LCQ21: Promoting cross-border healthcare services
17.5.2023

Following is a question by the Hon Chan Hok-fung and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 17): Question: It has been reported that during the three consecutive days of long holidays from the end of last month to the beginning of this month, the waiting time at the accident and emergency (A&E) departments of a number of public hospitals exceeded eight hours, reaching the maximum waiting time that can be shown on the website of the Hospital Authority. There are views pointing out that the Government should promote cross-border healthcare services to enhance healthcare services for Hong Kong residents. In this connection, will the Government inform this Council: (1) whether it will consider, by leveraging the advantages of land resources in the Mainland cities of the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), constructing hospitals of Tier 3 Class A ("Grade 3A" hospitals) in such cities and model them on the healthcare system of Hong Kong for use by residents in GBA (including Hong Kong residents), so as to alleviate the problem of excessively long waiting time of Hong Kong patients for healthcare services at present; if so, of the details; (2) whether it knows the average time taken for constructing "Grade 3A" hospitals in the Mainland cities of GBA in the past three years, as well as the number of "Grade 3A" hospitals already completed or soon to be completed in the Mainland cities of GBA; (3) whether it has assessed (i) the journey time for transporting patients from Hong Kong to Mainland hospitals (e.g. those located in Zhongshan or Zhuhai) for medical treatment, and (ii) the average waiting time for patients to receive medical treatment at A&E departments of public hospitals in Hong Kong during long holidays; and (4) as it is learnt that quite a number of Hong Kong residents are living, studying or working in the Mainland cities of GBA, whether the Health Bureau has plans to share the medical records of such Hong Kong residents across the border, thereby expediting the integration of the healthcare system in GBA; if so, of the details; if not, the reasons for that? Reply: President, The healthcare system of Hong Kong provides primary, secondary and tertiary healthcare services to cater for the different medical needs of the public. Primary healthcare (PHC) is the first point of contact in a continuous healthcare process, taking care of citizens with mild symptoms and emphasising on disease prevention and chronic disease management. At present, PHC is mainly provided by private doctors and public General Out-patient Clinics (GOPCs), while the target groups taken care by the latter are low-income and disadvantaged groups. The public healthcare system, in particular public hospitals, is on the other hand mainly responsible for the provision of secondary (including Accident & Emergency (A&E) and specialist services) and tertiary healthcare services for patients with urgent or more severe conditions, as well as serving as a healthcare safety net for the public. In consultation with the Hospital Authority (HA), the reply to the various parts of the question raised by the Hon Chan Hok-fung is as follows: (1) and (2) The development of the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) is a national strategy, the objectives of which are to further deepen co-operation amongst Guangdong, Hong Kong and Macao, fully leverage the composite advantages of the three places, facilitate in-depth integration within the region, promote co-ordinated regional economic development, and develop an international first-class bay area ideal for living, working and travelling. In terms of the development of healthcare services, under the principle of complementarity and mutual benefits and on the premise of benefitting the healthcare development of both the Mainland and Hong Kong, the Government has all along been enhancing co-operation with various Mainland cities of the GBA and working together to improve the level of healthcare within the region. The Government understands that there are currently more than 70 Tier III Class A hospitals in the nine cities of the GBA, and the Government has been exploring how to support Hong Kong citizens who work and live in the Mainland, with a particular focus on taking care of the medical needs of Hong Kong citizens residing in the GBA, through co-operation with suitable healthcare institutions in the area. That said, the healthcare systems and service delivery models in Hong Kong and the Mainland are different. The Government will progressively advance the work on this front step by step. For example, since 2015, the Government has allowed the elderly to use the Elderly Health Care Voucher (EHCV) to pay for the fees of designated outpatient healthcare services at the University of Hong Kong-Shenzhen Hospital (HKU-SZH). Starting from April 17 this year, the use of EHCV at the HKU-SZH has been further extended to cover the Huawei Community Health Centre, an offsite medical institution set up by the HKU-SZH. Besides, the Government also launched the Pilot Scheme for Supporting Patients of the Hospital Authority in the GBA (Pilot Scheme) on May 10 this year, to sustain services provided during the COVID-19 epidemic under the Special Support Scheme for Hospital Authority Chronic Disease Patients Living in the Guangdong Province (Special Support Scheme), such that eligible Hong Kong citizens may continue to receive subsidised medical consultations at the HKU-SZH. The Government