Hong Kong – LCQ14: Measures to enhance dental services

     Following is a question by Revd Canon the Hon Peter Douglas Koon and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (January 10):

Question:

     It has been reported that the current waiting time for public dental services is long and private dental clinics charge exorbitant fees which the grass-roots can hardly afford. Regarding measures to enhance dental services, will the Government inform this Council:

(1) whether it will consider extending the School Dental Care Service of the Department of Health to cover secondary school students and regularising the Jockey Club Children Oral Health Project; if so, of the details; if not, the reasons for that;

(2) as there are views pointing out that each eligible elderly person is allotted health care vouchers with a value of $2,000 each year and the cumulative value of health care vouchers is capped at $8,000 only, which is just a drop in the bucket for many elderly people who need to receive dental treatment, whether the authorities will consider introducing “dental care vouchers” for eligible elderly people and extending the scope of application of such vouchers to the Mainland cities of the Guangdong-Hong Kong-Macao Greater Bay Area, and study the introduction of elderly dental care services to allow elderly people who are aged 65 or above and do not reside in residential care homes for the elderly to receive regular dental check-ups; if so, of the details; if not, the reasons for that;

(3) given that the Elderly Dental Assistance Programme of the Community Care Fund only covers people who are aged 65 or above and are recipients of the Old Age Living Allowance, whether the authorities will consider lowering the age threshold of target beneficiaries to 60 years old and further expanding the scope of the subsidised items (to cover, for example, dental implant); if so, of the details; if not, the reasons for that;

(4) as there are views pointing out that at present, there are only 11 dental clinics providing general public dental services in Hong Kong, and with insufficient general public dental service sessions, such clinics only provide pain relief and extraction services, whether the authorities have plans to (i) set up additional government dental clinics and subsidise non-governmental organisations to operate mobile dental clinics, so that each of the 18 districts across the territory will have at least one government dental clinic and one mobile dental clinic, and (ii) improve general public dental services, including extending the service hours and expanding the service scope to cover services such as dental filling, fitting of dentures and root canal treatment; if so, of the details; if not, the reasons for that; and

(5) whether it will, by drawing reference from practices in overseas regions and the findings of the territory-wide Oral Health Survey 2021, expeditiously review the oral health goals and set more appropriate oral health goals for members of the public (particularly elderly people) and formulate the relevant feasible measures; if so, of the details and timetable; if not, the reasons for that?

Reply:

President,

     The Chief Executive announced in the 2022 Policy Address to conduct a comprehensive review of the dental services provided or subsidised by the Government. The Working Group on Oral Health and Dental Care (Working Group) was subsequently established in end 2022. The review covers policy objectives, implementation strategies, service scopes and delivery models of oral health and dental care. The Working Group just released an interim report to summarise the work progress in 2023. Making reference to the recommendations of the Working Group, the Chief Executive announced in the 2023 Policy Address a series of measures to enhance the dental services for different age groups and target groups.

     The Government noted the suggestion of the Working Group that the future development of dental services should be in line with the strategies of the Primary Healthcare Blueprint with the goal of retention of natural teeth and enhancing the overall level of citizens’ oral health. The Government agreed with the advice of the Working Group that when considering the provision of government-funded curative dental services, the long-term financial sustainability must be taken into account. It is more cost-effective to put the emphasis on preventive dental services to achieve the goal of enhancing the overall level of citizens’ oral health. At the same time, targeted assistance should be provided to individual underprivileged groups who had difficulties in obtaining dental services.

     The Government will strive to develop and promote primary dental services to assist citizens to manage their own oral health and to put prevention, early identification and timely intervention of dental diseases into action. The Government will also explore how to continue to develop appropriate and targeted dental services to the underprivileged groups defined by the Working Group.

     The reply to the various parts of the questions raised by the Revd Canon the Hon Peter Douglas Koon is as follows:

(1) As announced in “The Chief Executive’s 2023 Policy Address”, the Government plans to launch the Primary Dental Co-care Pilot Scheme for Adolescents in 2025 as an interface with the School Dental Care Service for primary school students by providing partial subsidies for private dental check-up services for adolescents aged between 13 and 17, so as to foster the establishment of a long-term partnership between the adolescents and the dentists in the non-governmental organisations (NGOs) or the private sector and to promote the adolescents’ life-long habit of regular dental check-ups for prevention of dental diseases.

     The Faculty of Dentistry of the University of Hong Kong launched the Jockey Club Children Oral Health Project in 2019 with the support of the Hong Kong Jockey Club Charities Trust. The Working Group reviewed the data collected by the Faculty of Dentistry of the University of Hong Kong and noted that the Project was effective in slowing down tooth decay among preschool children. The Project will be supported by the Hong Kong Jockey Club Charities Trust up to the 2025/26 academic year. The Working Group will continuously monitor the effectiveness of this Project to determine the way forward for dental services for preschool children.  

(2) The Elderly Health Care Voucher Scheme subsidises eligible Hong Kong elders aged 65 or above with an annual voucher amount of $2,000 to use private primary healthcare services, including dental services. In 2019, the accumulation limit of the voucher amount was raised to $8,000. Under the existing arrangement, the elderly can flexibly use the vouchers to receive private primary healthcare services that best suit their health needs. In 2022, the voucher amount claimed by the elderly for private dental services was about $343 million, represented 13 per cent of the total voucher amount claimed, which was the third highest among the 10 types of healthcare services in that period. The average amount per claim transaction for dentists was $1,190, which was the second highest among the 10 types of healthcare services.

