LCQ21: Antenatal check-up and delivery services
10.5.2023

âFollowing is a question by the Dr Hon Ngan Man-yu and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 10): Question: It is learnt that quite a number of pregnant women who use antenatal check-up services provided by private hospitals also use the relevant services provided by public hospitals at the same time in order to give themselves an extra layer of protection. There are views that such a situation has created an additional service demand and resource burden on both public and private hospitals. Regarding antenatal check-up and delivery services, will the Government inform this Council: (1) of the respective numbers of pregnant women who gave births in public and private hospitals in each of the past three years, and their percentages in the total number of pregnant women who gave births in that year; (2) of the respective numbers of pregnant women who registered for and used antenatal check-up services in public hospitals, private hospitals and Maternal and Child Health Centres (MCHCs) in each of the past three years, and their percentages in the total number of pregnant women in that year; (3) whether it has compiled statistics on the number of pregnant women (i) who originally made bookings for delivery in public hospitals but eventually gave births in private hospitals and the reasons for that, and (ii) who originally made bookings for delivery in private hospitals but eventually gave births in public hospitals and the reasons for that, in each of the past three years; (4) of the number of pregnant women who registered for and used antenatal check-up services in public hospitals but eventually did not give births in public hospitals or cancelled the bookings for their hospitalisation in advance in each of the past three years, together with a breakdown by the main reason for cancelling the booking; (5) of the details of regular antenatal and post-delivery check-up items (including antenatal check-ups, postnatal check-ups and physical examination for newborns) provided for pregnant women by public hospitals and MCHCs (e.g. the contents, number and duration of the check-ups) in the past three years, as well as the cost of each check-up item; (6) of the average cost of providing antenatal check-up and delivery services for each pregnant woman by public hospitals in each of the past three years; and (7) whether it has subsidised suitable pregnant women to receive antenatal check-up and delivery services in private hospitals, so as to effectively divert service demand, and at the same time shorten the waiting time for the relevant services in public hospitals and MCHCs; if so, of the details and the implementation situation; if not, the reasons for that? Reply: President, In consultation with the Department of Health (DH) and the Hospital Authority (HA), the consolidated reply to the various parts of the question raised by the Dr Hon Ngan Man-yu is as follows: The Maternal and Child Health Centres (MCHCs) under the DH and the Obstetrics and Gynaecology (O&G) Departments of the HA have together been providing pregnant women with a range of comprehensive antenatal shared-care, childbirth and postnatal care services to take care of their needs throughout the process from pregnancy to delivery. Specifically, the antenatal services provided by MCHCs to pregnant women include routine antenatal check-ups, blood tests and other investigations, as well as health education on pregnancy, breastfeeding, and infant and young child feeding issues, etc. The postnatal services include physical check-ups and advice on family planning, while the health services for newborn babies include physical examinations, free immunisation services, the health and developmental surveillance programme as well as the parenting programme. Pregnant women identified with high risk factors or suspected to have antenatal problems, or postnatal women and/or their newborns in need will be referred to the O&G Departments of the HA or other specialist services for follow-up and treatment. Meanwhile, the O&G Departments of the HA have been providing a range of free antenatal services for all local pregnant women with a booking for hospitalisation. The first antenatal check-up includes checking of personal and family medical history, physical examination and a blood test. If necessary, public hospitals will arrange specific investigations for pregnant women (Note). Generally speaking, check-ups are carried out once every four to six weeks before the 28th week of pregnancy; once every two to four weeks for pregnancies at 28 to 36 weeks; and once every one to two weeks for pregnancies after 36 weeks. O&G Departments of public hospitals and the MCHCs may make other appropriate arrangements having regard to the conditions of individual pregnant women. In the past three years, the relevant yearly service figures in the MCHCs and the Obstetrics Outpatient Clinics of the HA are set out below: Year MCHCs of the DH Obstetrics Outpatient Clinics of the HA's hospitals Number of registrations for antenatal care service Antenatal care service attendance Number of new case booking 2020 About 18 000 About 82 700 32 390 2021 About 16 500 About 73 300 30 863 2022 About 13 900 About 60 100 27 630 As for childbirth, according to the information maintained by the Census and Statistics Department, the numbers of live births in public and private hospitals in the past three years are set out below: Year Public hospitals Private hospitals Others (out-of-hospital/clinic birth or unknown place of birth) Total 2019 34 154 18 610 92 52 856 2020 26 789 16 146 96 43 031 2021 23 300 13 556 97 36 953 2022 Not available Pregnant women have different considerations when choosing to give birth in public hospitals or private hospitals. Generally speaking, the three main factors for pregnant women in choosing the delivery locations include personal choice (such as fees, visiting hours and accompanying arrangements, etc.), delivery methods (such as choosing different delivery methods including caesarean section/painless labour/natural birth etc.), and the clinical situations of the pregnant women and foetuses (such as whether the cases require supportive care of the neonatal intensive care unit). The Government and the HA do not maintain statistics on cases who registered for antenatal check-up services/booked delivery in public hospitals but gave birth in private hospitals eventually, or cases who registered for delivery in private hospitals but gave birth in public hospitals eventually, and the relevant obstetric services provided by private hospitals. With regard to costs, the expenditures in relation to the antenatal, postnatal and child health services in the MCHCs are absorbed within the overall provision for the DH's Family Health Services and therefore no breakdown is available. The HA also does not maintain the average cost and breakdown of the antenatal check-ups and delivery services provided by public hospitals for each pregnant woman. The Government and the HA have all along been closely monitoring the demand for and service development of childbirth and related medical services, including exploring the feasibility of implementing public-private partnership (PPP) programmes. When considering the implementation of PPP programmes, the HA will carefully consider relevant factors, including the demand for HA services, the suitable patient categories, the potential complexity of the programmes, the capacity and readiness of the private sector, as well as whether there will be any impact of the programmes on the attrition of specialist doctors in public hospitals. In fact, all in all, the effectiveness and sustainable development of PPP depend on the price of the relevant services in the private market and the difference between such price and the cost of those services in the public system. Therefore, when implementing PPP, the Government needs to be particularly mindful of whether such programmes will further drive up prices in the private market and/or exacerbate staff attrition in the public healthcare system. The Government and the HA will continue to monitor the demand for childbirth and relevant medical services, and will review and rationalise the existing antenatal, childbirth and postnatal service processes provided by the DH, the HA as well as those spanning the public and private sectors, including sharing of the relevant electronic health records and medical record, so as to take appropriate measures to meet the demand as well as enhance the quality and efficiency of services. Note: Including foetal morphology scan (ultrasound scan), blood sugar and oral glucose tolerance tests, amniocentesis, chorionic villus sampling and umbilical cord blood sampling. As for other hereditary diseases, public hospitals will offer screening for alpha-thalassaemia and beta-thalassaemia by conducting blood tests for pregnant women. If both expectant parents have thalassaemia, the pregnant woman will receive amniocentesis or chorionic villus sampling in a public hospital to determine whether the foetus may suffer from such disease.