Chief Secretary for Administration | The Government of the Hong Kong Special Administrative Region

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Enhancement Measures under the Community Care Fund Medical Assistance Programmes Help Patients with Rare Diseases

27 January 2019

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Photo courtesy of Hospital Authority

Healthcare services are livelihood issues of greatest public concern just after housing. It is the Government’s public healthcare policy to ensure that no one is denied adequate medical care owing to lack of means.

Medical assistance has always been a core part of the Community Care Fund (CCF) which provides assistance to patients facing financial difficulties, in particular those who fall outside the social safety net or those within the safety net but still have special circumstances that are not covered.

Two weeks ago, the Commission on Poverty (CoP) chaired by me met to approve the introduction of new drugs and a medical device for three Medical Assistance Programmes and their budget proposals as well as the recommendations to enhance the means test mechanism of the CCF Medical Assistance Programmes, further expanding the CCF’s function of plugging gaps in the existing system and enabling the CCF to play a pioneering role in these matters.

First of all, the CoP approved the inclusion of seven specified self-financed cancer drugs in the existing First Phase Programme of Medical Assistance Programmes starting from mid-February 2019. It is expected that the seven new drugs will benefit 384 patients in the first year after implementation, and the average amount of subsidy for each case will be around $230,000. The First Phase Programme covers a total of 22 self-financed cancer drugs for treatment of 14 types of cancers. The total funding approved for the coming year stands at $248.092 million.

Drugs for treating rare diseases are ultra-expensive indeed in comparison with common drugs, costing users hundreds of thousands of dollars every month. Patients with rare diseases are in dire straits as such drugs, which are unaffordable for not only grass-roots families, but also middle-class families, will bring heavy financial burden and enormous stress to patients and their families. The CoP has endorsed the budget for the programme “Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)” to provide funding totalling $143.736 million for the coming year.

In her Policy Address last year, the Chief Executive put forward the proposal of improving the drug treatment for patients in public hospitals. Last September, the CCF expanded the coverage of the programme “Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)” to include drugs for treating spinal muscular atrophy (SMA). As at December 2018, the Hospital Authority has approved a total of 18 cases under the programme, involving a total subsidy of $66.76 million and an average amount of around $3.71 million per case. Such expenses are not regarded as benefits, but instead as part of our responsibility to protect the public’s health. We are pleased to learn that the health of some patients has improved after they took the new drugs.

The CoP also endorsed the addition of Impella, a percutaneous ventricular assistance device for treating coronary disease, under the programme “Subsidy for Eligible Patients of Hospital Authority to Purchase Specified Implantable Medical Devices for Interventional Procedures”. With a total subsidy of around $5.01 million, the initiative is expected to benefit about 25 patients in the first year after implementation, which means the average subsidy per case will be around $200,000. The CoP has endorsed a total provision of $22.177 million for the programme in the coming year.

At the same time, the CoP approved the enhancement measures of the means test mechanism of the CCF Medical Assistance Programmes, including revising the definition of the term “household” as applied in the means test and the calculation of Annual Disposable Financial Resources (ADFR) for drug subsidy applications. These enhancement measures will help relieve the financial burden of paying for the ultra-expensive drugs on patients’ families, so that they will not find themselves in economic straits or need to exhaust their savings.

Under the revised definition of “household”, if an applicant is a non-dependent patient who is married, his family members will only include his spouse and dependent children living under the same roof. In case of a non-dependent patient who is unmarried, he will be treated as a single person household and the income and assets of his parents or siblings living under the same roof will not be taken into account. Such an arrangement can avoid the situation of parents exhausting their disposable assets to bear the medical expenses of their grown-up children. For dependent patients (i.e. unmarried and either under 18 years old or 18-25 years old receiving full-time education), the definition of “household” remains unchanged. The CoP also endorsed modifying the calculation of ADFR for drug subsidy applications by discounting 50% of patients’ household net assets.

In view of the dental care needs of elderly persons, the Government will extend the CCF Elderly Dental Assistance Programme for three years (from 1 March 2019 to 28 February 2022), and the target beneficiaries of the Programme will be expanded to cover all elderly persons receiving Old Age Living Allowance by lowering the age limit from 70 or above to 65 or above. It is expected that the number of eligible applicants will increase by 150 000 from 350 000 to 500 000. There will also be enhancement measures, including relaxing the number of visits for other free dental services from one time to two times for elderly persons for whom removable dentures are not appropriate and raising the maximum number of claim applications for X-ray films in each case from four films to six films for each eligible dentist. Besides, the Programme will continue to provide free removable dentures and other related dental services for eligible elderly persons.

The Government cares about the welfare of patients. By implementing various new measures through the CCF, it has demonstrated its commitment and determination to provide patients with the necessary assistance.

Besides implementing medical assistance programmes, the CCF has also been an important platform for poverty alleviation, plugging gaps in the existing system and playing a pioneering role in flexibly responding to the needs of society. Since its establishment in 2011, the CCF has launched 47 assistance programmes, 12 of which have been regularised by the Government. The total commitment has exceeded $9.5 billion and the number of beneficiaries is over 1.64 million. By making good use of its resources, the CCF will continue to develop thoughtful and practical programmes to fully address the needs of the disadvantaged.