英文

Editorial : Private hospitals' failure to provide low-charge beds adequately

【明報專訊】IT was as early as 2012 when the Audit Commission found that private hospitals whose land had been granted "at nil or nominal premium" had failed to provide low-charge beds for patients in accordance with land grant provisions. The issue dragged on for seven years and remains unresolved. As private hospitals do not inform patients of the availability of low-charge beds on their own initiative, patients have to ask doctors about them so as to use them. This demonstrates the government's failure to enforce the regulations adequately, and this has resulted in a waste of resources and the lack of protection of patient rights. The intentions of the policies are left unfulfilled. This exposes a bigger problem, i.e. a failure to monitor government policies. The government should take remedial action.

The private hospitals which have been named by the Ombudsman are Tsuen Wan Adventist Hospital and St. Teresa's Hospital. The Ombudsman says that the issue concerning these hospitals has to be investigated directly. As early as 2012, the Audit Commission criticised these hospitals in its report for violating the land grant provisions. St. Teresa's Hospital, for instance, delayed the provision of low-charge beds in accordance with the provisions by eight years. As of 2012, twenty-seven beds, or over 20 percent of the required number, were still lacking. Between 2007 and 2011, the utilisation rate of its low-charge beds ranged between 17 and 24 percent only. It was also found that patients assigned to low-charge beds were charged exorbitant prices for medicines, paying 50 percent more than patients in second-class hospital wards. As for Tsuen Wan Adventist Hospital, it was found that the hospital charged $500 to $550 daily for the use of its low-charge beds, significantly higher than the $100 fee charged by St. Teresa's Hospital.

At a Legco Public Accounts Committee meeting, Ko Wing-man, the then Secretary for Food and Health, said that he would demand higher transparency in hospital bed charges from private hospitals when responding to criticism of private hospitals' failure to provide sufficient information about low-charge or free beds detailed in the Report of the Director of Audit.

The government has never proposed effective measures targeting the low utilisation rates of low-charge beds. Now the Ombudsman has proposed a direct investigation. The Department of Health, which plays a supervisory role, discloses that the land grant provisions only provide that low-charge beds should be offered. But they do not have specific requirements for the use of low-charge beds. The department can only give private hospitals suggestions about ways to enhance the use of low-charge beds in a way that is practical and feasible.

The Hospital Authority (HA) then entered into an agreement with the two private hospitals, which states that the HA will transfer patients that are suitable to be transferred to these private hospitals during peak flu seasons. These patients will be given low-charge beds and only have to pay basic hospital charges equivalent to public hospital charges, and the difference will be subsidised by the HA. The design of the policy is itself excellent. Not only would it allow the two private hospitals to make full use of their beds and increase the utilisation rates of their low-charge beds, but it would also ease the strain on public hospitals and make room for the treatment of more seriously ill patients when their beds are in short supply and their patients are unable to receive medical services. However, the two private hospitals received merely 35 and 25 referred patients during the peak flu seasons in the summer of 2017 and the winter of 2017/18 respectively, even though the agreement stipulates that they should provide 164 beds.

All this has to be investigated by the Ombudsman. However, the government is culpable in the matter as it failed to act when public hospitals were bursting at the seams, patients were unable to receive proper treatment and Hong Kong was ravaged by the flu.

明報社評2019.07.11:良好政策設計缺乏監管 舉一反三查找不足

私家醫院以免地價或象徵式地價獲批地建院而未能按批地條款向病人提供低收費病牀的問題,早在2012年由審計署揭發,問題拉扯7年,至今仍未解決,私家醫院不主動向病人介紹可使用低收費病牀,要病人主動向醫生查詢才獲使用機會,揭示政府執行不力,浪費資源,病人權益得不到保障,政策原意沒有得到落實,暴露出更大的問題是政策缺乏監管,政府應該亡羊補牢。

今次申訴專員點名要主動調查的私家醫院問題,涉及荃灣港安醫院及聖德肋撒醫院,早在2012年已被審計署報告批評違反批地條件,其中聖德肋撒醫院遲了8年才開始按規定提供低收費病牀,截至2012年仍欠27張,短缺率逾兩成,2007年至2011年其低收費病牀使用率只有17%至24%,更被揭低收費病牀病人的藥物費昂貴,高於二等病牀病人收費的50%。至於荃灣港安醫院,則被發現低收費病牀收費每日高達500至550元,遠高於聖德肋撒醫院每日收100元。

在立法會帳目委員會會議上,對於審計報告批評私家醫院提供低收費或免費病牀的信息不足,時任食物及衛生局長高永文曾表示,會要求私院提高收費透明度。

政府對於低收費病牀使用率低,一直未見提出針對性的有效措施去處理。如今申訴專員提出要主動調查,負責監督的衛生署披露,現行批地條款只寫明要提供低收費病牀,惟條款沒有涵蓋低收費病牀使用的要求,衛生署只能在切實可行情况下,就改善低收費病牀的使用向有關私家醫院提出建議。

其後醫管局跟兩間私立醫院簽訂協議,於流感高峰期由該局轉介合適的公院病人,使用該兩間私家醫院的低收費病牀,病人只需支付等同公院的基本住院費用,私院收費的差額由醫管局補助。這個政策原本是一個極佳的設計,既可以推動兩間私院「牀盡其用」,增加低收費病牀的使用率,也可在公立醫院病牀不敷應用、病人無法得到醫療服務時,壓力得以暫時紓緩,騰出牀位治療更嚴重的病人。但在2017年夏季流感高峰期及2017/18年度冬季流感高峰期間,兩間私院按照協議提供164張病牀,卻分別只接收35名及25名轉介病人。

這些都有待申訴專員去調查,但在流感肆虐香江,公立醫院迫爆,病人無法得到適切的治療時,當局卻無動於中,實在難辭其咎。

■Glossary

provide that : to state that sth will or must happen

culpable : responsible and deserving blame for having done sth wrong

ravage : to damage sth badly

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