 (iii) Impactonhealthcareseekingbehaviour ............................................................................60 (iv) Priceandsubsidyforhealthcareservices............................................................................62 (v) Coverageofhealthcareserviceproviders ...........................................................................63

RECOMMENDATIONS .........................................................................................................................63

APPENDIX1FULLVERSIONANDCONDENSEDVERSIONOFCONSENTFORMSINEHEALTHSYSTEM

................................................................................................................................................................68

APPENDIX2LISTOFDISTRICTELDERLYCOMMUNITYCENTRESANDNEIGHBOURHOODELDERLY

CENTRESHOMES.....................................................................................................................................72

APPENDIX3PROTOCOLSONMONITORINGANDINVESTIGATIONOFTRANSACTIONCLAIMSMADE

THROUGHTHEEHEALTHSYSTEM............................................................................................................77

APPENDIX4LISTOFREASONOFVISITINRESPECTOFTHEHEALTHCAREPROFESSIONALSELIGIBLETO

JOINTHESCHEME ...................................................................................................................................86

APPENDIX5FREQUENCYDISTRIBUTIONOFAVERAGENUMBEROFVOUCHERSCLAIMEDPER

TRANSACTIONBYHEALTHPROFESSION ..................................................................................................92

APPENDIX6FREQUENCYDISTRIBUTIONOFVOUCHERSCLAIMEDBYHEALTHPROFESSION ..............102

ElderlyHealthCareVoucherPilotScheme:AnInterimReviewExecutiveSummary

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EXECUTIVESUMMARY TheElderlyHealthCareVoucherPilotScheme(theScheme)hasbeenin place for two years since its implementation in 2009. To assess theeffectiveness of the Scheme in enhancing primary care for the elderly, theGovernment initiated an interim review in the second half of 2010. TheoperationoftheSchemeandutilizationofthevoucherswereexamined. Theopinions and feedbackof theelderly andhealthcare serviceproviderswerecollected. Thisexecutivesummaryhighlightsthemajorfindingsofthereview,ourevaluationoftheextenttowhichtheSchemehasachieveditsobjectives,andourrecommendationsonthewayforwardwhenthecurrentpilotperiodendson31December2011.SchemeObjectives2. The Chief Executive announced in the 200708 PolicyAddress thatthe Government would launch a threeyear pilot scheme in the 200809financial yearunderwhichelderlypeopleaged70orabovewouldbegivenannually fivehealth care vouchersworth$50each to subsidise theprimaryhealthcareservicestheypurchasefromtheprivatesector. TheSchemewaslaunched on 1January 2009. It aims at providing partial subsidies for theelderly to receive private primary healthcare services in the community, asadditional choiceson topof theexistingpublicprimaryhealthcare services,with a view to enhancing primary healthcare services for the elderly. TheScheme implements the money follows patient concept on a trial basis,enablingelderlypeopletochoosewithintheirneighbourhoodprivateprimaryhealthcareservicesthatbestsuittheirneeds. 3. By providing partial subsidies for the elderly to choose privateprimaryhealthcare in the community, it is expected that the Scheme couldhelp promote key ingredients of good primary care among the elderly andhealthcare service providers, including: continued relationship between theelderly and their healthcare providers, more provision and utilization ofpreventivehealthcareservices,andpromotionofwellbeingamongtheelderly. With better access and a continuum of care from participating healthcareserviceproviders,weexpectthatmoreelderlypeoplewouldbeabletochooseprivate primary healthcare services close to their homes, and those elderlypeoplewhoneedtorelyonpublichealthcareservicesmightalsobenefitfrom


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thelessburdenedpublicprimarycareservices.ScopeandMethodologyoftheInterimReview4. The interim review was conducted when the Scheme has beenimplementedfor itsfirsthalfofthepilotperiod. Effortshavebeenmadetoshow thepositionup to31December2010, save for situationswhereonlydataupto31October2010wereavailableforanalysispurposes.5. ThescopeoftheinterimreviewcoverstheoperationoftheScheme,participation in the Scheme, utilization of vouchers, and feedback on theSchemeingeneralandspecificaspects. Inparticular,theinterimreviewhascoveredthefollowingaspectsby

(a) examiningvoucherutilizationbytheelderlyandparticipationofhealthcareserviceprovidersintheScheme;

(b) collecting feedback from the elderly (both participating and

nonparticipating)about theScheme, including theirawarenessof theScheme,means toget toknow theScheme, reasons forScheme participation / nonparticipation, desirable subsidyamount, age eligibility, healthcare services coverage, servicedeliveryandperceptionaboutchangeinservicefeesandchoiceofhealthcareserviceafterSchemelaunch;and

(c) collecting feedback from healthcare service providers (both

enrolledandnonenrolled)abouttheScheme,includingschemeoperation, service delivery, barriers of nonparticipation andreasonsforwithdrawal.

6. Data collected for analysis and examination include statistical datacaptured inthedatabaseoftheeHealthSystemandpurposelycollecteddatathroughstructuredquestionnairesandfocusgroupdiscussions. Tothisend,studieswere conductedby the SchoolofPublicHealthandPrimaryCareofFacultyofMedicineoftheChineseUniversityofHongKongtocollectfeedbackfrom the elderly and healthcare service providers, viz. the opinion survey,focusgroupdiscussionsandthewillingnesstopaystudy.


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SchemeOperationandImplementationeHealthSystem7. TheScheme isadministeredthroughanelectronicplatform,viz.theeHealth System. It is a webbased system on which voucherbased andsubsidy schemes operate. There is no need to issue or carry vouchers inpaper form as vouchers are issued andused through theelectronic system. TheeHealthSystemperformsthefollowingfunctions

(a) managing information on healthcare service providers andenrolment;

(b) managing health care voucher accounts, including registering

eligible elderly people under the Scheme, issuing vouchers,processingclaimsandrecordingusage;

(c) managingreimbursementofhealthcarevouchersonamonthly

basis;and(d) monitoring the Scheme by producing statistical reports to

facilitate planning and management of daily operation, andgeneratingalertmessageswheneveranirregularityintheuseofvouchers is detected to facilitate followup actions andinvestigations.

UseofSmartIdentityCardReader8. Tofurtherstreamlineproceduresandprovidegreaterconveniencetohealthcare serviceproviders,arrangementshavebeenmade in late2010 tomakeuseofthecardfacedatafunctioninthechipsoftheSmartHongKongIdentity Card (HKID) for registration and authentication. It provides analternative means to participating healthcare service providers to registerpersons eligible for vouchers and to access their accounts for claimingvouchers,obviatingmanualinputandensuringdataaccuracy.


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PrivacyImpactAssessmentandPrivacyComplianceAssessment9. Measurestoprotectpersonaldataprivacyandtopreventabusehavebeen instigated prior to and during Scheme implementation. A PrivacyImpactAssessment (PIA)andaPrivacyComplianceAssessment (PCA)on thedesignandoperationalproceduresof theScheme (phase I)were conductedbetween July and December 2008 by Deloitte Touche Tohmatsu. ThisensuresthattheeHealthSystemhasbuiltinfeaturestosafeguardthesecurityof personal data transferred and stored within it in compliance with therelevantlegislationandgovernmentguidelinesonprotectionofpersonaldataprivacy. Prior to full launchofSmartHKIDdeployment foreHealthaccountcreationandvoucherclaims inOctober2010,PIAandPCAonphase IIoftheeHealthSystemwereconductedbetweenAprilandJuly2010. SecurityRiskAssessmentandAudit10. Inaddition, theDepartmentofHealth (DH)engagedComputerandTechnologicalSolutionsLimited(C&T)toconductSecurityRiskAssessmentsofphaseIandIIoftheeHealthSysteminMay2008andJune2010respectively. Thecurrentsecurity risk levelofeHealthSystemwas foundsatisfactory,andcompliedwiththeGovernmentsITSecurityPolicyandSecurityRegulations.PostclaimcheckingandAuditing11. As at 31 December 2010, a total of 852,721 claim transactionsinvolving2,136,630voucherswereprocessedforreimbursementandatotalofabout $106 million have been reimbursed to enrolled healthcare serviceproviders. Toensureproperdisbursementoffundingforvoucherclaims,DHhasput inplaceamechanism forcheckingandauditingvoucherclaims. Itinvolves (a) routine checking, (b)monitoring and investigation of aberrantpatterns of transactions, and (c) investigation of complaints. By endDecember 2010, a total of 1,711 inspection visits were conducted, having30,241claimscheckedwhichrepresents4%ofclaimtransactionsmade. Thecheckingcovers77%ofenrolledhealthcareserviceproviderswithclaimsmade. The postclaim checking and auditing revealed 25 cases of wrong claims,representing 4% of the checked claims. These claims involved errors inprocedures or documentation. So far, two medical practitioners and oneChinesemedicinepractitionerhavebeendelistedfromtheScheme.


