HAB-P275 (Annual Report on Community Care Fund) · Transcatheter Aortic Valve Implantation (TAVI) for severe aortic stenosis and MitraClip System for severe mitral regurgitation

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For decision HAB-P275 on 28.6.2018

Hospital Authority

Annual Report on the Operation of the Community Care Fund Programmes Purpose This paper :

(a) reports on the operation of the four Community Care Fund (CCF) assistance

programmes with involvement of the Hospital Authority (HA); and (b) seeks Members’ approval for the draft audited accounts of these CCF

assistance programmes for the financial period ended 31 March 2018, which have been presented to and endorsed by the Finance Committee (FC) on 21 May 2018 via FC Paper No. P793.

2. Members may wish to note that in relation to the operation of the CCF, i.e. (a) above, the various recommendations for respective drugs / indications / medical devices for coverage in the CCF medical assistance programmes have been discussed and supported by the relevant subject-related governance platforms, and reported to the Medical Services Development Committee (MSDC) as appropriate.

Background 3. The CCF is a trust fund established in early 2011 under the Secretary for Home Affairs Incorporation Ordinance (Cap. 1044) with the Secretary for Home Affairs Incorporated as its trustee. Its main objective is to provide assistance to people facing economic difficulties, in particular those who fall outside the social safety net or those within the safety net but have special circumstances that are not covered. In addition, the CCF may also consider introducing programmes on a pilot basis to help the Government identify those measures that can be considered for incorporation into its regular assistance and service programmes. 4. The CCF has been integrated into the work of the Commission on Poverty (CoP)１ since 2013. The CCF Task Force, set up under the CoP as chaired by the Chief

１ The CoP was re-organised in December 2014. To deal with various issues more effectively, four task forces were

set up under the second-term CoP to conduct an in-depth study and deliberate on specific areas respectively, namely the CCF Task Force, the Social Innovation and Entrepreneurship Development Fund Task Force, the Special Needs Groups Task Force, and the Youth Education, Employment and Training Task Force.

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Secretary for Administration, is responsible for advising the CoP on the CCF’s various arrangements (including investment, finance and administrative operations), as well as the formulation of assistance programmes, the co-ordination and overseeing of the implementation of assistance programmes, and the evaluation of their effectiveness. The CCF Task Force also liaises closely with other CoP task forces and provides mutual support, so as to draw up programmes to provide assistance to the underprivileged. 5. Since its establishment, CCF has rolled out 46 assistance programmes covering the medical, education, welfare and home affairs areas for various target beneficiary groups including children, elderly persons, persons with disabilities, patients, new arrivals and ethnic minorities.

6. Currently, HA is responsible for administering three CCF Medical Assistance Programmes under the supervision of the Food and Health Bureau (FHB), and acting as one of the service providers for the Dementia Community Support Scheme, for which FHB assumes an overall leading role. The four programmes are summarised as below:

(a) First Phase Programme２２２２ was introduced on 1 August 2011. It provides

financial assistance to HA patients for purchasing specified self-financed (SFI) cancer drugs that have not been covered by the Samaritan Fund (SF) safety net but have been rapidly accumulating medical scientific evidence and with relatively higher efficacy.

(b) Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs

(Including Those for Treating Uncommon Disorders) (UED Programme) was introduced on 1 August 2017. It provides financial assistance to needy HA patients who meet specific clinical requirement to use those ultra-expensive drugs, including those for treatment of uncommon disorders, which have not yet been brought into SF safety net.

(c) Subsidy for Eligible Patients of HA to Purchase Specified Implantable

Medical Devices for Interventional Procedures (MD Programme) was introduced on 1 August 2017. It provides financial assistance to needy HA patients to have early access to specified implantable medical devices for interventional procedures which have not yet been incorporated as part of HA’s standard services due to the need for accumulating further evidence for cost-effectiveness.

２ The Second Phase Programme, rolled out on 16 January 2012, aimed to provide subsidy to needy patients who

marginally fall outside the SF safety net for the use of specified SFI drugs. It complemented the SF by providing additional subsidy to HA patients by reducing their maximum contribution ratio from 30% to 20% of their household annual disposable financial resources (ADFR) to use the specified SFI drugs supported by the SF. The Second Phase Programme had been approved by the Government for incorporation into the Government’s regular assistance programme, i.e. the SF, with effect from 1 September 2012. Upon regularisation, the Second Phase Programme ceased operation on 31 August 2012.

