Name of Journal: Improving Hong Kong Title of article: The Hospital Authority Drug Formulary (HADF) Name: Ng Ka Lok (Peony) UID: 2009504279 Email: [email protected] hk Introduction The Hospital Authority (HA) has introduced the Drug Formulary in the fall of 2005. It is a list of drugs that are 1) prescribed freely (HA standard), 2)not prescribed freely but the Samaritan Funds will provide financial assistance if needed(Non-HA standard I)and 3)not prescribed freely and are not protected by a safety net(Non-HA standard II)1.
At present, there are about 1300 drugs listed as HA standard drug, while there are 14 types of Non-HA standard I and 88 types of Non-HA standard II drugs. The purpose of Drug Formulary suggested by the WHO is to provide information about safe and effective drugs to the public rather than “to make rational choice on the best available drugs”2. Many questioned if the HA embarked the Drug Formulary purely to cut cost and neglect the needs of patients in the recent years3. The problems The Drug Formulary running today has 2 major problems.
Firstly, many expensive and often essential drugs4 such as Glivec and Interferon are listed as Non-HA standard I1, it appears that the only criteria to distinguish between standard drugs or non-standard drugs is the cost of the drugs. The Society for Community Organization stated the threshold of application of Samaritans Funds is too high5 as the income of the patient’s family is also counted during assessment. If the family monthly income is greater than the Hong Kong family income median (of the family of the same size) they are not likely to be assisted6.
For example, Ms. Fan is in a family of four. She suffers from autoimmune disease and is required to take Interferon as treatment. The cost of Interferon per month is $7200HKD while her total family income is only $17000HKD. She applied for the Samaritan Funds for four times, but only succeeded once with a help of $1000HKD7, which is obviously a limited help. Secondly, the guideline given by the HA to the doctors to prescribe Non-HA standard drugs in emergency is not clear, doctors might hesitate to prescribe these drugs even if needed8.
The case of Wang Pei – an illustration of the fail of HADF In 2009, Wang Pei arrived at the Queen Elizabeth Hospital suffering from a massive blood loss resulted from a car accident. Her family was required to pay $20,000HKD before she was offered the effective hemostat as it is a Non-HA standard drug. The hemostat immediately improved her condition and she was safe. After media exposure of this incident, the HA was heavily criticized that they are neglecting the lives of patients when embarking the HADF9.
So Yiu Wa, the president of Society of Hospital Pharmacists of Hong Kong even stated that HADF is one of the factors causing the aggravations of the patient’s condition10. Solution 1: To issue Non-HA standard drugs to patients immediately in critical conditions if needed The Hong Kong Public Doctors’ Association criticized that the drugs formulary has become one of their scruples to issue drugs in emergency as they have to “save people’s lives while paying attention to the charging procedures”. 1 After the incident of Wang Pei, HA issued a guideline to all doctors stating if the patient is in critical condition, non-HA standard drugs can be issued as long as evidence proving the drug’s effects and an approval by a senior doctor are both present12. However the guideline is still quite confusing and complicated. Time is very precious in critical situations and should not be wasted in search of approval and evidence. It is suggested to simplify the guideline to allow the doctors in charge to issue Non-HA drugs in critical conditions if he/she finds the need. Solution 2: To lower the threshold to the application of Samaritan Funds.
Many special drugs are not listed as HA standard drugs, therefore patients who are required to take these drugs in a long term might have to pay for these drugs. To improve on this system, the HA should assess the financial condition of the patient alone instead of the patient’s family, as some patients do not live with their family and do not receive financial support from the family. It is also suggested that threshold should be lowered. Assistance should be given even the patient’s family monthly income is greater than the median, as the medication can takes up a large proportion of the family income.
Conclusion: In conclusion, the HADF though can serve a good purpose has a relatively poor implementation, and it might become a threat to the patients’ life both in emergency and in a long term as the Samaritan Funds are not providing full protection. It is suggested that HA set a clearer guideline for doctors in the use of drugs and lower the threshold to the application of Samaritan Funds. Total word: 795 1. Hospital Authority. HOSPITAL AUTHORITY DRUG FORMULARY [online]. 2011. Available: http://www. ha. org. hk/hadf/pdf/hadf_extended_list_20110108. pdf Accessed: 2011 January 27 2.
World Health Organization. How to develop a national formulary based on the WHO Model Formulary – A practical guide [online]. 2004. Available: http://apps. who. int/medicinedocs/en/d/Js6171e/2. 2. html Accessed: 2011 January 27 3. Hospital Authority cost orientated turns patients into test object [online]. Oriental Daily 2009 20th December. Available: http://orientaldaily. on. cc/cnt/news/20091220/00186_001. html Accessed: 2011 January 29 4. Hospital Authority finally realize the needs to review HADF[online]. Oriental Daily 2009 18th June. Available: http://orientaldaily. n. cc/cnt/news/20090618/00176_030. html Accessed: 2011 January 29 5. 6 expensive drugs scheduled to be protected by safety net[online]. The sun 2009 5th November. Available: http://the-sun. on. cc/cnt/news/20091105/00407_022. html Accessed: 2011 February 23 6. Hospital Authority. Samaritans Funds [online]. 2009. Available: http://www. ha. org. hk/haho/ho/hesd/100193c. htm Accessed: 2011 February 23 7. Lee T. Threshold for Samaritans Funds is too high blocking patients to apply. [online]. (undated). Hong Kong: Journews, Baptist University. Available: http://www. kbu. edu. hk/journewsnet/news/news781. html Accessed: 2011 February 5 8. Groups demand for abrogation of HADF[online]. Takungpao 2009 18th June. Available: http://www. takungpao. com. hk/news/09/06/18/GW-1099476. htm Accessed: 2011 February 5 9. Father of patient criticized the usual practice is risking patient’s life[online]. Hong Kong Headline 2009 15th June. Available: http://www. hkheadline. com/news_topic/nt_content. asp? sid=1592&nt=np Accessed: 2011 February 5 10. Patients cut medication by themselves worsening their conditions[online].
Hong Kong Daily News 2010 23rd June. Available: http://www. hkdailynews. com. hk/news. php? id=100623 Accessed: 2011 February 5 11. Hong Kong Public Doctor’s association criticize HA shirking its responsibility[online]. Oriental Daily 2009 1st July. Available: http://orientaldaily. on. cc/cnt/news/20090701/00176_020. html Accessed: 2011 February 15 12. Front line doctors criticize HA leaders shirking their responsibilities[online]. The sun 2009 1st July. Available: http://the-sun. on. cc/cnt/news/20090701/00407_083. html Accessed: 2011 February 20