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12. In mid 2008, the Corruption Prevention Department of theIndependent Commission Against Corruption offered corruption preventionadvicetoDHontheadministrationoftheSchemepriortoitslaunch. Also,toascertainwhethertherearepotentialriskstoregularity,proprietyorfinancialcontrolinthemanagementoftheSchemeanditsoperationalmechanism,theAuditCommissionconductedariskauditoftheSchemein200910. DHhastaken into account their suggestions and observations in finetuning themodusoperandioftheScheme.StatisticsonSchemeParticipationandUtilizationHealthcareserviceproviders:distributionofplacesofpractice13. Asat31December2010,thereareatotalof2,736healthcareserviceprovidersenrolledintheScheme,involving3,438placesofpractice. Amongthem, 39.6% (1,363) are in Kowloon, 23.4% (803)Hong Kong Island, 19.8%(681)theNewTerritoriesWest,16.0%(549)theNewTerritoriesEastand1.2%(42)Islandsdistrict. Ofthe18districts,YauTsimMongdistrict(549)hasthehighestnumberofplacesofpractice.Healthcareserviceproviders:Enrolmentandparticipationrate14. Nine categories of healthcare professional who are registered inHongKong are eligible to participate in the Scheme. They are medicalpractitioners, Chinese medicine practitioners, dentists, chiropractors,registered and enrolled nurses, physiotherapists, occupational therapists,radiographers and medical laboratory technologists. Medical practitionersaccount for the highest percentage of enrolled healthcare service providers(52.3%)(1,431),followedbyChinesemedicinepractitioners(27.9%)(762)anddentists(8.7%)(239).15. We estimate that the participation ofmedical practitioners,whichformed themajority of the enrolled healthcare services providers, is about34.1% of the potential pool of medical practitioners actively providinghealthcareservicesintheprivatesector. Theparticipationrateisonparwithotherpublicprivatepartnership schemes launchedby theGovernment (e.g.vaccination subsidy schemes). Participation among other eligible health


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professions is relatively lower, at 16.1% for dentists and 12.5% for Chinesemedicinepractitioners.ElderlypeoplejoiningtheSchemeandclaimingvouchers16. As at 31 December 2010, a total of 385,657 eHealth accounts(representing 57% of eligible elderly people) were created and 300,292eHealthaccountsmade voucher claims (representing45%ofeligibleelderlypeople). ThenumberofeligibleelderlypeoplewhohaveregisteredwiththeScheme has increased from 42% in end 2009 to 57% in end 2010. Thenumberofeligibleelderlypeoplewhohave registeredwith theSchemeandmadevoucherclaimshas increased from29% to45%over thesameperiod. Bytheendofthesecondyearofthepilotperiod,131,801elderlypeople,or34%ofelderlypeoplewhohaveregisteredwiththeScheme(some20%oftheeligibleelderlypeople),usedupthevoucherstheywereentitledtobythen.Claim transactions made: distribution among health professions, vouchersclaimpatternandusage17. With regard to the distribution of claim transactions among thedifferent professions, themajority (88.1%) (751,212 out of 852,721) of theclaim transactions are made by medical practitioners. Chinese medicinepractitioners (9.3%) (79,377) and dentists (1.9%) (16,396) rank second andthird in terms of utilization of vouchers. In terms of number of vouchersclaimed, medical practitioners constitute the largest proportion (87.1%)(1,861,348 out of 2,136,630 vouchers), followed by Chinese medicinepractitioners(8.4%)(180,324)anddentists(3.5%)(74,751). 18. Amongtheninehealthprofessions,dentistshavethehighestaveragenumber of voucher claimed per transaction (4.56 vouchers per transaction)whereas the two lowest are medical practitioners (2.48 vouchers pertransaction) and Chinese medicine practitioners (2.27 vouchers pertransaction). Themedianofvouchersclaimedpertransactionfordentists is4.75whereasformedicalpractitionersandChinesemedicinepractitionersare2.77and2.43respectively.19. Fordistributionofclaimsbyreasonofvisit,ahighproportionofclaimtransactions(69.4%)aremadeformanagementofacuteepisodicconditions.


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Followup/monitoringoflongtermconditionsaccountfor21.4%. Only6.5%and2.7%oftheclaimtransactionsaremadeforpreventivehealthcareserviceandrehabilitativecarerespectively.20. Intermsofthenumberofvouchersusedduringeachtransaction,themostcommonpattern(40.4%) istheuseoftwovouchers($50x2),followedbythreevouchers($50x3)(21.8%)andonevoucher($50x1)(21.1%). Noinformationonadditionalchargesabovethevouchersclaimed isavailableashealthcareprovidersarecurrentlynotrequiredtosupplysuchinformation.21. The eHealth statistics reveal that there are 25% eHealth accountswithclaimtransactions involvingtwoormoremedicalpractitioners. 75%ofeHealth accountswithmore than one claim transaction involved only onemedicalpractitioner. Mostoftheelderlytendtostaywiththesamemedicalpractitionerwhenusingvouchers. OpinionSurveyandWillingnesstopayStudy22. Togaugetheviewsandopinionsoftheelderlyandhealthcareserviceproviders about the Scheme, an opinion survey and four focus groupdiscussionswere conducted between January and June 2010. In order tofurther assess thewillingness topay forprivateprimaryhealthcare servicesamongtheelderlyandtoexaminethe levelofsubsidythatwould incentivizetheelderly tochange theirhealthcare seekingbehaviour forprivateprimaryhealthcareservices,awillingnesstopaystudywasconductedinJuneandJuly2010. These studieswere undertaken by the School of Public Health andPrimaryCareofFacultyofMedicineoftheChineseUniversityofHongKong.Opinionsurvey 23. A total of 1,026 elderly people were recruited from public parks,GeneralOutpatientClinicsofHospitalAuthority,ElderlyHealthCentresoftheDepartment of Health and private general practitioners clinics. TheyincludedparticipantsandnonparticipantsoftheScheme. 70%oftheelderlysaid that theywereawareof theScheme. 35% said that theyhadactuallyusedthevouchers.


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Reasonsforusingvouchers24. Thesurveyrevealsthatelderlypeoplewhoareusedtoseeingprivatedoctors are more ready and prepared than those relying on the publichealthcare system to register and make use of health care vouchers. Comparison ismadeonuseofvouchers forsubpopulationsaccording to thetype of doctors they usually visit. 24% of the elderlywho usually visitedpublicdoctorshadmadeuseoftheirvouchers. Forthosewhousuallyvisitedprivate general practitioners clinics, 49% of them had made use of theirvouchersduringconsultation. Comparison isalsomadefortwosubgroups,viz.voucherusersandnonvoucherusers. For thosewhohadmadeuseofvouchers, comparatively speaking,moreelderlypeoplewereused to seeingprivate doctors (27.5% usually visited private doctors, 49.4% visited bothprivate and public doctors, and only 23.0% usually visited public doctors). Forthosewhohadnevermadeuseofvouchers,manyofthemwereusedtoseeingpublicdoctors(43.2%usuallyvisitedpublicdoctors,40.2%visitedbothprivate and public doctors, and only 16.6% usually visited private doctors). Thetriggerfortheuseofvoucherswastomakegooduseofthesubsidygivenby the Government (36%), followed by shorter waiting time (33%), andrecommendationfromfriends,doctorsandnurses(18%).25. For thosewhowereawareoftheSchemebuthadneverused theirvouchers (328), the reasons for not using vouchers included the healthcareprofessionalswhomtheyusuallyvisitedhadnotenrolledintheScheme(24%),theelderlywereusedtoseeingpublicdoctors(24%),theelderlywerehealthyanddidnothavetoconsulthealthcareprofessionals(23%),andtheycouldnotfindanenrolledhealthcareprofessionalnearby(22%).Schemeawareness26. Some 71% of the interviewed elderlywere aware of the Scheme. Televisionadvertisement(58%)wasthekeysourceofinformation,followedbypressandmagazines (23%),andenrolledhealthcareserviceproviders (20%). Among those elderly people who were aware of the Scheme, 47% of therespondents felt the information provided to themwas very, quite or fairlysufficient. Among the31%ofelderlypeoplewho felt that the informationwasinsufficient,53%wouldliketolearnmoreonhowtousethevouchersand43% would like to know the channels where they could obtain the list of


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enrolledhealthcareprofessionals.Schemescope:subsidyamount27. Ofthe1,026elderlypeoplewhoparticipatedinthesurvey,17%(35%werevoucherusers)ofthemconsideredtheannualsubsidyamountof$250wasenough. 68%(39%werevoucherusers)ofthemconsideredthesubsidyamountof$250perannumwasnotenough. Amongthosewhoconsideredtheamountwasnotenough,36%preferredasubsidyamountof$300$500and32%preferredasubsidyamountof$501$1,000.Schemescope:ageeligibility28. Atotalof233elderlypeopleaged6069wereinterviewedduringthesurvey. The majority of the respondents (74%) thought that the ageeligibilityshouldbelowered. Amongthem,70%suggestedloweringtheageto65yearsold.Schemescope:healthservicecoverage29. Ofthe1,020elderlypeoplewhoansweredthequestiononcoverageofhealthservices,24%ofelderlypeoplethoughtthatthecoverageofhealthservices was insufficient. Among those who provided suggestions toenhance theservicecoverage (173),63%suggestedaddingpublicclinicsand28% suggested adding optometrist to the list of participating healthcareprofessionals.Schemedelivery30. Elderly peoples satisfaction of the Schemewas assessed by askingwhethertheyconsideredtheSchemeusefulorconvenienttouse. Some65%of interviewedelderlypeople(includingbothvoucherusersandnonvoucherusers) considered the Scheme useful. Among the 359 voucher users, 79%consideredtheSchemeuseful.31. Inaddition,theelderlywerealsoaskedonwhethertheyconsideredthe vouchers were convenient to use. Some 64% of the interviewees(including both voucher users and nonvoucher users) considered the


