20 April 2015
The Government had launched the Elderly Health Care Voucher Pilot Scheme in 2009 and converted the Scheme from a pilot project into a recurrent support programme for the elderly. The current annual voucher amount is $2,000 and the accumulation limit of the voucher amount is $4,000. The public seemed not knowing much about the Scheme since its launching. To learn more about what the public thinks about the Scheme, the Hong Kong Medical Association had commissioned the Public Opinion Programme of the University of Hong Kong to conduct a survey through randomized telephone interview in January 2015. The Centre successful interviewed 506 senior citizens aged 70 or above and 510 local adult, living or taking care of an aged family member. In view of that there are at present some 1,700 doctors enrolled in the EHCVS, HKMA had survey on our members for their opinions on EHCVS. Totally, 1,173 valid questionnaires were received, among which responses of 723 private practising doctors were being analyzed.
Dr. CHAN Yee Shing, Alvin, the HKMA Vice-President cum Chairman of the HKMA Task Force on Vaccination Public-Private-Initiative announced the results of the two surveys on behalf of HKMA. In the public’s opinions, half of the elderly would seek help from general practitioners in their neighborhood when they feel unwell. General Outpatient clinics came second, about 37.9%. Over 80% of the elderly had used health care vouchers and most commonly used for general consultation. Only 16.1% used on preventive medicine, e.g. vaccination and medical checkup. If the elderly are accompanied by a family member/caregiver for medical consultation, those seeking help from general practitioners in their neighborhood (63%) are doubled than those who go to General Outpatient clinics (GOPC) (30.1%). It reflects that the traditional Chinese value on family is rooted in Hong Kong people. When the elderly feels unwell, the family member/caregiver will accompany him/her for medical consultation by choosing a doctor in neighborhood to avoid the long waiting time in GOPC.
The elderly and the caregivers viewed differently on the sufficiency of the current annual voucher amount. 41.9% of the elderly considered the $2,000 amount sufficient, slightly higher than those who considered insufficient (37.2%). 64% of the caregivers thought $2,000 was insufficient and proposed increasing it to an average amount of $4,000. 70% of the elderly and 80% of the caregivers supported to reduce the eligible age for EHCVS from 70 to 65. Almost all of the respondents, 88.2% of elderly and 93.7% of caregivers, highly recognized the importance of preventive medicine and supported it to be implemented in the community and/or in hospitals as well.
Majority of the respondents, 74% of elderly and 65.9% of the caregivers, had not taken the early assessment test on Major Cognitive Disorder (dementia) 1, nor having a plan to do so in foreseeable future. Dr. Alvin CHAN believed that it reflected that the general public lack of the awareness on dementia, and neglect the importance of early detection and grasp the timely treatment during the golden period. As such, the vouchers are rarely used in detecting and treating the disease.
Two-thirds of the elderly had received seasonal influenza vaccination in the past 5 years and the vaccinations were subsidized by the Government. Whereas, only 36% received pneumococcal vaccination in the past 5 years. For those who had not received vaccinations, the key reason was that they believed they were in good health and would not get infection; some were worried about the side effects. Dr. Alvin CHAN hoped more public education would be carried out by the Government to address the misconception that vaccinations would create side effects. This could motivate the general public by getting vaccinated in time for better health protection. Most of the elderly thought the Government’s subsidy for seasonal influenza vaccination ($160) and pneumococcal vaccination ($190) were good enough, nonetheless, the subsidy amount of the latte did not include the recent pneumococcal vaccines that the Scientific Committee on Vaccine Preventable Diseases of the Centre for Health Protection (CHP) encouraged people aged 65 above to receive. The eligible elderly should use the vouchers in disease prevention, such as the appropriate vaccination uptake.
In the HKMA members' survey, we found that 32.4% of the private doctors had enrolled in the EHCVS. Most of the respondents who did not enroll in the Scheme considered that the eHealth System was too troublesome or some other reasons. 35.5% of the respondents thought the $2,000 annual voucher amount was generally sufficient while 32.4% of them considered it insufficient and proposed increasing the amount to $3,000. As for the suggestion to increase the accumulation limit of voucher amount to $6,000, over 70% of the private doctors supported. Nearly 60% of the respondents agreed to reduce the eligible age for EHCVS from 70 to 65.
Representing the Hong Kong Medical Association, Dr. SHIH Tai Cho, Louis, JP, suggested the following:
1. To reduce the eligible age of the Elderly Health Care Voucher Scheme to 65, in line with that of the Senior Citizen Card Scheme.
2. To increase the annual voucher amount of EHCVS to $4,000.
3. To increase the accumulation limit of EHCVS to $6,000.
4. To educate the public on utilizing the Elderly Health Care Voucher on preventive medicine, e.g. vaccination and medical checkup.
5. In view of the aging problem, more public education is needed on dementia and the Government should encourage the elderly to receive early assessment.
6. To place resources for implementing preventive medicine in the community.
7. To promote EHCVS towards doctors through the Continuing Medical Education programmes on “Preventive Care for Older Adults in Primary Care Settings” co-organized by the HKMA and Department of Health in various districts.
According to the information from the Hong Kong Alzheimer’s Disease Association, 1 out of 10 elderly at aged 70 or above has dementia. The ratio grows to one in three at the aged of 85 or above. The prevalence of dementia in Hong Kong will increase from 103,433 in year 2009 to 332,688 in year 2039.
Notes to editors:
The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts. The foremost objective of the Association is to safeguard and promote public health. The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world. In fulfilling these goals, the association hopes to better serve the people of Hong Kong.