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(d) Dementia Community Support Scheme (DCSS)３３３３ is a two-year pilot scheme covering the period from 1 February 2017 to 31 January 2019. The primary objective is to develop a medical-social collaboration model in providing community support services in District Elderly Community Centres (DECCs) to elderly persons with mild to moderate dementia so as to enhance their functioning level and quality of life and to provide better support for their carers.

7. Under the CCF Medical Assistance Programmes, HA, being the implementing agency of the three Medical Assistance Programmes under the supervision of FHB, is required to report progress of the Medical Assistance Programmes to the CCF Task Force and CoP. The governance structure in HA for the administration of CCF Medical Assistance Programmes as well as the delegation and approving authority were approved by the Board at its meeting on 31 May 2011 via Administrative and Operational Meeting Paper No. 769.

Programme Operations and Progress Update

First Phase Programme

8. As at 31 March 2018, the First Phase Programme was supporting 16 SFI drugs covering 14 types of cancers as set out in Annex 1 (items 1 – 7, 8a, 8d, 9 – 16). The existing SF financial assessment mechanism has been adopted for determining patients’ eligibility for subsidy and contribution to the annual drug costs. 9. Regarding the cumulative application statistics from August 2011 (i.e., programme commencement) to end of March 2018, a total of 9 572 applications were approved and the total amount of subsidies granted was $671.9 million. The average amount of subsidies granted per application was around $70,000. The “big spenders” were four lung cancer drugs – Pemetrexed, Gefitinib, Erlotinib and Afatinib, which accounted for 71% of the total amount of subsidies granted.

10. For the financial year 2017/18 (from 1 April 2017 to 31 March 2018), the number of approved applications was 2 006 and the total amount of subsidies granted was $117.0 million. Pemetrexed, Gefitinib, Erlotinib and Afatinib (the four lung cancer drugs) accounted for 46% while Pertuzumab (a breast cancer drug introduced in August 2017) accounted for another 18% of the total amount of subsidies granted. The application statistics for 2015/16, 2016/17 and 2017/18 are set out in Annex 2.

３ DCSS was endorsed and approved at the CCF Task Force and CoP meetings on 6 May 2016 and 31 August 2016

respectively. The role of HA includes: (i) identifying suitable patients and making referrals to DECCs; (ii) formulating and reviewing care plan for individual patients; (iii) assisting DECCs in the service arrangement according to the agreed care plans; (iv) coordinating, arranging and participating in training; (v) assisting in monitoring the services provided by DECCs and providing advice; (vi) attending case conference at DECCs; and (iv) providing inputs/required data for programme evaluation.

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UED Programme

11. In order to provide financial assistance to needy patients who meet specific clinical requirement to use those ultra-expensive drugs which have not yet been brought into the SF safety net, the UED Programme was endorsed and approved at the CCF Task Force and CoP meetings on 7 March 2017 and 29 May 2017 respectively. 12. The programme was subsequently rolled out on 1 August 2017, covering the drug Eculizumab for treating Paroxysmal Nocturnal Haemoglobinuria (PNH). HA Drug Management Committee’s recommendation for Eculizumab for Atypical Haemolytic Uraemic Syndrome (aHUS) to be covered by UED Programme was reported to MSDC on 9 October 2017 via MSDC Paper No. 499. With the support from HA CCF Administration Committee and the CCF Task Force at their meetings on 18 September 2017 and 8 November 2017 respectively, and subsequent approval by CoP at its meetings on 17 November 2017, the new indication for aHUS was introduced on 25 November 2017. 13. As at 31 March 2018, there were nine applications approved with total amount of subsidy granted at $32.9 million４. The average amount of subsidies granted per application was around $3.66 million.