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vouchers were convenient to use. Among the 359 voucher users, 80%consideredthevouchersconvenienttouse. Schemeimpact:choiceofhealthcareservicesafterSchemelaunch32. Of 1,026 elderly peoplewho participated in the survey, one third(32%) said that the Scheme encouraged them to use private primary careservice more than before. Some 66% of the elderly considered that theSchemedidnotchangetheirbehaviour inseekingprivateprimaryhealthcareservices. Majorreasonsfornochangeofhealthseekingbehaviour includedusedtoseeingpublicdoctors(26%)andthesubsidyamountwastoo little(24%). Schemeimpact:changeinservicefeesafterSchemelaunch33. In the survey, the elderlywere askedwhether, from a perceptionpointofview,theconsultationfeesingeneralhadincreasedsubsequenttothelaunchoftheScheme. 45%didnotperceiveanyincreaseinconsultationfees. 42% reported that they did not knowwhether the Scheme had led to anyincrease in consultation fees. 14% perceived that the consultation feesincreasedasaresultoftheScheme. Willingnesstopaystudy 34. To assess the elderlys willingnesstopay, their sensitivity towardssubsidyamountandhealth seekingbehaviour, theWillingnesstopay (WTP)StudywasconductedbetweenJuneandJuly2010among1,164elderlypeopleaged60orabove. Willingnesstopayandcopay35. Theelderlywereaskedwhatwas themaximumamount theywerewilling to pay for a visit to see a privatemedical practitioner for differentconditions,andwhatwasthemaximumadditionalamounttheywerewillingto copay if theGovernmentprovided subsidy for them to seek care in theprivatesector. Theresultsshowthattheirwillingnesstopay(WTP)andtheamountstheywerewillingtocopayforprivateprimarycareservicesvariedbytypeofdiseasesandservices.


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36. The averageWTP amounts for generalhealth conditions and acuteconditionwerewithinthecurrentpricerangeinprivatesector. However,theWTPamountsforchronicconditionandpreventivecaresuchashealthcheckand dental check fell below the price range in private sector. For chronicconditions(47%)anddentalcheck(54%),almosthalfoftherespondentswereunwilling topay forprivatehealthcareservice (WTP=$0). Forhealthcheck,36%of respondentswereunwilling topay for such service (WTP=$0). 32%outof the total respondentswerewilling topayanamountwithinorabovethepricerangeforhealthcheck inprivatesector,andanother32%willingtopayanamountbelowthemarketpricerangeforhealthcheck. Theelderlyingeneralweremorewillingtopayforacuteepisodiccondition. 76%ofelderlywerewillingtopayforsuchservices, including65%willingtopayanamountwithinorabove theprice range inprivate sectorand11%willing topayanamountbelowmarketpricerange. Themainreasons forbeingunwillingtopay forprivatehealthcare servicewere used to seeingpublicdoctorsandprivatehealthcareservicesweretooexpensive. 37. The elderly were also asked on themaximum amount they werewilling to pay for servicemanagingminor illness and chronic illness, if theGovernmentprovided themwithdifferent levelof subsidy. It isnoted thatmorethanhalfoftheelderlywerewillingtocopaythesameamountdespitedifferentamountsofsubsidiespotentiallyprovidedbytheGovernment. Subsidy38. The elderlywere asked the lowest amountofGovernment subsidythatwould encourage them (i) to see aprivatemedicalpractitioner amongthosewhohavebeen consultingpublicdoctors fordifferentdiseases, (ii) tohaveahealthcheckregularly intheprivatesectoramongthosewhohadnotdone so, and (iii) to have dental check in the private sector. The findingsrevealthatthesubsidyrequestedvariesbytypeofdiseasesandservices. Byand large, theelderly requestedmore subsidy for chronic conditions,healthchecksanddental check. Inotherwords, theelderlyweremorewilling topay formanagementofacuteepisodicdiseases than chronic conditionsandpreventivecare.


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ConclusionandRecommendations

39. The interimreviewbringsto lightpointsworthnotingregardingtheSchemeoverthepasttwoyearsthroughitsinitialoperation,andatthesametime identifies areas requiring further attention. It deepens ourunderstanding of the behaviour of elderly people and healthcare serviceproviders in the use of health care vouchers and in seeking and providinghealthcare services. Its findings provide us with a foundation formakingobservations and recommendations to improve the Schemewith a view toachieving the objectives of enhancing the health of the elderly. It alsoenables us to identify potential pitfalls in publicprivate partnership thatprovide useful inputs to the design of any other publicprivate partnershipschemesfordeliveringhealthcare.40. Inoverallterms,thereviewshowsthattheScheme,whilemightnothavebeenable to readilyachieveall theobjectives itwas intended for,hasmade a start in establishing an effective and efficient mechanism for theprovision of healthcare services with government subsidies throughpublicprivate partnership. Meanwhile, the interim review also reminds usthat it is no easy task to induce behavioural changes among the elderly inseekingandamongtheproviders inprovidinghealthcareservices. Itshowsthatmoreeffortsarerequiredforthekeynotionsofgoodprimaryhealthcareespeciallypreventivecare,aswellastheconceptofcontinuumofcaretobemorewidelypromotedandacceptedamongelderlypopulationandhealthcareproviders. Italsopoints totheneed for theSchemeoperation including itssupportingplatformtobefurtherstrengthened.KeyObservationsontheScheme

(i)Schemeawarenessandparticipation41. ThefindingsoftheinterimreviewshowthattheSchemehasmadeagood start in raising theawarenessof theelderly toprimaryhealthcareandwidening the choices of healthcare services to the elderly. The highawarenessoftheelderlyoftheScheme(over70%)signifiesthattheSchemehas gradually taken root in the community. Thisprovides a goodbasis forfurtheringtheobjectivesofthepilottoenhanceprimarycare fortheelderlyand also for the promotion of other publicprivate partnership schemes in


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healthcare.42. The participation rate of the elderly (57% eligible elderly peopleregistered in theSchemeand45%eligibleelderlypeoplehaveactuallyusedvouchers as at 31 December 2010) is noticeably higher than otherpublicprivatepartnershipschemes,signifyingthattheschemehasbeenabletoattracttheattentionoftheelderly. However,giventhatoneofthemainreasons fornotusingvouchers is that theelderlyareused toseekingpublichealthcare, and that these elderly are less likely to seekprivatehealthcare,moreeffortwouldbeneededtoencourageparticipationamongtheelderly.43. The participation rate of healthcare professionals (34% formedicalpractitioners)hasbeenonparwithotherpublicprivatepartnershipschemesandgeographicallydistributedacrosstheterritory,providingalargenumberofchoicesfortheelderly. However,giventhatoneofthemainreasonsfornotusingvoucheristhattheproviderusuallyseenbytheelderlyhasnotenrolledin the Scheme, there appears room for further improvement in promotioneffortsandparticipation rateamonghealthcareprovidersespeciallymedicalpractitioners.

(ii)SatisfactionwiththeScheme 44. Convenienceanduserfriendlinessare the twoguidingprinciples indesigningandfinetuningtheeHealthSystemonwhichtheSchemerunsandoperates. InthesurveyaboutthegeneralperceptionoftheSchemeofboththevoucherusersandnonvoucherusers,amajority(64%)perceivedthatthevouchers were convenient to use and 65% of interviewed elderly peopleconsideredtheSchemeuseful. Amongthosewhoactuallyusedthevouchers,80%of them agreed that the voucherswere convenient touse and79%ofthem considered the Scheme useful. It shows that the Scheme has beendesignedalongtherighttrack,andhasprovidedasoundbasisforthefurtherdevelopment of publicprivate partnership in healthcare and subsidizationschemesaimingatenhancingprimaryhealthcare.45. The operation of the Scheme had encountered various teethingproblemsattheinitialphaseoftheScheme,mostlyconcerningtheuseoftheelectronicplatformandtheproceduresformakingclaims. Thesehavesoonbeen identified and addressed through the concerted efforts of parties


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concerned, and theoperationdetailsof the Schemehavebeen streamlinedsignificantly since. Improvements on this front are recognized by elderlyusers, as evidenced by the favourable response they gave in the opinionsurvey concerning convenience of using vouchers. The use of vouchers inelectronic form through the eHealth System has helped promotefamiliarizationofetransactionamong theelderlypopulationandhealthcareproviders. Some healthcare service providers, nevertheless, consider theeHealth System can further be improved its userfriendliness in the light ofclinicaloperation. 46. After the initial phase, the operation of the Scheme including itsclaimsmechanism and eHealth System has been smooth and efficient, asindicatedby the lownumberof support requestsor complaints fromusers,thehighcompliancewithpledgedperformancetargetsforclaimsprocessing,and the effective monitoring of the operation of the Scheme and claimspattern. The eHealth System established and refined enables us toimplementand further test theconceptofmoney followspatient,andhasalsobenefitedotherpublicprivatepartnershipschemes (e.g. thevaccinationsubsidy schemes) inprovidingahighlyefficientplatform forproviding smallamount of government subsidies for healthcare services that are high involume.47. TheSchemehadalsoestablishedanetworkofhealthcareprovidersin the community who are mostly involved in the provision of primaryhealthcare services to the elderly aswell as the population at large. Theengagement of these providers through various publicprivate partnershipschemes in delivery healthcare services, including the Elderly Health CareVoucherPilotScheme, is instrumental to the implementationofourprimarycaredevelopmentstrategyanddevelopmentofprimaryhealthcareservicesinthecommunity,astheprivatesectorprovidesthemajorityofprimaryhealthcare services available to the population. In this regard, the Scheme hastakenamajorstepinthedirectionofestablishingapublicprivatepartnershipmodelandplatformthat isnecessarytoenablechangeofhealthcareseekingandprovidingbehaviouramongusersandproviders.

