Ensuring cancer patients in Hong Kong have the best choice of drugs

Time and again, we read local news reports about the plight of cancer patients who cannot afford the ultra-expensive target therapy drugs, with some families even having to sell their properties to pay for treatment. This has created an impression that Hong Kong's public health care system has gone back to the 1950s, when the availability of reasonable medical care hinged on one's wealth. This is grossly untrue.

First and foremost, our public hospital services are highly subsidised by taxes to offer universal access to all residents who choose to use them. They are even free for those patients who cannot afford the nominal fee, under the waiver mechanism.

Yet, public resources are finite. Public health care services can be provided only at an appropriate level to meet the needs of patients. So far as the use of medication is concerned, since July 2005, the Hospital Authority has used a drug formulary, which currently covers about 1,300 drugs in four categories.

The first category is drugs available for general use. The second is special drugs, which are mainly used under specific clinical conditions with a specialist's prescription. Both categories constitute around 92 per cent of all drugs on the Hospital Authority's drug list and are provided at a highly subsidised rate in public hospitals and clinics.

The third category is self-financed drugs, covered by the authority's safety net. These are drugs of clinical benefit but extremely expensive for the public system to provide as part of its standard services. There are currently 21 self-financed items under this category, and subsidies for drug expenses are provided through the Samaritan Fund for those who need the drugs but struggle to afford them. In early 2011, the government introduced an "additional" safety net - the Community Care Fund - to provide financial assistance to patients to purchase nine specified self-financed cancer drugs that are not yet covered by the Samaritan Fund but, as increasing scientific evidence shows, could prove effective. Both funds adopt the same financial assessment criteria.

Medical social workers assess and consider patients' maximum contribution to drug costs with reference to their household income, expenditure and capital assets. Property occupied by a patient's household and their tools of trade are excluded from the calculation. Patients struggling to pay can thus obtain subsidies from the safety net in line with the government's long-standing health care policy that "no one would be denied adequate medical care through lack of means".

The fourth category is self-financed drugs not covered by the safety net. These are drugs for which there is only preliminary medical evidence - those with marginal benefits over alternatives but at significantly higher costs, and lifestyle drugs. These drugs are not highly efficient and are not provided at the standard fee in public hospitals and clinics. If they choose to, patients can pay for these drugs themselves while continuing to receive other highly subsidised health care services. Those who choose not to use self-financed drugs will continue to receive appropriate care under the established treatment options in public hospitals and clinics.