(d) Extend Queen Elizabeth casualty department to relieve present overcrowding. This item will be submitted for the Public Works Progremme (category E) and will cost less than $0.5 million. Completion could be by 1974.
(e) Extend Queen Elizabeth B Block to provide facilities for open heart surgery and an extended clinical pathology service. The extension would also allow the addition of about 100 general acute beds. Capital costs of the project have been estimated at $13.5 million and recurrent costs at $6.8 million. The facilities could be open in 1978.
(f)
Add a burns unit to Queen Mary Hospital. No estimates have been made for this project yet, but the initial idea is to provide space by reprovisioning the existing 2-storey canteen block. The order of cost would be $5 million non-recurrent and $1 million recurrent. Given an early approval, work could be completed by 1977.
48. Having established the feasibility of a regional grouping of facilities, with the attendant advantages that patients not requiring sophisticated treatment will not be referred to acute general hospitals, and that patients in acute beds (whether regional or district) will be moved to non-acute beds as soon as possible for convalescence, it is clear that there would have to be a greater degree of integration between hospitals and clinics in the Government and aided sectors than exists at the present time, that uniform fees for those hospitals within the integrated scheme would be necessary, and that to introduce uniform fees would require modification of the way in which some aided hospitals proposed for the scheme are subvented.
49. In Government hospitals patients in third-class beds are charged, as has been said, an all-inclusive fee of $2 a day for maintenance and treatment. This was fixed in 1961 and the service given is very highly subsidized indeed. Apart from this remission system operates, whereby poor patients pay nothing. It would be entirely reasonable to raise the fee immediately to $3 a day, and to $5 a day in 12 to 18 months' time. At that stage a like fee of $5 a day could be adopted by the aided hospitals in the scheme (with a fee remission system, the cost being met from public funds).
50. Once the fees for aided hospitals were fixed in this manner hospitals hitherto subvented on a cost-per-bed basis would be unable
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to regulate their income from this source any longer, and would have to be transferred to the deficiency grant basis of subvention, whereby the difference between expenditure and income from fixed fees is made up from public funds. This would involve in its turn close control over a hospital's expenditure and policies, by means of an Executive Com- mittee on which the Financial Secretary and the Director of Medical and Health Services would be represented, with detailed annual budgets approved by the Executive Committee submitted to Government for approval.
51. Included in the regionalization scheme as proposed above are three hospitals of the Tung Wah Group. By tradition these are free hospitals (with trivial exceptions). However, inasmuch as the charging of fees is an integral part of the regionalization scheme, a completely free service over a significant section of that organization would be anomalous. Bearing in mind the very large sum of money involved in subsidizing the Group of hospitals every year, that a remission system now exists, and that staff have approximately equal conditions of service with Government staff, including equal pay, it seems reasonable that for the uniform operation of the regionalization scheme by all hospitals concerned in the scheme, fees should be paid by patients in acute third- class beds of the Group's hospitals, though the infirmaries could still remain free (being outside the proposed scheme).
52. It has been estimated that the benefits to be derived from the scheme outlined in this Chapter are that it
(a) produces the equivalent of 1,800 general beds;
(b) helps towards the objective of improved accident services;
(c) achieves fuller use of existing expensive acute beds and equip-
ment;
(d) reduces the costs (both recurrent and non-recurrent) of future
hospital building projects.
Non-recurrent costs would be about $33 million. A rough order of recurrent costs would be $15.9 million if all hospitals in the scheme were charging a $3 daily fee (for patients in third-class beds) and, of course, at $5 a day the figure would be less. Remissions would increase the cost.
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