MD Programme

14. In order to provide subsidy for needy patients to have early access to specified implantable medical devices for interventional procedures which have not yet been incorporated as part of HA’s standard services due to the need for accumulating further evidence on local experience and cost-effectiveness, the MD Programme was endorsed and approved at the CCF Task Force and CoP meetings on 7 March 2017 and 29 May 2017 respectively. 15. The programme was subsequently rolled out on 1 August 2017, covering Transcatheter Aortic Valve Implantation (TAVI) for severe aortic stenosis and MitraClip System for severe mitral regurgitation. 16. As at 31 March 2018, there were 29 applications approved with total amount of subsidy at $7.9 million. The average amount of subsidies granted per application was around $270,000. DCSS

17. DCSS is a two-year pilot programme starting from February 2017 and supported by CCF. The pilot programme aims to develop a medical-social collaboration model in providing community support services to elderly persons with mild to moderate dementia, and enhance the capacity and expertise of the staff of non-governmental

４ The expenditure on subsidies of drug cost to beneficiaries is net of a drug rebate receivable of $2.7 million from the

drug supplier according to the terms of supplier contract.

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organisations (NGOs) at the community level in the provision of dementia support services to the elderly persons. 20 DECCs operated by 16 NGOs in eight districts, namely Sha Tin, Tai Po, Kwun Tong, Tseung Kwan O, Eastern, Wan Chai, Tuen Mun and Yuen Long have joined the Pilot Scheme to provide community support services to patients with mild to moderate dementia referred by the Geriatrics and Psychogeriatrics services of the Hong Kong East Cluster (HKEC), Kowloon East Cluster (KEC), New Territories East Cluster (NTEC) and New Territories West Cluster (NTWC) of HA. 18. As at 31 March 2018, 1 540 patients were referred to DECCs to join DCSS. While the CCF assistance to DCSS would cease from February 2019, the DCSS would be regularised by then and expanded to all 41 DECCs and the other HA clusters (i.e. Hong Kong West Cluster, Kowloon Central Cluster and Kowloon West Cluster) by phases. The recurrent funding for HA to support the regularisation of the scheme has been secured through 2018/19 Resource Allocation Exercise. FHB has commissioned Sau Po Centre of Aging of the University of Hong Kong to conduct a comprehensive project evaluation on the service model which will then be further refined according to the results of the evaluation. Budget for the three Medical Assistance Programmes administered by the HA 19. The cash flow budgets５ for the First Phase Programme and the two new CCF Programmes for the period of 1 August 2017 to 31 March 2019６ were supported by the CCF Task Force and approved by the CoP on 7 March 2017 and 29 May 2017 respectively. Details are as follows:

Programmes

Budget

First Phase

Programme

($’ million)

UED Programme

($’ million)

MD Programme

($’ million)

Cash flow budget for subsidy to beneficiaries

354.4 114.6 16.5

Over-commitment facility for approval of subsidies to beneficiaries ７７７７

531.5 171.8 24.8

Administrative cost 17.5 2.8 0.8

５ The CoP approved at the meeting on 24 March 2014 the revision of budget mechanism for the third year of

operation and subsequent years for the First Phase Programme. According to the revised budget mechanism, the cash flow budget will be utilised for meeting the cash flow requirements for drugs consumed by patients in the respective year of operation irrespective of the approval date of applications.

６ Since the launch of the CCF Medical Assistance Programmes on 1 August 2011, the annual budget is determined

according to the operational year, i.e. from August to July of the next year. In order to dovetail with the annual reporting of the programme operation and audited accounts which is based on the HA’s financial year (from April to March of next year), the current budget period (originally from 1 August 2017 to 31 July 2018) has been extended till 31 March 2019.

７ Over-commitment facility is a practical administrative measure approved by CoP on 28 March 2013 to allow HA to

better utilise the budget for approval of subsidy.