(iii)Impactonhealthcareseekingbehaviour48. Broadly speaking, the Scheme has so far failed to induce any


xv

noticeable behavioural change on the part of both users and providers ofprimaryhealthcareservices,duringthefirsttwoyearsofthepilotperiod. Inparticular,thereisnoevidencesofarthattheSchemehasbroughtaboutanynoticeablechangesinthehealthcareseekingbehaviouramongtheelderly,orresulted in an increase in the utilization and provision of preventive careservice. Thereviewindicatedthatinertiaoftheelderlyalreadyseekingcarein the public sector, participation of healthcare providers that the elderlyusuallysee,andtherelativelylowerwillingnesstopayforpreventivecarearemainfactorsimpedingthedesiredchanges.49. Thefactthatonlyabout6.5%ofhealthcarevouchersclaimedwenttowardspreventiveservice(withabout70%forepisodiccare)showsthatmostelderly people give preventive services a low priority when it comes tohealthcarespendingdecision. TheWillingnesstopayStudyalsoshowsthattheelderlyarelesswillingtopayforpreventivecarethanepisodiccare. Thisisaconceptionthathastakenrootamongtheelderly,andtakestimeandtheconcertedeffortsofallGovernment,healthcareserviceproviders,themedia,etctograduallyinduceaculturalchangethatputsmorevalueandemphasisonpreventivecare.50. It appears from the review that thesebehavioural changes arenoteasy to induce, even with the aid of health care vouchers. The reviewshowedthatelderlypeoplewhoareusedtoseeingprivatedoctorsaremoreready and prepared than those relying on the public healthcare system toregister andmake use of health care vouchers. On the other hand, thoseelderlywho are accustomed to seeking healthcare in the public system areonlymarginallymotivatedtoseekprivateprimarycareservicesonaccountofthesubsidiesprovidedbythevouchers. Mostelderlypeopletendtofollowtheirusualhealthcareseekingpatterndespite the availabilityofhealth carevouchers.51. On the other hand, the review showed encouraging signs that theelderlydotendtostaywiththesamehealthcareprovidertheyusevouchersfor especially in the case ofmedical practitioner. This is conducive to thedevelopment of continuous doctorpatient relationship and the concept offamilydoctorprovidingcomprehensivecaretothem. Withtherightdesignand incentive, it is still possible for the Scheme to initiate the desiredbehavioural changes essential to the development of comprehensive and


xvi

holisticprimaryhealthcare. However,furtherandmoreindepthmonitoringand analysiswouldbeneeded to assess the effectsof the Schemeon suchchanges.

(iv)Priceandsubsidyforhealthcareservices52. Thereviewindicatesthatsubsidy,priceandcopaymentrequiredforhealthcare services are important factors to be considered in affecting theelderlys healthcare seeking behaviour. As the Willingnesstopay Studyshows,theelderlyingeneralaremorewillingtopayforcurativecare,withtheaverage fallingwithin the price range for private curative healthcare. Thismayalsobeoneofthereasonsforthevoucheruseconcentratingoncurativecare. On theotherhand, theelderlyare relativelymuch lesswilling topayforpreventiveandchronicdiseasecare. Thissuggeststhatpriceandsubsidylevelarekeyindicatorstobemonitored.53. The launchoftheSchemeaimsatprovidingpartialsubsidiesfortheelderlytoreceiveprivateprimarycareservices inthecommunitywithaviewto enhancing primary healthcare services for the elderly and promotingwellbeing among them. The launch of the Scheme is also expected tointroducetheconceptofcopaymentamongtheelderlyinseekinghealthcareservices. We note that in most instances when vouchers are used, theelderlypeopleconcernedalsomeetpartoftheirconsultationfeesoutoftheirown pocket. In this respect, the concept of copayment is realized. However, as revealed by theWillingnesstopay Study, there is only limitedincentivefortheelderlytocopaymore(inabsoluteterms)whenthevoucheramountisincreased. Therelativelylowerwillingnesstocopayforpreventivecarethancurativecareandtheconcentrationofvoucheruseoncurativecarealsomakesitdifficulttoassesstheeffectofsubsidyoncopayment.54. SincethecurrentSchemedoesnotrequireproviderstoprovidemorespecific information on healthcare services provided and additionalcopaymentchargedovervouchers,wecannotascertainwithcertainty iftheactual copayment charged for specific healthcare services are withinaffordable range of the elderly, or if the copayment charged for specificservices are beyond the willingnesstopay of the elderly. The samplingsurvey suggests no significant degree of perceived increase in service fees,though a smallbutnot insignificantproportionofelderlypeopledid report


xvii

perceivedincreaseinservicefeesduetotheuseofvouchers. However,giventhe sampling size and also lack of benchmark for comparison, we cannotconcludewithcertaintyhowcopaymentlevelhasplayedaroleininfluencingthehealthcareseekingbehaviouroftheelderly,and if increasingthesubsidylevelmighthelpchangesuchbehaviour.55. The above observations suggest that any increase in subsidy levelthroughhighervoucheramountshouldbecarefullycalibratedtoaddresstheintention to influence the desired healthcare behavioural changes and theneed to promote appropriate copayment for healthcare service utilization. This is necessary to ensure that public monies are properly spent whilesuitablyaddressingtheobjectivesoftheSchemeandtheneedsandconcernsoftheelderly. Theabovealsosuggestthatthemonitoringandassessmentofprice and subsidy level for different healthcare services should bestrengthened,sothattheeffectofgovernmentsubsidythroughthevouchersonhealthcareseekingandprovidingbehaviourcouldbebetterevaluated.

(v)Coverageofhealthcareserviceproviders56. Optometrists are not currently included as eligible healthcareprovidersundertheScheme. Wenotethatsomeelderlypeople(28%oftheelderly as revealed in the opinion survey) have expressed the wish forincludingOptometristsundertheSchemesothathealthcareservicesprovidedby themcouldalsobemet throughhealth carevouchers. Wealsonote inparticularthatOptometristswithPartIregistrationundertheSupplementaryMedical Professions Ordinance (Cap. 359) are qualified to provide certainpreventive care services concerningeye conditions, forexample, to conductvisual acuity examination for patients suffering from cataract and diabetes. Their inclusionmay thushelp facilitate thegreateruseofpreventivecarebytheelderly. Recommendations

57. Having regard to the findingsof the interim review,we recommendthat the Scheme be extended for another pilot period of three years, from1January2012to31December2014,whenthecurrentpilotperiodendson31December2011. This is toallow further testing theeffectivenessof theSchemeinfurtheringthepolicyobjectivestoenhancetheprimaryhealthcare


xviii

for theelderlyand toenable them tochooseprivateprimaryhealthcare intheir neighbourhood, through providing partial subsidies to the elderlythroughhealthcarevouchers. 58. The proposed extension of the pilot period of the Scheme is inkeepingwith the strategies for the promotion and development of primarycare as set out in the StrategyDocument on Primary CareDevelopment inHongKongandcantie inwiththePrimaryCareCampaigntobe launched inQ22011. Inparticular, theextended Schemewill allow a longerperiod toassess the effectiveness of using vouchers to promote good primary careamongtheelderlyandhealthcareproviders,including:continuedrelationshipbetween the elderly and their healthcare providers, more provision andutilizationofpreventivehealthcareservices,andtheconceptofcontinuumofcareandwellbeingamongtheelderlyandtheirhealthcareproviders. 59. Inthisregard,onthebasisofthe findingsofthe interimreview,werecommendthatthefollowingspecificmeasuresbetakeninconjunctionwiththeextensionoftheSchemeforthefurtherthreeyearpilotperiod

(a) Increase the voucher amount per year for the next threeyearpilotperiod (from1 January2012 to31December2014) from$250to$500,whilekeepingthedollarvalueofeachvoucherthesameasbefore(i.e.$50each). Thenumberofvouchersgiventoeacheligibleelderlypersonwillbe increasedtoten. Inthisconnection,wenote that therearedemands for increasing thevoucheramount from theelderlyanddifferentquartersof thecommunity. We also note that an increased voucher amountwould help better assess the effectiveness of the Scheme inachieving itspolicyobjectives. Ontheotherhand,weneedtocarefullyconsiderwhetherand,ifso,towhatextentanincreasein voucher amount would affect the healthcare seekingbehaviour among the elderly, the prices to be charged byhealthcare service providers, the amount elderly people arewilling to copay and the emphasis elderly people put onpreventiveservices. Weconsiderthattherecommendationtoincrease the voucher amount per year to $500 strikes a rightbalance,andensuresthatpublicmoniesareproperlyspent.


xix

(b) There is a need to forge closer collaboration with healthcareprofessionalstofurtherpromotetheimportanceofprimarycare,both among elderly people and service providers, and toencourage utilization and provision of such services, havingregard to the reference framework to be developed for theelderlyundertheprimarycaredevelopmentstrategy. Apartfrom publicity and education, we will enhance efforts topromote,inpartnershipwithinterestedandqualifiedhealthcareservice providers, a voluntary, protocolbased elderly healthcheck programme at affordable prices for elderly people. Elderlypeopleaged70orabovecouldmeetthepayment,partlyor wholly, through health care vouchers. The health checkprogrammewill bemodeled on the established practices andservice protocol of the Elderly Health Centres under theDepartmentofHealth.

