Middle class covered under health safety net

Working families will enjoy free public hospital services and drugs if their medical spending exceeds a set percentage of their annual household income under the new health policy being drawn up. This is being seen as a 'second safety net' in the public health-care system - in addition to the first one for people on welfare and those who have passed a means test for a financial assistance scheme called the Samaritan Fund. A person familiar with the new policy said the second safety net was aimed at providing better protection to middle-class people suffering catastrophic and long-term diseases. The ceiling above which people could receive public funding has not been set, but Patients' Rights Association spokesman Tim Pang Hung-cheong said it should be no more than 10 per cent of income. Food and Health Bureau figures show that while most public patients spend less than HK$300 a year on hospital bills, about 1 per cent pay a substantial portion of their incomes. 'This minority of public patients have to pay tens of thousands of dollars in hospital bills, which puts a lot of financial stress on the whole family. This second safety net aims to help these people by setting a spending limit for them, over which the government will pay the rest,' the person said. About 25 per cent of public patients are on welfare and enjoy free medical services. The bureau is expected to roll out the new policy after public consultation on a voluntary medical insurance plan later this year. At present, patients at public hospitals or clinics need to pay only HK$10 for each three-month course of drugs on a standard list of subsidised medicines. For others, which are known as self-financed drugs, the costs must be covered by patients. The Samaritan Fund, which is mostly supported by public funding, provides financial assistance for 18 self-financed drugs, such as interferon and medicines for leukaemia, breast cancer and colon cancer. Patients have to pass a means test to use the fund. The fund also covers some privately purchased medical items including heart pacemakers and prosthetics. One of the most commonly financed items is surgical equipment for a procedure known as percutaneous transluminal coronary angioplasty (PCTA) - insertion of a balloon to open up obstructed blood vessels in the heart. Hospital Authority figures show that, for this procedure, subsidies provided by the Samaritan Fund range from HK$10,000 to HK$48,000, depending on the complexity of the operations. Subsidies for pacemakers range from HK$11,000 to HK$36,000. The fund also pays for implantable defibrillators - which correct potentially fatal heartbeat irregularities - up to a maximum of HK$138,000 and eye lens implants up to HK$1,100 each. The person with knowledge of the new policy said the means test for the fund was very stringent. 'In the future, if a patient's medical spending exceeds the limit, they will also be covered by the fund - even if they are on a middle income.' The bureau says the government should be able to afford the new policy as only a minority of patients require expensive medical items or drugs. The idea of a 'second safety net' was first raised in 2008 when the bureau released a consultation document on health-care reform titled 'Your Health, Your Life'. One of the problems highlighted in the paper was that the current safety net does not cater sufficiently for patients struck by illnesses requiring costly treatment. 'This is especially the case for a patient who comes from a middle-income family which does not meet the means-testing criteria under the current fee waiver and financial assistance mechanisms,' the document said. 'The concept is to set a limit on the proportion of annual household income spent by a family for secondary health care in public hospitals, beyond which financial assistance would be provided.' The government will soon consult the public on a voluntary medical insurance scheme, to be supported by HK$50 billion of public funding over 25 years. The government wants the subsidies and incentives to cover at least 500,000 people. The fund would be used in three areas to subsidise the premiums of policyholders aged over 65 and high-risk patients. It is also designed to provide incentives for young people to buy into the plan early. Patients' rights campaigner Pang said his association objected to the government spending HK$50 billion on the medical insurance scheme, saying it would only benefit insurance companies and better-off people. 'If the money was spent on public hospitals, the services could be improved a lot,' he said. 'The voluntary medical insurance scheme will only boost the private health-care sector, while the total medical spending of the whole of society will rise.' By the end of the 2008-09 financial year, the Samaritan Fund had a balance of HK$1.2 billion. The fund approved 4,426 applications in that year, costing HK$155 million. The government has committed HK$1 billion to the fund, spread over four years from 2008-09. Some treatments covered by the Samaritan Fund PTCA (angioplasty): HK$10,000 to HK$48,000 Pacemaker: HK$11,000 to HK$36,000 for basic models, and up to HK$138,000 for an implantable defibrillator Lens implant: up to HK$1,100 per lens Cancer drugs: between HK$180,000 and HK$200,000 a year for trastuzumab, a breast cancer treatment; between HK$78,000 and HK$170,000 a year for oxaliplatin, a colon cancer treatment