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Future Development Coverage

20. On the recommendation of the HA Drug Management Committee and the Medical Device Advisory Committee, the HA CCF Administration Committee supported at its meeting on 8 March 2018 the introduction of the following new drugs/ indications/ medical items for the First Phase Programme, UED Programme and MD Programme:

CCF Programmes Proposed New Items First Phase Programme 3 new drugs/ indications (including Nivolumab,

Obinutuzumab and Bevacizumab) (Items 8b, 8c, 17 and 18 in Annex 1)

UED Programme 1 new drug (Nusinersen) for treatment of Spinal Muscular Atrophy (SMA)

MD Programme 2 medical devices (including Subcutaneous Implantable Cardioverter Defibrillator and Percutaneous Pulmonary Valve Implantation)

The above recommendations for First Phase Programme and the MD Programme were reported to MSDC on 25 April 2018 via MSDC Paper No. 522; whereas the recommendation on UED Programme will be reported to MSDC in December 2018. 21. For First Phase Programme and UED Programme, it is estimated that the additional financial implication for the new drugs/ indications can be contained within the original approved cash flow budget for the period from 1 August 2017 to 31 March 2019 as mentioned in paragraph 19 as a result of the significant price reduction of an existing lung cancer drug since mid-2017 for First Phase Programme and in view of the latest application status for UED Programme. For MD Programme, the proposed revised budget to meet the additional financial implication of the new medical items and projected increase in the number of approved applications is summarised below:

($’ million) Original Approved Budget Proposed Revised Budget Financial Period 1 August 2017 to 31 March 2019

Cash flow budget for subsidies to beneficiaries

16.5 26.2

Over-commitment facility for approval of subsidies to beneficiaries

24.8 39.3

Administrative Costs 0.8 0.8

22. The proposed new drugs and medical items for the three Medical Assistance Programmes, together with the proposed revised budget for MD Programme, were presented to the CoP for approval at its meeting on 21 June 2018 after support from the CCF Task Force obtained at its meeting on 1 June 2018. Thereafter, the new drugs/ indications/ medical items for First Phase Programme and MD Programme will be introduced in August 2018. As for the new drug Nusinersen for UED Programme, the exact implementation date is subject to the registration of this drug in Hong Kong.

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23. In recent years, the public called on HA to expedite the inclusion of new drugs in the Drug Formulary of HA and the safety net so as to provide more timely support to needy patients. In response to the above public feedback, the frequency for reviewing the drugs supported by the SF and the CCF Medical Assistance Programmes will be increased from once to twice a year so as to shorten the lead time for introduction of new drugs to the safety net coverage.

Consultancy Study on Review of Means Test and Co-payment Mechanism for SF/CCF

24 At the 2017 Policy Address, the Government advised that HA would expedite the review of the patient’s co-payment mechanism under the UED Programme with a view to alleviating the financial burden on patients requiring long-term ultra-expensive drug treatment. Against this background, HA has commissioned Jockey Club School of Public Health and Primary Care of the Chinese University of Hong Kong and the Department of Social Work of Hong Kong Baptist University to conduct a consultancy study on review of means test and co-payment mechanism for SF/CCF. The key areas of the study include:

(a) Co-payment level for ultra-expensive drugs (CCF);

(b) Income limit and patient contribution ratio for very expensive non-drug item (CCF); and

(c) Patient contribution for repeated applications and multiple self-financed

items (SF and CCF).

25. In May 2018, the consultant team has completed the first six months of the study and has proposed to further explore improvements to the means test mechanism of the SF and CCF Medical Assistance Programmes along the following directions:

(a) Modifying the calculation of patients’ annual disposable household financial resources (ADFR) to lower patients’ out-of-pocket spending for avoiding financial hardship by lowering the contribution of asset to the calculation of ADFR;

(b) Redefining “household” in the calculation of ADFR to further remove

non-monetary barriers to access to the services and relieve families’ financial and emotional burden; and

(c) Establishing an appropriate upper limit for patient contribution, especially for

patients with recurrent use or in needs of multiple items. Latest development of the above proposed measures will be reported to the Board in due course.

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Draft Audited Accounts for the Financial Period ended 31 March 2018 (the Accounts) 26. To fulfil its governance role, HA is required to submit the auditor’s report together with the annual accounts of each CCF programme to FHB and CCF Secretariat within three months after the financial year-end. The external auditor, Mazars CPA Limited, has completed the audit for the four CCF Programmes stated in paragraph 6 and has given an unqualified audit opinion on the Accounts. 27. The Accounts of the four CCF Programmes were reviewed and endorsed by the HA CCF Administration Committee on 11 May 2018, and subsequently endorsed by the Finance Committee (FC) on 21 May 2018 via FC Paper No. P793. The Accounts are set out in Annexes 3 to 6 and the financial results of these CCF programmes are described in paragraphs 28 and 29 below for Members’ information.