(c) Allow, on a oneoff basis on account of extension of the

threeyear further pilot period, the unspent balance of healthcare vouchers under the current pilot period (ending31December 2011) to be carried forward into the next pilotperiod(from1January2012to31December2014). This istoallowafullerassessmentoftheeffectivenessoftheSchemeandtheutilizationofhealth carevouchers in thenextpilotperiod. Giventhesignificantfinancial liabilityarisingfromaccumulationofvouchers,allunusedvouchers should lapseon theexpiryofthe extended pilot period ending 31 December 2014,irrespective of whether the voucher scheme will continue orotherwise.

(d) Improve upon the operation of the Scheme and step up

monitoringover theuseofhealth care vouchersbyenhancingthe datacapturing functions of the eHealth System in thefollowingtwoaspects

(i) Diagnosis information:wewouldexplore the feasibility for

participating healthcare service providers to input morespecific informationon thehealthcareservicesprovided tovoucher users. For example, participating medical


xx

practitioners would be required to provide more specificclinicaldiagnosis,ratherthanthebroadindicationunderthecurrent reason of visit arrangement, for their voucheruserssoastobetterenabletheAdministrationtoassessandmonitorthehealthcareservicesprovidedtotheelderly;and

(ii) Copayment: participating healthcare service providers

would be required to input the copaymentmade by anelderly person for each consultation involving the use ofhealthcarevoucher(s). Coupledwith(i),thiswillallowthepriceandsubsidylevelforspecifichealthcareservicestobebettermonitored,andtheimpactofvouchersonhealthcareservicesbebetterassessed.

(e) Add optometrists with Part I registration under the

SupplementaryMedicalProfessionsOrdinance(Cap.359)totheScheme with effect from the next pilot period, i.e.1January2012,subjecttotherequirementthatvouchersshouldonlybeusedforprovisionofhealthcareservicesandmustnotbeusedtocoverthepurchaseofequipment(e.g.spectacles).

60. Apartfromtheabove,wedonotrecommendmakinganychangestoother rules of the Scheme. Specifically,wewill, in the further threeyearpilotperiod,continueto

(a) Maintain the existing age eligibility, i.e. aged 70 or above. Inview that the effectiveness of the vouchermodel in changinghealthcareseekingbehaviourhasyettobefullyascertained,weconsider it prudent to continue the pilot scheme with theexistingpoolofeligibleelderlyandfurtherassessthe impactofthe Scheme on healthcare utilization and price. Given theproposed increase in voucheramount,maintaining thepoolofeligible elderly would also help minimize the risk of priceinflation of private healthcare services due to increasedgovernmentsubsidy.

(b) Keep the current ruleson theuseofhealth carevouchers (i.e.

usable for private healthcare services, but not for purchase of


xxi

drugs at pharmacies, purchase of medical items, or publichealthcareservices,etc). GiventheobjectiveoftheSchemetoenhance primary healthcare for the elderly throughpublicprivate partnership and in view of concerns overdoublesubsidyusingpublicmoney,wemaintain the view thatvouchers should only be used for private services, but not formedicalitemsorpublichealthcare.

(c) Retainthecurrentflexibilityinusinghealthcarevouchers(i.e.no

limit on the number of vouchers thatmay be used for eachepisode of healthcare services, no restriction on the type ofhealthcareservicesorprovidersforwhicheachvouchermaybeused, and no limit on the amount of vouchers to be used fordifferent typesofhealthcare servicesorproviders). This is toallow thevouchermodel tobe furtherandmore fullyassessedon itseffectiveness toenhanceand incentivizevariousprimaryhealthcare services. However, restrictions or limitations mayneed tobe imposedeventually in the lightof further reviewofthe Scheme especially voucher utilization over the extendedpilotperiod.


Page 1

PURPOSE

Theobjectiveofthis interimreview istoexaminetheoperationandutilizationoftheElderlyHealthCareVoucherPilotScheme(theScheme)andtocollectfeedbackfromtheelderlyandhealthcareserviceprovidersinorderto evaluate the effectiveness and efficiency of the Scheme and to makerecommendationsonitsimprovementandwayforward.BACKGROUND

POLICYADDRESS2. TheChiefExecutiveannouncedinhis200708PolicyAddressthattheGovernmentwouldlaunchathreeyearpilotschemetoprovideelderlypeople(aged70orabove)withhealthcarevoucherstopartiallysubsidisetheiruseofprimarycareservicesintheprivatesector. SCHEMEOBJECTIVES3. TheSchemeaimsat

(a) providingpartialsubsidies for theelderly to receiveprivateprimaryhealthcareservicesinthecommunity,asadditionalchoicesontopoftheexistingpublicprimary care services,with a view toenhancingtheprimarycareservicesfortheelderlyandpromotingcontinuityofcareofelderlypeoplewiththeirchosenhealthcareserviceproviders;

(b) implementing themoney followspatientconceptona trialbasis,

enabling the elderly to choose their own private primary careservices in theirneighbourhood thatsuit theirneedsmost, therebypiloting a new model for subsidised primary care services in thefuture;and

(c) throughprovidingpartialsubsidies,serving topromote theconcept

of continuum of care for health care among patients and ensureappropriate use of healthcare services through copayment, andfacilitatingaccesstoprivateprimarycareasanalternative.


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IMPLEMENTATIONSCHEMEDESIGNANDFEATURES ElderlypersonseligibletoparticipateintheScheme4. The Scheme was launched to eligible elderly people on1January2009. Under theScheme,elderlypersonsaged70orabovewhoholdaHong KongIdentityCard(HKID)orCertificateofExemptionduringtheimplementationperiodoftheSchemewouldbeprovidedwithfivehealthcarevouchers of $50 each annually for using services provided by healthcareserviceprovidersparticipatingintheScheme.

HealthcareserviceproviderseligibletoparticipateintheScheme 5. Nine types of healthcare professional who are registered in HongKongareeligibletoparticipate intheScheme:medicalpractitioners,Chinesemedicinepractitioners,dentists,chiropractors,registeredandenrollednurses,physiotherapists, occupational therapists, radiographers and medicallaboratory technologists. Healthcare service providers who wish toparticipateintheSchemeshouldregisterwiththeDepartmentofHealth(DH)inadvance. Restrictionsontheuseofhealthcarevouchers6. Healthcarevouchersaredesignatedforservicesprovidedbyenrolledhealthcare service providers. The health services could be preventive,curativeorrehabilitativeinnature. Healthcarevoucherscannotbeusedforthepurchaseofdrugsatpharmaciessoastoavoidselfprescription. Neithercan they be used for the purchase of prosthesis or other medical items. Health care vouchers also cannot be used to pay for subsidised publichealthcare services, including those publicly subsidised healthcare servicespurchased from theprivatesectorsuchasthehealthcareservicespurchasedbyHospitalAuthorityfromtheprivatesectorinTinShuiWai.7. HealthcarevouchersarevalidwithinthethreeyearimplementationperiodoftheScheme,andvouchersunusedeachyearmayberetainedforuse


Page3

inthefollowingyear(s),butnoadvanceofvoucherswhichareyettobeissuedisallowed.SCHEMEOPERATION Mechanismforissuingandusinghealthcarevouchers8. Vouchersareissuedandusedthroughanelectronicplatform,viz.theeHealth Systemwhich alsomanages healthcare service provider enrolment,voucher accounts, claims and reimbursement. Vouchers are not issued inpaperformseparately. Theelderlydonotneedtoregisterinadvance,collector carry vouchers. When using vouchers, they only need to choose anenrolled healthcare service providerwhose practice displaying the Schemelogo and show their HKIDs or Certificate of Exemption for registration. Participatinghealthcareserviceprovidersinputthepersonalparticularsoftheelderly persons (such as name, HKID number and date of birth) into theeHealth System for registering and opening individual health care voucheraccountsforfirsttimevoucherusers. ThevouchersforwhichtheelderlyareeligibleduringthepilotperiodoftheSchemearethenissuedanddepositedtotheelderlyshealthcarevoucheraccountscreated.9. The elderly can use the health care vouchers in their accountsthrough any participating healthcare service providers after their accountshavebeencreated. HealthcareserviceprovidershavetoensurethatthereissufficientvoucherbalanceintheeHealthaccountsbeforetheyareallowedtodeduct vouchers from theelderlypersons accounts. Prior to any voucherdeduction,healthcareserviceprovidershavetoobtainconsent formssignedby the elderly on the number of vouchers to be deducted. They are alsorequired to keep the duly signed consent forms for random checking,verificationandauditingbytheAdministration. Upondeductionofvouchersfrom theelderlypersonsaccounts, thehealthcareserviceprovidershave toinputbasic information (e.g.thereasons forelderlypersonstoseekmedicalconsultationandthehealthcareservicestheyhavereceived)intotheeHealthSystem. Information captured by the eHealth System provides importantdata for theAdministration to conductanalysesondifferentaspectsof theSchemesothatshortcomingscouldbeidentifiedandimprovementscouldbemadeasandwhennecessary.


