The Health, Welfare & Food Bureau has proposed to replace the standard rates for private consultation service by pre-set ranges, while the Hospital Authority intends to divide the level of expertise required into two levels and to charge a consultation fee according to the complexity of individual cases.

In a Legislative Council paper, the bureau said the fixed rates are inflexible and cannot accurately reflect variations in the complexity of a patient's condition and the special expertise that might be required in providing treatment.

The fixed rates result in both instances of over-charging and under-charging for individual patients, and are contrary to the general practice in the private sector where charges are set on the basis of the expertise involved and resources consumed.

The authority intends to divide the level of expertise required into two levels - Associate Professor/Specialist and Professor/Consultant, with each expertise level commanding a sub-range of fees.

Using the proposed range of fees for new specialist out-patient consultation as an example, treatment of a relatively simple case with a 20-minute consultation by Associate Professor/Specialist will cost the lower limit of $550, while the upper limit at $1,750 will be for the treatment of a complex case taking a 45-minute consultation by a Professor/Consultant.

The bureau said in this way, the fee structure will be able to take much more appropriate account of the resources used, both in terms of expertise and clinical complexity, for the provision of private consultation service.

There are two main types of private services at public hospitals: private specialist out-patient services and private in-patient services. Majority of the specialist out-patient services are concentrated at the two teaching hospitals of the Queen Mary Hospital and the Prince of Wales Hospital.

The paper said in 2004-05, total bed-days utilised in public hospitals was 7,380,600, and only 0.57% of which are private bed-days. The volume of private in-patient activities was on a slight declining trend in recent years, although the significant drop in 2003-04 can be attributed mainly to the SARS outbreak.

The amount of income generated by private in-patient services was $111 million in 2004-05. To ensure public services will not be adversely affected by private in-patient services, the bureau and the authority agreed the total number of private beds in public hospitals should be capped at 379.

The bureau said the main rationale for the provision of private services at public hospitals is due to the fact that there are levels of expertise and facilities within the public medical sector, which are not generally available in the private sector.

It is therefore considered appropriate to offer the public, some of whom might want to procure private services, a means for accessing these specialised services.

The bureau said the charging policy of private service is according to market rates, which should at least equal to the full costs of providing such services, so as to ensure the authority's private services will not interfere with the normal operation of the private market.

On the problem of pregnant Mainland women owing medical fees, the bureau said it has considered the option of amending the law to make the issuance of a birth certificate contingent upon clearing of the debt.

But according to legal advice, it will be objectionable from the legal point of view to amend the law to deprive a child of a right provided by the Basic Law because of the parent's failure to settle debts.

The bureau said it is also exploring the viability of amending the law to allow a public officer to seek the court's agreement to issue a direction to the Director of Immigration to prevent a visitor who has yet to settle their medical fees from re-entering Hong Kong.

It will report to the Legislative Council the viability of such an option upon completion of the review.