     To make better use of resources to promote primary healthcare, the Department of Health (DH) launched the Elderly Health Care Voucher Pilot Reward Scheme from November 13, 2023 for three years. For each year during this period, elderly persons only need to accumulate the use of vouchers of $1,000 or more on designated primary healthcare purposes such as disease prevention and health management services (including dental check-ups, scaling, filling, extraction) within the year, and they will be automatically allotted a $500 reward into their voucher account, which can be used on the same designated primary healthcare purposes. This measure would incentivise the elderly to use the voucher for regular dental check-ups.

     Furthermore, eligible elderly may also use the voucher to pay for services provided by the University of Hong Kong-Shenzhen Hospital, including dental services. As announced in “The Chief Executive’s 2023 Policy Address”, the Elderly Health Care Voucher Greater Bay Area Pilot Scheme will be rolled out this year to extend the coverage of the Elderly Health Care Vouchers (EHCV) to suitable medical institutions in the Greater Bay Area, including individual designated medical institutions providing dental services in places such as Shenzhen. The Health Bureau (HHB) and the DH have already commenced work to take forward the Pilot Scheme.

     The HHB will include oral health information into the Life Course Preventive Care Plan promulgated by the Primary Healthcare Office to promote the habit of regular dental check-ups among different age groups, including the elderly.

     The Government currently subsidises elderly to use private healthcare services including dental services through EHCV. At the same time, the Government provides subsidies covering dental services to elderly persons with financial difficulties, including the Elderly Dental Assistance Programme (EDAP) funded by the Community Care Fund (CCF) and the dental grant under the Comprehensive Social Security Assistance (CSSA) Scheme. At this stage, the Government does not have any plan to introduce an EHCV designated for dental services. However, the Government will explore how to incentivise elderly persons to receive regular dental check-ups by various measures, such as the Elderly Health Care Voucher Pilot Reward Scheme and the promotion of dental check-ups in collaboration with the dental profession.

(3) The EDAP funded by the CCF was launched in September 2012. The EDAP aims to provide free removable dentures and related dental services to low-income elderly who are users of home care services subvented by the Social Welfare Department and recipients of the Old Age Living Allowances (OALA) aged 65 or above (i.e. all OALA recipients). The number of eligible elderly of EDAP is now over 710 000, representing about 44 per cent of the population of elderly at the age of 65 or above. The spending on this Programme was close to $300 million in 2022-23.

     The Government will enhance the EDAP in the third quarter of 2024 to lift the essential requirement of fixing removable dentures, so as to enable eligible elderly to receive services such as dental check-ups, scaling, extraction and filling without applying for removable dentures, with a view to encouraging elderly to identify and treat dental diseases in an early stage and to retain natural teeth as far as possible. Taking into consideration the priority in the allocation of resources, there is no plan to lower the minimum eligible age of 65 under the Programme at this stage.

(4) The Government currently provides or subsidises limited dental services, which mainly include the management of dental emergencies for the public, the implementation of measures catering for persons with special dental care needs, especially the elderly and families with financial difficulties or persons who have difficulties in accessing general dental services. Services provided for persons with special dental care needs include special care dental services for persons with intellectual disability and the Healthy Teeth Collaboration, as well as dental care support for the elderly under the Outreach Dental Care Programme for the Elderly and the EDAP funded by the CCF. Also, elderly may use health care vouchers to receive dental services in the private sector, and persons with financial difficulties may apply for dental grant to cover dental treatment expenses under the CSSA Scheme.

     At present, general dental services are provided mainly by the private sector and the NGOs. The Government provides dental services limited to the management of dental emergencies to the public. Free emergency dental service (generally referred to as General Public (GP) Sessions) are provided by the DH through designated sessions each week in its 11 government dental clinics. Dental service under the GP Sessions only include treatment of acute dental diseases, prescription for pain relief, treatment of oral abscess and teeth extraction. The dentists will also provide professional advice based on individual needs of patients. Under the civil service terms of appointment, the Government is obliged to provide dental benefits for civil servants/pensioners and their eligible dependents. Dental clinics under the DH are established primarily for fulfilling this obligation. That said, the Government uses a small fraction of the service capacity of the dental clinics to provide supplementary emergency dental service to the general public. 

     The Working Group considered that the current mode of service of GP Sessions was not effective in targeting underprivileged groups in need. Taking into consideration the dentist manpower shortage in the DH, the Working Group considered that it is more appropriate to increase the service capacity in collaboration with the NGOs. As announced in “The Chief Executive’s 2023 Policy Address”, the Government will collaborate with the NGOs to increase the emergency dental services targeting at the underprivileged groups with financial difficulties in 2025 through expansion of service capacity, service points and service scope. The HHB is exploring the details and will announce the details in due course.

(5) Hong Kong established the oral health goals to be achieved by year 2010 and 2025 in 1991. The Report No. 68 of the Director of Audit published in 2017 on provision of dental services has recommended the review of oral health goals. 

     Before formulating policies and oral health goals in Hong Kong, the DH needs to collect the most recent information on the oral health status and related behaviour of the people in Hong Kong. The first community-wide Oral Health Survey (OHS) conducted by the DH was conducted in 2001, undertook to carry out an OHS every 10 years. The OHS 2011 was therefore conducted, and the following round of OHS already commenced in November 2021. Due to the COVID-19 epidemic, the survey work was delayed and was completed in end 2023. The DH will release the survey report and will set oral health goals for people of different age groups in Hong Kong within this year. The Government will also invite the Working Group to provide comments on the oral health goals.