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Arrangementforreimbursementofhealthcarevouchers10. Eachmonth,participatinghealthcareserviceproviderscanaccesstheSystemfortheirmonthlystatementswhichcontainreimbursementdetailsofhealth care voucherspayable to them. The reimbursementwouldbepaiddirectly into the bank accounts designated by healthcare service providerseachmonth. eHealthSystem11. The eHealth System is a webbased system which serves as anelectronic platform onwhich voucherbased and subsidy schemes operate. With the System, electronic vouchers are used, obviating the need forpaperform vouchers. The Systemwas originally designed for the Schemelaunchedon1January2009. TheeHealthSystemhasbeenexpandedsincelate2009 tocovervaccination subsidy schemes including seasonal influenzaandpneumococcalvaccination.12. KeyfeaturesoftheeHealthSystemareasfollows(a) Managinginformationonhealthcareserviceproviders

eHealth System maintains a database of participating healthcareservice providers. Healthcare service providers who wish toparticipateintheSchemecanprovidethroughtheSystempartoftheinformation required for enrolment, amend the information afterenrolment,accessmonthlystatements,etc.

(b) ManagingeHealthaccountsandmakingclaims

The Systemmaintains a database of eHealth accounts created foreligibleelderlypeople. TheSystemwillopeneHealthaccounts forelderly persons who visit participating service providers and usevoucher(s) for the first time. The System will issue and depositvouchersforwhichelderlypersonsareeligibleduringthepilotperiodoftheSchemetotheireHealthaccounts. Itservestoprocessclaimsfor the use of vouchers and record the usage. To facilitate themakingof claims, the Systemwilldisplay, interalia, thenumberof


Page5

unusedvouchersunder theScheme. Relevant informationsuchasthenumberofvouchersused,servicedateandreasonforvisit,etcisalsocaptured.ElderlypersonscanchecktheirvoucheraccountbalancethroughtheSystem via Internet (https://apps.hcv.gov.hk/hcvr/en/) by keying intheir HKID number and date of birth. They can also check theirvoucher account balance through telephone (i.e. the InteractiveVoiceResponseSystem(IVRS))on28380511.

(c) Managingreimbursementofhealthcarevouchers

TheSystem compiles,onamonthlybasis, consolidated informationontheamountreimbursableundertheSchemeforeachparticipatinghealthcare service provider. This facilitates payment directly intobankaccountsdesignatedbyhealthcareserviceproviders.

(d) MonitoringtheSchemeThe System generates regular statistical reports to facilitate theplanningandmanagementofthedailyoperationoftheScheme. Itwillalsodetect irregularity in theuseofvoucherssoas to facilitatetimelyfollowupactionsand,wherenecessary,investigations.

PrivacyImpactAssessmentandPrivacyComplianceAssessment

13. DHcommissionedDeloitteToucheTohmatsu (Deloitte) inMay2008to conduct a Privacy Impact Assessment (PIA) and a Privacy ComplianceAssessment (PCA) of the eHealth System. The PIAwas to identify any keyrisksinthecollection,maintenanceanddisseminationofpersonaldataintheeHealth System, with reference to the Personal Data (Privacy) Ordinance(Cap.486), the Code of Practices approved and issued by the PrivacyCommissioner for PersonalData and the Registration of PersonsOrdinanceand Regulations. It also assessed whether controls on use of personalinformation were in place and provided recommendations in handlingpersonaldatawithaview tominimizingoreradicating the identifiedprivacyimpacts. ThePCAwastoensurethattheprivacy issues identified inthePIAwereaddressedandthatsafeguardstoenhanceprivacyprotectionwereduly


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implemented.14. ThePIAonphase IofeHealthSystemwascarriedoutbetween JulyandDecember2008whereasthePCAwasconductedinDecember2008. ToexaminedifferentmodulesoftheeHealthSystemfromprivacyimpactpointofview, Deloitte assessed the data management process, general computercontrols, network security and conducted the Personal Data (Privacy)Ordinance compliance analysis. ThePCA concluded thatallprivacy relatedissuesbroughtforthduringthecourseofPIAwererectifiedandresolvedpriortorolloutoftheeHealthSystemon1January2009.15. ThePIAandPCAonphase IIofeHealthSystem taking intoaccountthe enhancement of SmartHKID deployment for creating eHealth accountsand claiming voucherswere carriedoutbetweenApril and July2010. Theprivacy related findings and issues identified during the course of PIAwererectifiedbyDHbeforethe full launchofSmartHKIDdeployment foreHealthaccountscreationandvoucherclaimsinOctober2010. SecurityRiskAssessmentandAudit16. In addition, DH engaged Computer and Technologies SolutionsLimited(C&T)toconductSecurityRiskAssessments(SRA)andAuditsofphaseIandIIoftheeHealthSystem inMay2008andJune2010respectively. ThestudiesaimedtoevaluatethesecurityrisksoftheeHealthSystem,toidentifyandrecommendmeasures tostrengthen the levelofsecurityprotectionandrevisethesecuritystatusafterthesemeasureshadbeenimplemented. BothassessmentsconcludedthatthevulnerabilitiesidentifiedinthecourseofSRAwere fixed and solved. The current IT security risk level of theeHealthSystemwas foundsatisfactory,andcompliedwith theGovernmentsITSecurityPolicy,andSecurityRegulations.

Theelectronicplatformpilotingamodelforschemeadministration17. The significance of the eHealth System is that it pilots theestablishment of an electronic platform for administrating targetedsubsidizationforhealthcareservices(i.e.theElderlyHealthCareVoucherPilotScheme in this case)which are low in amount ($250 per year per eligibleelderly person) and high in volume (about an average of 400,000 claim


Page7

transactions involvinganaverageofabout1,000,000electronicvouchersperyear), at a relatively low administrative costs. The Government hasearmarked$30million fordevelopingandmaintaining theelectronic systemand$38milliontocoverstaffcostandotheroperatingexpenditureduringthepilotperiod. A fundingof$505.33millionhasbeenearmarked forvoucherreimbursement during the threeyear pilot. Our aim is to keep theadministrativeoverheadoftheScheme,asfaraspossible,tobelow10%oftheamountofsubsidies,andtoachievefurthereconomyofscalewhenthescopeand number of vouchers or subsidies are expanded. In 2009, theeHealthSystemhasbeenexpandedtoincludeothersubsidisationschemes,viz.thevariousvaccinationsubsidyschemes.18. TofurtherstreamlinetheSystemoperationand improveeaseofuseoftheSystem,variousenhancementsand improvementmeasureshavebeenintroducedsince2009.IMPROVEMENTMEASURES19. Sincethe launchoftheScheme inJanuary2009,theAdministrationhas implementeda seriesof improvementmeasures for the convenienceofboth healthcare service providers and the elderly in the light of actualoperationanduserfeedback. Datainputofclaimtransactions20. In April 2009, the eHealth Systemwasmodified and enhanced tomake it more userfriendly to healthcare service providers. The changesallowedenrolledhealthcareserviceprovidersgreaterflexibilityinenteringandsubmitting data to the System by suitably adjusting the arrangements forbackdateentryof transactions. The time limitof inputting servicedateofmakingclaimswasallowedandextendedtosevendays. ModificationtoConsentForm21. Theformatofpatientsconsentformshasalsobeenmodified. Newprinting options were added with a view to reducing paper usage. Theoptionforprintingfullversion(oneclaimperpage)andcondensedversion(multipleclaimsononepage)ofconsentforms(Appendix1)areavailableon


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the Internet for selection by healthcare service providers. An enrolledhealthcare service provider is free to select the way how consent form isprinted. He can preset the desired printing option or select the printingoptioneachtimewhenaclaimismade. NoneedtoarrangeVoucherAccountCreationForm22. Before September 2009, eligible elderly people were required toapproachaparticipatinghealthcareserviceproviderof theirchoice,producetheirHKIDandsignaform(i.e.VoucherAccountCreationForm)tocreateanaccountintheeHealthSystemwhentheyusedthevouchersforthefirsttime. From September 2009 onwards, it is no longer necessary for enrolledhealthcare serviceproviders to requireaneligibleelderlyperson to sign theVoucherAccountCreationForm. Flexibilityhassincebeengiventoenrolledhealthcare service providers to obtain consent in a form they deemappropriate for thecreationofvoucheraccounts. TheeHealthSystemonlyrequires thatadeclarationbemadevia the system that sucha consenthasbeensecured.23. In response to the feedback from some of the healthcare serviceproviders about their storage problem on the bulk of Voucher AccountCreation Forms for their clients, DH, in November 2009, made a specialarrangement to collect the Voucher Account Creation Forms from enrolledhealthcareserviceproviders. ThereturnofVoucherAccountCreationFormstoDH isonavoluntarybasisandhealthcareserviceprovidersmaychoosetoretainthe forms forrecordpurpose if theywish. Inaddition, theminimumretentionperiodoftheVoucherAccountCreationFormswasreducedfrom30yearsto7years. UseofSmartIdentityCardReader24. Tofurtherstreamlineproceduresandprovidegreaterconveniencetothehealthcare serviceproviders, it isnow feasible tomakeuseof thecardface data1 function in the chips of the Smart HKID for registration andauthentication. Itprovidesanalternativemeans toparticipatinghealthcareserviceproviderstoregisterpersonseligible forvouchersandtoaccesstheir

1 Card face data refers to the data of card holders printed on the face of SmartHKID, i.e. the

ChineseandEnglishnames,dateofbirth,HKIDnumberandthedateofissueoftheHKIDs.