Highlights of Income and Expenditure Accounts

28. Income and expenditure of the CCF Programmes are summarised in the following table and highlighted below:

($’ million)

First Phase

Programme

(Annex 3)

UED

Programme

(Annex 4)

MD

Programme

(Annex 5)

DCSS

(Annex 6)

Financial Period 1 Apr 2017 –

31 Mar 2018 1 Aug 2017– 31 Mar 2018

1 Feb 2017 –

31 Mar 2018

Income

Funding from CCF 122.9 33.6 8.2 8.7

Other income (e.g. subsidies recovered after post-approval check)

0.7 - - -

123.6 33.6 8.2 8.7

Expenditure

Subsidies to beneficiaries

117.0 32.9 7.9 -

Staff costs 6.5 0.2 0.3 8.2

Programme costs/ administrative costs

0.1 0.5 - 0.5

123.6 33.6 8.2 8.7

29. Funding provided by CCF for supporting the financial requirements of each CCF programme was recognised as income in the Income and Expenditure Account to match with the expenditure incurred for the reporting period, including subsidies to beneficiaries for the First Phase Programme, UED Programme and MD Programme (as described in paragraphs 10, 13 and 16), staff costs, and programme costs/ administrative

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costs incurred for supporting the implementation and ongoing operations of the CCF programmes８. Highlights of Balance Sheet

30. The financial position as at 31 March 2018 of each CCF programme is summarised in the following table:

($’ million)

First Phase

Programme

(Annex 3)

UED

Programme

(Annex 4)

MD

Programme

(Annex 5)

DCSS

(Annex 6)

Assets

Accrued income – CCF 104.2 13.6 - -

Other receivable (drug

rebate from a supplier) - 2.7 - -

Cash and cash equivalents 9.6 7.8 4.8 1.6

113.8 24.1 4.8 1.6

Liabilities

Outstanding liabilities * 113.8 24.1 4.7 0.8

Deferred income (i.e.

unspent funds from CCF) - - 0.1 0.8

113.8 24.1 4.8 1.6

Net Assets - - - -

* Included accounts payable, provisions and accrued charges, and amount due to HA as

reported in the Balance Sheet.

31. As shown above, the Accounts of the CCF Programmes have reported outstanding liabilities for approved subsidy applications, other programme costs and administrative expenses. To meet the financial obligations of each CCF programme, funding is provided by CCF through FHB on a quarterly basis. Hence, each CCF programme maintained a bank balance as at 31 March 2018 to meet the cash flow requirements for the coming quarter. For First Phase Programme and UED Programme, funding to be received after the financial year-end for meeting the outstanding liabilities was reflected in the Accounts as an accrued income from CCF as at 31 March 2018, while the unspent funding already received from CCF for MD Programme and DCSS was captured in the deferred income (i.e. a liability) account.

８ For DCSS, four clusters of HA, namely KEC, NTEC, NTWC and HKEC have supported the pilot scheme and

incurred staff costs of $8.2 million for the 14 months up to 31 March 2018 for employing additional nursing and clerical staff to provide direct services. Programme costs (e.g. staff travelling expenses) and other administrative expenses (e.g. computer and stationery expenses) of $0.5 million were also incurred in the course of service delivery.

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Quality Assurance

Clinical Audit

32. Clinical Audit under quality assurance programme has been introduced to ensure the doctor’s referral criteria for CCF are in compliance with the prevailing clinical guidelines. Sorafenib for Hepatocellular carcinoma had been selected for clinical audit for the applications approved in the fifth year of operation (i.e. 1 August 2015 to 31 July 2016). 33. After peer review of the 15 selected cases by clinical audit team formed by four clinicians of related specialty, it was concluded that all cases selected fulfilled the prevailing clinical guidelines. The audit report had been circulated to the Coordinating Committees in Clinical Oncology and the findings had been reported to the HA CCF Administration Committee.

