A decade ago, Alan Kah-kit Leong, a former member of the Hong Kong Legislative Council (LegCo), raised a non-binding motion, in 2008 – stating that “the current funding provision for the Kowloon East Hospital Cluster is far more insufficient than other clusters and lags far behind the needs of the population and the communities of Kwun Tong and Tseung Kwan O”.

The motion was later passed. In the government’s progress report with regards to the motion, it said an additional HKD17.7 million was allocated to the Hospital Authority (HA) in 2008 – 2009 to implement a number of initiatives for service enhancement.

However, has this really addressed the unequal resource allocation within the clusters?

The issue of uneven resource allocation was recognised – but not addressed

Apart from the motion raised in 2008, the Steering Committee (SC) on Review of Hospital Authority, set up in August 2013 and chaired by the Secretary for Food and Health, has also acknowledged the issue of uneven resource allocation within clusters.

In its report published in July 2015, the Committee was aware of the fact that Kowloon East Cluster (KEC) received the least amount of allocated resources among the seven clusters on a per capita basis.

“While 15.5% of HA’s patients had ever used KEC service, KEC was only allocated with 10.7% of the total recurrent funding allocated to clusters for the year 2013 – 2014,” the Committee stated in the report.

Such recurring issue to a large extent arose from the resource allocation model HA had adopted since 2012 – 2013. According to the report, resource allocation to clusters – including manpower, equipment, facilities and other operating needs – is determined based on the following considerations:

a) the resources needed to sustain the baseline operations of respective clusters, including their core primary and secondary services as well as any centralised services under their management;
b) additional resources required to deliver the new services that have been supported during the annual service planning process; and
c) any other resources needed to address specific pressure areas/gaps.

Critics comment that these considerations have failed to take into account the service demand, which is considered to be related to the number of patients and population in a cluster. Consequently, the growth of healthcare manpower within KEC is struggling to catch up with the growth of its population.

Should HA allocate resources in accordance with a population-based model?

In March 2017, LegCo member Hon Wilson Or raised a motion on “Urgently improving public healthcare services in Kowloon East”. In the motion, Or mentioned the need to expedite the completion of the United Christian Hospital (UCH) expansion.

In addition, LegCo member representing the medical sector Dr Pierre Chan amended the motion and added the expansion projects of the Haven of Hope Hospital. He also reinforced HA should allocate “additional resources to shorten the waiting time for specialist outpatient services and general outpatient services of public hospitals in Hong Kong, with a view to benefiting residents of Kowloon East, in accordance with a population-based funding model”.

Back in 2015, the Steering Committee has also expressed their support to a population-based model in their report. However, they noted that “a pure population-based model would not be able to take into account the territory-wide tertiary and quaternary services provided by certain hospitals in selected clusters, the inflow demand for cross-cluster services experienced by certain clusters and the special role of certain hospitals” – such as teaching hospitals shoulder teaching duties on top of providing clinical service. In view of this concern, they recommended adopting a refined population-based resource allocation model by taking these factors into consideration.

The discussion on the motion has ended and the government has published another progress report in July 2017. In its closing remarks, it said “The Food and Health Bureau (FHB), Department of Health (DH) and HA will keep in view Kowloon East residents’ needs in healthcare services as a whole, and continue to commit resources and enhance public healthcare services in order to cope with the challenges brought by an ageing population in the region.”

Only time will tell if the government is really taking substantial measures to address the matter in discussion. MIMS

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Sources:
http://www.info.gov.hk/gia/general/200803/10/P200803100197.htm
http://www.legco.gov.hk/yr07-08/english/counmtg/motion/cm0312-m3-prpt-e.pdf
http://www.fhb.gov.hk/download/legco/replies/170405_sfc/fhb-h-e.pdf
http://www.fhb.gov.hk/download/committees/harsc/report/en_full_report.pdf
http://www.legco.gov.hk/yr16-17/english/counmtg/motion/m_papers/cm20170329cb3-411-e.pdf
http://www.legco.gov.hk/yr16-17/english/counmtg/motion/cm20170329m-ocs-prpt-e.pdf
http://www.legco.gov.hk/yr16-17/english/counmtg/motion/m_papers/cm20170329cb3-432-e.pdf