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accounts for claiming vouchers, obviatingmanual input and ensuring dataaccuracy.25. SinceAugust2010,DHhasmadeavailableandfreelydistributedtheSmart IdentityCardReader to reducehealthcareserviceprovidersefforts ininputtingtheelderlysrelatedpersonalparticularsintotheeHealthSystemandminimize the chance of errors during manual input. DH together witheHealth System Information Technology Support Team and the Office ofGovernmentChiefInformationOfficerjointlyorganisedfourdemonstrations/briefingsessionsontheinstallationanduseofSmartIdentityCardReaderfortheenrolledhealthcareserviceproviders.PUBLICITYANDPROMOTION26. The Scheme was publicized through television and radioannouncements of public interest. As at 31 December 2010, therewereover 471,000 visits to the website (http://www.hcv.gov.hk/). A total of120,000 pamphlets, 11,000 posters and 5,000 DVDs were distributed. Publicity materials were disseminated through General Outpatient Clinics,public hospitals, Senior Citizen Card Office, Elderly Health Centres andDistrictOffices in18districts. Over150DistrictElderlyCommunityCentresandNeighbourhoodElderlyCommunityCentresalsoreceivedtheinformationpamphlets and posters through the Visiting Health Team of Elderly HealthServices. DH arranged briefing sessions for healthcare service providers,nongovernmentalorganizations involved inprovidingservices to theelderly,and other stakeholders to enhance their understanding of the Scheme andsolicittheirsupport. ByendDecember2010,atotalof36,500enquiriesontheSchemewerereceivedthroughthegeneralenquiry line (35824102)andtheIVRStelephoneenquirysystem(28382311). 27. To facilitate registration and accounts creation among the elderlywithspecialneedsboth inthecommunityand inResidentialCareHomesfortheElderly(RCHEs),aspecialcampaignwas launched inQ42009tohelptheelderly create eHealth accounts for receiving subsidised vaccination andclaiming health care vouchers. Senior Citizen Home Safety Association(SCHSA)wasengaged toassist theelderly living in thecommunityorRCHEs. The campaignwas launched in two stages. The first stage commencedon29September 2009 and was completed prior to the start of the 200910


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vaccinationseason. Thesecondstagestartedon15December2009andwascompleted in a couple ofweeks for preparation ofHuman Swine Influenzavaccinationamongtheelderly.28. The campaign targeting elderly people in the community waslaunchedon14September2009andcompletedon30November2009. DH,incollaborationwiththeSocialWelfareDepartment,introducedthecampaignto 788 RCHEs on 11September 2009. Promotionalmaterialswere sent toDistrictElderlyCommunityCentresandNeighbourhoodElderlyCentresHomes(Appendix2). Anofficial letterappealingtostakeholderswassenttosolicittheir support on 15 September 2009. In collaboration with theHong Kong Council of Social Service, DH organized a briefing session on24September2009 to staff of elderly centres introducing the ElderlyVaccination SubsidySchemeandRegistration foreHealthAccountCampaignfortheelderly. 29. With the sustainedpublicity andpromotionefforts, thenumberofelderlypeopleregisteredforhealthcarevouchershasbeenrisingcontinuouslysince the launch of the Scheme,with an average of 16,000 elderly peoplenewlyregisteringeachmonth. REIMBURSEMENT30. TheAdministrationpledgestoreimburseenrolledhealthcareserviceproviders for valid voucher claimsmade through theeHealth Systemwithin30days after theendof eachmonth. As at31December2010, a totalof852,721claim transactionsunder thevalidatedaccounts involving2,136,630voucherswereprocessedforreimbursement,with100%compliancewiththeperformancepledge. Atotalofabout$106millionhavebeenreimbursedtoenrolledhealthcareserviceproviders.POSTCLAIMCHECKINGANDAUDITING31. TheHealthCareVoucherUnitsetupunderDHisresponsiblefortheimplementationof theScheme including themonitoringandauditingof theuseofvouchers inordertoensurethatvouchersareusedbyeligibleelderlypersons only and are genuinely used for healthcare services in compliancewiththerequirementsoftheScheme.


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32. As a general rule, participating healthcare service providers areresponsibleforcheckingHKIDofindividualswhoclaimtheirvoucherstoverifytheiridentityandeligibility. Individualsclaimingthevouchersarerequiredtosign a form to signify their claims, and thehealthcare serviceproviders arerequiredtokeepsuchformsaswellasrecordsoftheservicesprovidedtotheindividuals. 33. DH, through the eHealth System, validates relevant information inrespectofvoucherrecipientswiththeregistrationofpersonsrecordskeptbythe Immigration Department to confirm the eligibility of the personsconcerned. MeasurestopreventabuseoftheScheme34. Toensuretheproperdisbursementof funding forvoucherclaims,amechanismforcheckingandauditingofvoucherclaimshasbeenputinplace. The checking mechanism covers three areas, viz. (a) routine checking, (b)monitoring and investigation of aberrant patterns of transactions, and (c)investigation of complaints. For routine checking, it is random compliancecheck on enrolled healthcare service providers. To facilitate the targetedinvestigationonaberrantpatternof transaction claims,a function isbuilt intheeHealthSystemtogeneratereportsonaberrantpatternsoftransactions. An alert report will be generated in situation where there are frequentepisodesofvoucherusedbyasinglerecipientwithinashorttimeinterval,andanenrolledhealthcareserviceproviderhavinganabnormallyhighnumberofclaims bymultiple voucherswithin a short span of time. In the course ofcheckingandinvestigation,consentformssignedbytheelderlyconcernedandrelevant informationwouldbechecked. Service recordskeptbyhealthcareservice providers and their consistency with the data kept in theeHealthSystem would be checked. Voucher recipients and their carerswouldalsobe contactedwherenecessary toascertainwhether transactionsdidtakeplace. TheprotocolsonmonitoringandinvestigationoftransactionclaimsmadethroughtheeHealthSystemisatAppendix3.35. As at 31 December 2010, a total of 1,711 inspection visits wereconducted, involving 1,663 routine checking, 37 targeted investigations onaberrant patterns and nine complaint or reported problem cases (with two


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cases each involving two inspection visits). A total of 30,241 claimswerechecked,representing4%ofclaimtransactionsmade. Itcovers77%(1,571)enrolledhealthcareserviceproviderswithclaimsmade. 36. The postclaim checking and auditing revealed 25 cases of wrongclaimsasat31December2010,which representsabout4%of the checkedclaims and 1.7% of healthcare service providers checked. These claimsinvolved errors in procedures or documentation. In order to avoid therecurrence of similar problems, DH had issued reminders to all healthcareserviceprovidersonproperproceduresanddocumentationofvoucherclaims. 37. TheGovernmentmayatanytimeterminatetheAgreementforthwithby written notice to an enrolled healthcare service provider if: (a) theGovernment has reasonable doubt that the enrolled healthcare serviceproviderhasfailedtoprovidehealthcareserviceinaprofessionalmannerorisotherwiseguiltyofprofessionalmisconductormalpractice;or(b)theenrolledhealthcareserviceproviderorhisAssociatedOrganizationfailstocomplywithanyprovisionintheAgreementorwithanydirectionorrequirementgivenbytheGovernmentortheDirectorofHealth inrelationtotheScheme. Sofar,twomedicalpractitionersandoneChinesemedicinepractitionerhavebeendelistedfromtheScheme.

TheCorruptionPreventionDepartmentof IndependentCommissionAgainstCorruption

38. The Corruption Prevention Department (CPD) of the IndependentCommission Against Corruption examines the practices and procedures ofGovernment departments / bureaux and public bodies, and makesrecommendationsonhowopportunities forcorruptioncanbeeliminatedorreduced. Inmid2008,CPDoffered corruptionprevention advice toDHonthe administration of the Scheme prior to its launch. As the Scheme hasbeen up and running for some time, CPD is currently conducting aCorruptionPreventionStudyontheScheme. TheAuditCommission39. Toascertainwhethertherearepotentialriskstoregularity,proprietyand financial control in themanagementof the Schemeand itsoperational


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mechanism, theAuditCommission conducted a risk auditof the Scheme in200910. DH has taken into account their suggestions and observations infinetuningthemodusoperandioftheScheme.INTERIMREVIEW

40. The Pilot Scheme is designed initially with basic parameters of amodel piloting subsidisation for primary care services in the private sector. LimitationsundertheScheme includingrestrictionsontheusageofvouchersare kept to theminimum to facilitate acceptance of the Scheme by bothprovidersand theelderly,andwitha view to testingout theoperationandutilizationoftheScheme. It istheAdministrations intentiontocontinuetomodifyandenhancetheScheme,taking intoconsiderationsofthe feedback,actualoperationalexperienceand circumstantialvariances. As theSchemehasbeen implemented forsome time, it isopportune toconductan interimreview of the Pilot Scheme so as to streamline its operation, recommendenhancementandconsideritswayforward.