will continue to explore various feasible measures under the principle of complementarity and mutual benefits with a view to supporting the medical needs of Hong Kong citizens residing in the Mainland cities of the GBA more effectively. These include exploring further extension of the relevant initiatives to other Mainland healthcare institutions in the GBA with similar healthcare service standards and clinical governance structures as the HKU-SZH, in particular those adopting a "Hong Kong management model"; and studying the feasibility of allowing Hong Kong people residing in the Mainland cities of the GBA to use EHCV to reimburse the premiums of local medical insurance, etc. This is to facilitate Hong Kong people who travel between the two places and intend to settle in the GBA to reside and integrate into local life, instead of relying solely on healthcare resources in the Mainland to meet the needs of Hong Kong people. (3) Regarding the waiting time of A&E departments in Hong Kong, the 18 public hospitals under the HA currently provide A&E services for critically ill or seriously injured people and victims of disasters. In order to ensure that citizens with urgent needs can receive timely A&E services, the A&E departments implement a patient triage system. Patients are classified into five categories, namely Critical, Emergency, Urgent, Semi-urgent and Non-urgent according to their clinical conditions, and would receive treatment as prioritised by their urgency category. The HA's service target specifies that Critical patients will receive immediate treatment, and most Emergency (95 per cent) and Urgent (90 per cent) patients will be treated within 15 or 30 minutes respectively. The average waiting time for each triage category of A&E services for the last three years is provided in the Annex. In gist, about half of the patients belong to the Critical, Emergency and Urgent categories and their average waiting time is 0 (i.e. no waiting needed), 8 and 26 minutes respectively. For Semi-urgent and Non-urgent patients, their waiting time would inevitably be affected by the actual service demands of patients with more urgent conditions, and most of the former could be treated in PHC. With the recent surge of influenza and upper respiratory tract diseases in Hong Kong, coupled with the fact that most family doctors/clinics were closed during the long holidays, many patients chose to visit A&E departments which offer services at relatively low fees instead of seeking consultation from private PHC services, resulting in a longer waiting time of A&E services for Semi-urgent and Non-urgent patients recently. In order to meet the service demands of the A&E departments and enhance the patient experience, the HA has adopted multiple measures, including centrally publishing the waiting time of all A&E departments on different platforms, such as the website of the HA, the "HA Go" mobile application and the A&E Registry, so that patients with mild illnesses can obtain information on the overall service situation of the A&E departments before going to the A&E departments or registering hence decide whether to seek medical treatment in the A&E departments. In addition, the HA will also provide information on private hospitals and doctors, refer patients with stable conditions, and implement the Special Honorarium Scheme as appropriate in order to recruit additional healthcare staff and meet demands. The HA also has different measures to manage the service demands in the community and minimise unnecessary A&E services, including strengthening support for Residential Care Homes for the Elderly (RCHEs) through the Community Geriatric Assessment Service, Community Nursing Service and Visiting Medical Practitioner Scheme, so that simple cases can be handled outside of the hospitals; increasing the number of geriatric outreach sessions for RCHEs, and arranging follow-up for the elderly after discharge, so as to reduce their chances of readmission; as well as actively following up on the conditions of patients with chronic diseases through the Patient Support Call Centre, with a view to strengthening support for them and improving their self-care ability. The HA will continue to review and introduce improvement measures to strengthen and optimise the diagnosis process so as to provide patients with appropriate emergency healthcare services. The HA does not maintain relevant time and statistics on the transfer of Hong Kong citizens to Mainland hospitals for medical treatment. (4) Regarding medical records, to enable patients to receive continuous care, the Government has made special arrangements during the epidemic to allow participants of the Special Support Scheme to pass their medical records stored on the Electronic Health Record Sharing System (generally known as "eHealth") to the HKU-SZH for use during their follow-up consultations, with authorisation given to the HA and following the established mechanism for data access. The arrangement will continue to be implemented under the Pilot Scheme. The Government will draw reference from the practical experience gained from the passing of medical records to the HKU-SZH and actively consider the further implementation of cross-boundary use of electronic medical records, with a view to improving the level of cross-boundary mutual access and recognition of medical and testing records, as well as enhancing the cross-boundary standardisation of healthcare records, so that residents of the two places can receive more timely and accurate diagnosis and treatment.