pacity, I asked the Director of Social Welfare if he thought that the expenditure incurred was fully justified, especially when considered in relation to the principle governing another element in the composition of the public assistance grant, which restricts assistance towards the cost of private accommodation to a maximum based on the rent in public housing estates.
56. Whilst he accepted the logic of limiting the assistance given towards private schooling and did not exclude the possibility and desirability of persuading assisted families to send their children to Government and aided schools in suitable cases, the Director of Social Welfare expressed the opinion that it was appropriate to continue to include as an element of public assistance, fees for attendance at private primary schools. He based this view on the possibility that the free places at present unoccupied might not necessarily be convenient for use by the children concerned and that to deprive families of assistance towards private education might result in their resources being diverted to this object, at the expense of other essential requirements.
57. Head 83-Subventions: Medical. Subhead 109. Hong Kong Buddhist Hospital. Amongst the accounts of subvented organizations reviewed during the year were those of the Hong Kong Buddhist Hospital, which in 1975-76 received a recurrent subvention of $3,401,604. The hospital was opened in July, 1970 with a comple- ment of 180 general beds. Later 45 private beds were added and in April, 1975 the number of general beds was increased to 250, to give a total of 295 beds. As early as 1973 the Finance Branch of the Government Secretariat had become concerned at the relatively high cost of the hospital and in the following year expressed the view that of all the subvented hospitals, it was not only the most expensive per bed but it also had the lowest rate of occupancy. It seems probable that the latter was because the contribution made by the Buddhist Association towards the running costs amounted, according to my analysis of the audited accounts of the hospital for 1974-75 and earlier years, to not much more than the sum needed to finance the private beds (which do not qualify for subvention) and therefore to cover the 25% non-subvented element of the general beds, the fees charged to patients admitted to the general wards were possibly higher than those which could reasonably be afforded by the majority of the population in the catchment area of the hospital.
58. In July, 1974 the Medical and Health Department endeavoured to overcome the underutilization of the hospital's facilities and at the same time relieve pressure on its own medical staff, by transferring convalescent patients from Queen Elizabeth Hospital and paying from Government funds the amounts by which the fees at the Buddhist Hospital exceeded those charged at Government hospitals. This scheme did not seem to achieve more than limited success. It increased the average occupancy rate of the Buddhist Hospital from 49% in 1973-74 to 62% in 1974-75 and to 82% in August, 1976, but did little to alleviate the burden on Government's clinical consultants who continued to attend the patients transferred even though, so I am informed, the medical staff at the Buddhist Hospital could have coped with the increased work occasioned by the additional patients. From a financial viewpoint, the use of Government staff at the Buddhist Hospital had the effect of providing a subven- tion to the hospital additional to that provided by the Legislative Council.
59. I have suggested that there would seem to be a strong case for an early and detailed investigation into the cost of the services provided by the Buddhist Hospital and also that ways should be explored to enable the hospital to make better use of its existing capacity and so lower the cost-per-bed. I have invited attention to the fact that although the hospital has the capacity to accommodate 350 patients, since its completion part of the hospital has remained closed and certain of its facilities underemployed: indeed at the time of my visit earlier this year, one complete floor remained unused. For so long as this situation persists it would seem doubtful if full value is being received for the public moneys voted in aid of the hospital.
60. Head 83—Subventions: Medical. Subhead 114. Pok Oi Hospital. Another subvented medical institution with a history of relatively high costs and low bed occupancy is the Pok Oi Hospital, which in 1975–76 received a subvention of $2,996,939. During the period 1971-72 to 1974-75 the cost-per-bed rose by 90% to $21,400 per annum, but because the average occupancy rate did not exceed 70% of capacity, the cost per "patient-year" went even higher, to $30,600. A factor in the cost is the ratio of staff to beds but as standard figures applicable to subvented hospitals have not been laid down by the Medical and Health Department, I am unable to express a view on the extent to which it was material. Meanwhile I have invited the attention of the Director of Medical and Health Services to a sequence of events which might have given rise to an overpayment of the subvention. It is a condition of the award of a discretionary grant that it should not be applied towards the cost of maternity beds but I understand that expenditure relating to 32 maternity beds was included when assessing the amount of subvention payable to the hospital for 1972–73. In the following year all the maternity beds appear to have been reclassified as obstetrical and gynaecological beds and were thus ranked as eligible for subvention, but despite the consequent absence of maternity beds per se, the hospital's statistical records still showed that in the first eight months of that year 683 live births were recorded, with an average period of hospitalization of the patients concerned of 4.5 days. The Director of Medical and Health Services has agreed that some of the maternity cases are normal but considers that as others are admitted with complications or under emergency conditions it is not possible in the circumstances of this hospital to define which beds are for normal maternity cases and which are for complicated cases.
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