Objectivesoftheinterimreview41. The objectives of the interim review are to (a) examine voucherutilizationby theelderlyandparticipationofhealthcare serviceproviders inthe Scheme; (b) collect feedback from the elderly (both participating andnonparticipating)abouttheScheme,includingtheirawarenessoftheScheme,means to get to know the Scheme, reasons for Scheme participation /nonparticipation,desirablesubsidyamount,ageeligibility,healthcareservicescoverage, service delivery and perception about change in service fees andchoice of healthcare service after Scheme launch; and (c) collect feedbackfromhealthcareserviceproviders(bothenrolledandnonenrolled)abouttheScheme including scheme operation, service delivery, barriers ofnonparticipationandreasonsforwithdrawal.

Methodologyandsourceoffindings42. Data collected for analysis and examination include routine datastored in the database of the eHealth System and purposely collected datathroughstructuredquestionnairesandfocusgroupdiscussionsundertakenbytheSchoolofPublicHealthandPrimaryCareoftheFacultyofMedicineofthe


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Chinese University of Hong Kong. Two surveyswere conducted to collectfeedback from theelderly,viz. theopinionsurveyand thewillingnesstopaystudy. Four focusgroupdiscussionswereheldand16telephone interviewswereconductedtocollectfeedbackfromhealthcareserviceproviders.


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STATISTICSONPARTICIPATIONANDUTILIZATION(From1January2009to31December2010)

METHODOLOGY43. DatakeptintheeHealthSystemwereexaminedtoassessthepatternof voucherutilizationby theelderly aswell ashealthcare serviceprovidersparticipation in theScheme. Assessmenton the statisticaldataoneHealthaccountssuchaswhere,whenandhowtheclaimsweremadeareconductedas it can largely reflect the extent of elderly peoples participation in theScheme. Efforts have been made to show the position up to31December2010,saveforsituationswhereonlydataupto31October2010wereavailableforanalysispurposes.RESULTS(A) Statisticsonhealthcareserviceproviders

Numberofenrolledhealthcareserviceproviders

44. To get prepared for the Scheme launch on 1 January 2009,recruitmentofhealthcareserviceproviderstookplaceinSeptember2008. Alarge proportion of service providerswere enrolled before Scheme launch. On 1 January 2009, therewas a total of 1,783 healthcare service providersenrolled in the Elderly Health Care Voucher Pilot Scheme (the Scheme),involvingatotalof2,116placesofpractice2. 45. Asat31December2010,thenumberofhealthcareserviceprovidershas increased to2,736, involving3,438placesofpractice. Abreakdownoftheplacesofpracticebyareasasat2009and2010isshowninTable1. Distributionofplacesofpractice46. Figure1 shows theoveralldistributionof theplacesofpracticebyfive regions in 2010. 39.6% (1,363) of the places of practice are in theKowloon region, inwhichYauTsimMongdistricthas thehighestnumberof

2 Healthcareserviceprovidersmayregistermorethanoneplaceofpracticeduringenrolment.


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placesofpractice(549)(not justfortheKowloonregion,butalsoamongthe18 districts). Hong Kong Island constitutes 23.4% (803) of the places ofpractice,withthemostandtheleastparticipationinCentral&Westerndistrict(281)andtheSoutherndistrict(74)respectively. TheproportionoftheNewTerritoriesWestandtheNewTerritoriesEastare19.8%(681)and16.0%(549)respectively. There are 1.2% (42) places of practice scattered in Islandsdistrict. When comparing the proportion of places of practice over theterritory i.e.HongKong Islands,Kowloon, theNewTerritoriesEast, theNewTerritoriesWestand Islands, it ismoreor less the samebetween2009and2010 (Table 1). Figure 2 and Table 2 show the distribution of places ofpracticeinfiveareasand18districtsin2010.Table1:Locationofplacesofpracticeofenrolledhealthcareserviceproviders

Numberofplacesofpractice

(%oftotalplacesofpractice)Area

Asat31Dec2009 Asat31Dec2010

HongKongIsland

(Districts: Central & Western,Eastern,Southern&WanChai)

790(24.7%) 803(23.4%)

Kowloon

(Districts:KowloonCity,Kwun Tong,Sham Shui Po, Wong Tai Sin &YauTsimMong)

1,270(39.7%) 1,363(39.6%)

NewTerritoriesEast

(Districts:ShaTin,TaiPo,SaiKung&North)

493(15.4%) 549(16.0%)

NewTerritoriesWest

(Districts: Kwai Tsing, Tsuen Wan,TuenMun&YuenLong)

615(19.2%) 681(19.8%)

Islands 34(1.1%) 42(1.2%)

Total 3,202(100.1%) 3,438(100.0%)

Note:Figuresmaynotaddupto100%duetorounding


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Figure1:Locationofplacesofpracticeofenrolledhealthcareserviceprovidersasat

31December2010

Figure2:Overalldistributionofplacesofpracticebyfiveareasand18districtsasat

31December2010


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Table2:Overalldistributionofplacesofpracticebyfiveareasand18districtsasat

31December2010

Area/DistrictNumberofplacesof

practicebyarea(%)

Numberofplacesof

practicebydistrict(%)

HongKongIsland 803(23.4%)

Central&Western 281(35.0%)

Eastern 207(25.8%)

Southern 74(9.2%)

WanChai 241(30.0%)

Kowloon 1,363(39.6%)

KowloonCity 195(14.3%)

KwunTong 326(23.9%)

ShamShuiPo 146(10.7%)

WongTaiSin 147(10.8%)

YauTsimMong 549(40.3%)

NewTerritoriesEast 549(16.0%)

ShaTin 170(30.9%)

TaiPo 159(29.0%)

SaiKung 131(23.9%)

North 89(16.2%)

NewTerritoriesWest 681(19.8%)

KwaiTsing 141(20.7%)

TsuenWan 215(31.6%)

TuenMun 171(25.1%)

YuenLong 154(22.6%)

Islands 42(1.2%)

Total 3,438(100%)

Note:Figuresmaynotaddupto100%duetorounding

Enrolmentamonghealthcareprofessionals47. At present, nine categories of healthcare professional who areregistered inHongKongareeligible toparticipate in theScheme. Theyaremedicalpractitioners,Chinesemedicinepractitioners,dentists,chiropractors,registered nurses and enrolled nurses, physiotherapists, occupationaltherapists, radiographers and medical laboratory technologists. Table 3


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provides an overview of the 2009 and 2010 enrolment figures for the ninehealthcareprofessionals.Table3:Enrolmentfiguresbytypeofhealthcareprofessional

Typeofhealthcareprofessional

Cumulativenumberofenrolledhealthcareserviceproviders

(asat31Dec2009) (asat31Dec2010)

MedicalPractitioner 1,348 1,431

ChineseMedicinePractitioner 671 762

Dentist 221 239

Physiotherapist 186 189

Nurse Registered Enrolled

406

396

Chiropractor 20 18

MedicalLaboratoryTechnologist 17 17

Radiographer 16 16

OccupationalTherapist 15 19

Total 2,540 2,736

48. When comparing the enrolment figures between 2009 and 2010,there is a slightly increase in four categories of healthcare profession, viz.medical practitioners, Chinese medicine practitioners, dentists andphysiotherapists (Table3). An insignificantdropofenrolment isrecorded inregisterednurses (lessone)andchiropractors (less two). Theenrolmentofmedical laboratory technologists, radiographers,occupational therapists andenrollednursesremainsunchanged. Figure3showstheenrolmentpositionfortheninehealthcareprofessionalsin2009and2010.


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Figure3:Numberofenrolledhealthcareserviceprovidersin2009and2010

Note: Others include chiropractor, medical laboratory technologist, radiographer,occupationaltherapist,enrolledandregisterednurses Participationamonghealthcareprofessionals49. We estimate that the participation ofmedical practitioners,whichformed themajority of the enrolled healthcare service providers, is about34.1% of the potential pool of medical practitioners actively providinghealthcareservicesintheprivatesector. Theparticipationrateisonparwithother publicprivate partnership schemes launched by the Government(e.g.vaccinationsubsidyschemes). Participationamongothereligiblehealthprofessions is relatively lower, at 16.1% for dentists and 12.5% for Chinesemedicinepractitioners. DetailsoftheparticipationofthesethreehealthcareprofessionalsaresetoutinTable4.


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Table4:Enrolmentfiguresaspercentageofpotentialhealthcareserviceproviders

Cumulativenumberofenrolled

healthcareserviceproviders

Enrolledhealthcareserviceprovidersas%of

potentialserviceproviders

Typeofhealthcareprofessional

(asat31Dec2009)

(asat31Dec2010)

Estimatednumberofpotentialservice

providers* (asat31Dec2009)

(asat31Dec2010)

MedicalPractitioner 1,348 1,431 4,1953 32.1% 34.1%

ChineseMedicinePractitioner 671 762 6,110 11.0% 12.5%

Dentist 221 239 1,4864 14.9% 16.1%

* Not all the registered healthcare professionals on the registers are practising theirprofessions inHongKong. Intheabsenceofthenumberofhealthcareprofessionalswhoactually practising their professions, the pool of potential healthcare professionals isdeduced by deducting the following from the total number of registered healthcareprofessional:(a)theeconomicallyinactiveprofessions3&4;and(b)thenumberofhealthcareprofessionalswhoareworking inthepublicsector(includingHospitalAuthorityandtheDepartmentofHealth)andacademicsector. Enrolm

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