Measures are in place to prevent abuse of the medical fee waiver system, the Social Welfare Department says, adding it must also consider non-financial factors in processing applications, to ensure vulnerable groups have access to proper care.

In response to the Ombudsman's 2006-07 Ombuds News No.1 issued today, the department and the Hospital Authority said they generally accept the recommendations and agree with the principle that public resources should be prudently managed and used for those genuinely in need.

The following measures have been included in the latest operational guidelines issued on March 29 for implementation:

*strengthening the checking mechanism, with the supervisor to check all waivers approved on non-financial grounds;

*medical social workers must submit all new cases to their supervisors for endorsement within five working days from the date of receipt;

*all service units must select 1% of the medical fee waiver cases for random checks each six months; and

*medical social workers are reminded to cross-check applicants' information.

Balanced consideration

The department said it would study the feasibility of implementing the Ombudsman's other recommendations, while the authorities would continue to improve the medical fee waiver system.

However, the department said in processing the medical fee waiver applications, it needed to strike a balance between patients' access to medical services and effective use of public funds, so that needy patients are not deterred from seeking necessary medical treatment by complicated and over-stringent administrative procedures.

Social workers will consider both the financial factors as well as social, or non-financial, factors in processing waiver applications.

Applications from the disabled, chronically ill, the elderly and psychiatric patients may not meet the financial criterion. But based on individual case merit and difficulties, social workers will consider granting a waiver on social grounds.

On cases highlighted in the report, the department did not agree with the comment that it had 'dismissed the matter so readily' and was 'covering up mistakes'.

Referring to a case involving a chronic psychiatric patient who needed long-term treatment, the department said a medical social worker had admitted that due to her oversight, she wrongly interpreted the patient's monthly income, and waived his medical charges for three months on financial grounds. The total value of the waiver involved was $124.

After the mistake was discovered by another medical social worker, the case was reviewed by the supervisor and the Assistant District Social Welfare Officer, who considered that there had been an oversight and duly advised the worker involved to make necessary improvements.

However, considering the patient's mental condition, there were adequate non-financial factors to justify granting a medical waiver, as an incentive to encourage him to receive treatment.

But the second worker filed a complaint that the patient had produced false information and suggested the case be referred to the Police for investigation.

Upon receiving the complaint, the concerned supervisor and district management investigated the case and concluded that it was not a fraud case, concurring that the medical waiver was granted under professional judgment with due consideration to the patient's mental condition.

The department said it had not covered up any mistake in this case. Headquarters and district management had conducted an assessment and investigation into the case in accordance with the existing guidelines, and the staff who had committed the mistake had been reprimanded.

The department reiterated it supported the general direction of the Ombudsman's recommendations to improve the medical fee waiver system and it would work hand in hand with the Hospital Authority to prevent abuses.