LCQ14: Elderly Health Care Voucher Scheme
Hong Kong (HKSAR) - Following is a question by the Hon Chan Hak-kan and a written reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (December 6):
The Elderly Health Care Voucher Scheme (EHCVS) aims to supplement the existing public healthcare services by providing financial incentive to enable the elderly to choose private healthcare services that best suit their needs, including preventive care. It has been reported that there are cases of abusive use of the health care vouchers (HCVs). Examples include: a Chinese medicine practitioner tricked an elderly person into buying expensive Chinese medicine powders using her HCVs; an optometrist disregarded an elderly person's eye disease and merely checked his eyesight and prescribed glasses for him in return for his HCVs, without referring that elderly person to an ophthalmologist for follow-up which resulted in his becoming blind due to delay in diagnosis and treatment; and another optometrist misled an elderly person into being prescribed a pair of expensive brand-name glasses using his HCVs. Moreover, there are views that the Government should increase the annual voucher amount in order to relieve the financial pressure on the elderly with chronic diseases, and should also raise the accumulation limit of HCVs to help the elderly cope with unexpected and expensive medical expenses. In this connection, will the Government inform this Council:
(1) of the number of complaints about HCVs received by the Government in each year since the launch of EHCVS in 2009, with a breakdown by nature of the complaint;
(2) whether a mechanism is currently put in place to monitor, on a regular basis, if there is any abusive use of HCVs; if so, of the details; if not, the reasons for that;
(3) whether the authorities will, in the light of the aforesaid press reports, step up the monitoring on the use of HCVs; if so, of the details and whether they will employ the tactic of posing as customers for the collection of evidence; if they will not step up the monitoring, the reasons for that;
(4) of the ordinances that may be invoked by the authorities at present to institute prosecutions against private service providers who have tricked elderly persons into using HCVs improperly, the details of the relevant law enforcement actions, as well as the penalties generally imposed on the convicted persons; and
(5) whether it will adjust upward both the annual voucher amount and the accumulation limit of HCVs; if so, of the details; if not, the reasons for that?
The Government launched the Elderly Health Care Voucher (EHV) Pilot Scheme in 2009 to subsidise Hong Kong elders aged 70 or above to use primary care services provided by the private sector. The scheme was converted from a pilot project into a recurrent programme in 2014. Since the implementation of the EHV Scheme, we have introduced various enhancement measures. For examples, the annual voucher amount for an eligible elder has increased progressively from the initial sum of $250 to $2,000, and the financial cap has been revised upward from $3,000 to $4,000. The face value of each voucher was changed from $50 to $1 in 2014 to make it more convenient for the elders to use the vouchers. Moreover, the eligibility age for the EHV Scheme has been lowered from 70 to 65 since July 1, 2017. Details of actual voucher expenditure since the launch of the Scheme in 2009 are at the Annex.
My reply to various parts of the question is as follows:
(1) According to the available statistics, the Department of Health (DH) dealt with 11, 24, 42 and 51 complaints about the EHV Scheme in the respective years from 2014 to 2017 (as at end of October). The complaints involve the coverage of the scheme, operational procedures, administrative and supporting services, suspected fraud, improper voucher claims and issues related to service charges of participating service providers, etc.
(2), (3) and (4) To protect the interests of the elderly, it is stipulated in the terms and conditions of the EHV Scheme Agreement that participating service providers shall ensure that the voucher amount used by an elderly person does not exceed the fee for the healthcare service received on a particular occasion. They shall not charge the elderly any fees for creating a voucher account or using vouchers. The DH issues regularly to participating service providers a set of Proper Practices under the EHV Scheme, which include reiterating that they shall not charge the elderly any fees for creating a voucher account or using vouchers. It has also issued letters to participating service providers to remind them of the proper practices in making voucher claims, which include not imposing different levels of fees based on whether vouchers are used or not, enhancing the transparency of service charges as far as possible, explaining the charges to patients at their request before providing service, and allowing patients to make choices of different healthcare treatment/ management options which may have different service charges upon explanation by healthcare staff. Besides, registered healthcare professionals have to abide by their codes of professional conduct and ethics and to fulfil their professional obligations. The DH also advises elders to ask service providers about the service charges before they give consent to use their vouchers.
To ensure proper reimbursement of voucher claims to participating service providers and prudent use of public money, the DH has put in place measures and procedures for checking and auditing voucher claims. These include conducting routine inspections to service providers, monitoring and surveillance to detect aberrant patterns of transactions so as to take timely follow-up actions and necessary investigation; and conducting investigations into the complaints received.
The DH will take appropriate follow-up actions in respect of any complaint, media report and related information about the EHV Scheme. Generally speaking, if any participating service provider is found to have failed to comply with the terms and conditions of the EHV Scheme Agreement, the voucher claims will not be reimbursed by the Government. In case the reimbursement has been made, the Government will recover the amount from the service provider concerned. For any service provider suspected of fraud, the DH will refer the case to the Police and/or relevant law enforcement agencies for follow-up and for consideration of any necessary enforcement actions (including whether to conduct a decoy operation). The DH may also disqualify the service provider concerned from participating in the EHV Scheme. For any service provider suspected of professional misconduct, the DH will refer the case to the relevant professional regulatory board/council for follow-up.
According to the record of the DH, as at the end of October 2017, one service provider was prosecuted and sentenced to imprisonment for making false voucher claims.
(5) There is currently no restriction on the number of years that an elder may carry forward the unspent vouchers but the cumulative amount of vouchers in a voucher account cannot exceed $4,000. Raising the accumulation limit further may not be conducive to achieving the aim of encouraging elderly persons to make more frequent use of the vouchers on primary care services (including preventive care services). Moreover, with an ageing population and the implementation of the enhancement measure in 2017 to lower the eligibility age for the EHV Scheme from 70 to 65, we anticipate that both the number of elders using the vouchers and the annual financial commitments involved will continue to increase substantially. In considering whether to increase the annual voucher amount and put in place other enhancement measures, we will need to assess in details the long-term financial implications on the Government.
Thank you, President.
Published on: 2017-12-06
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