Post-Approval Check

34. With the ultimate objective of ensuring the use of public money is safeguarded, a post-approval checking mechanism for the CCF Medical Assistance Programmes is in place for detecting and deterring potential fraud and abuse. The commencement of post-approval check (PAC) for First Phase Programme started on 28 February 2012, while the commencement of PAC for UED Programme and MD Programme started on 30 November 2017. HA publicises the post-approval checking arrangement through patient information leaflets, posters and HA’s website. Moreover, patients are well informed of the checking mechanism during their application process. 35. From the commencement of PAC for CCF Medical Assistance Programmes on 28 February 2012 to 31 March 2018, a total of 1 336 applications were randomly selected and distributed to the respective Cluster Checking Units (CCUs) for checking of which 481 applications were selected in 2017/18. Among the 1 117 completed cases, 51 number of cases were found to have under-reported assets and involved non-entitled subsidy of $1,385,027９.

36. For applications which warranted reduction of subsidies after PAC, actions would be taken in accordance with the prevailing guidelines and instructions of FHB to recover the granted subsidy from patients.

37. Out of the 51 cases found to have under-reported assets and involved non-entitled subsidy, two cases with outstanding amount $215,654 in total remained outstanding up to 31 May 2018. One of the cases with non-entitled subsidy, in the amount of $132,654, of a deceased patient identified in the PAC (PAC result approved in September 2017) remained outstanding up to early March 2018. HA had taken all

９ From August 2011 (i.e., programme commencement) to end of March 2018, a total of 9 572 applications were

approved and the total amount of subsidies granted was $671.9 million.

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necessary debt recovery actions for the concerned case１０ but no response was received by early March 2018. In this connection, the case was submitted to FHB for seeking approval for write-off. In accordance with the delegation of authority endorsed by the CoP, Permanent Secretary for Food & Health (Health) approved on 4 April 2018 the write-off of $132,654 of the concerned case. FHB has informed CCF Secretariat of the write-off and a case summary was submitted to the CCF Task Force at its meeting on 1 June 2018.

38. For another case with outstanding amount $83,000, the PAC result was approved in March 2018. The concerned case was reported to FHB seeking advice for further debt recovery actions. 39. To minimise the possibility of similar write-off cases in future and to enhance the PAC mechanism by focusing on those high risk applications, the following measures were proposed after discussion with FHB:

(a) shortening the lead time of case selection for PAC so that under-reported assets and non-entitled subsidy will be identified early to minimise debt recovery action after completion or termination of treatment, and hence the possibility of write-off in particular for deceased beneficiaries; and

(b) increasing the checking coverage of high risk cases (i.e. cases with approved subsidy amount over $300,000) to 100%.

40. Subject to the progress of IT system enhancement for case selection for PAC, Online Owner’s Properties Information Service (for conducting land search) and further review on the resources and manpower readiness, the above proposed measures would be implemented by phases in 2018/19.

Publicity of CCF 41. To enhance publicity of the First Phase Programme, HA posts application statistics, such as the cumulative number of approved applications and subsidy amount, on the HA’s webpage on a monthly basis. HA has also arranged both internal and external publicity measures. Guidelines and relevant documents are promulgated to frontline staff as and when necessary. External publicity measures include publication of articles in patient newsletters, updating of CCF webpage on HA’s website, enhancing publicity through the “Smart Patient Website” of HA and patient forums, and distributing leaflets at HA hospitals and clinics.

１０ Debt recovery actions included issuance of notification letter and making follow-up phone call, conducting

probate searches, issuance of letter to the deceased patient’s mother to urge for the return of non-entitled subsidy, and filing Caveat to the Probate Registry.

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Mechanism for introduction of new indications for existing drugs with no budget implication 42. The CoP, at its meeting on 17 November 2017, authorised HA to introduce new indications or revise the clinical application for existing drugs without the approval from CoP provided that no additional budget is required.

43. Based on the above authorization, for introducing new indications for existing CCF drugs or relaxation of clinical guidelines of CCF drugs without the need of additional budget, endorsement would be sought from HA CCF Administration Committee. The endorsed proposals would be reported to the CCF Task Force and CoP subsequently through FHB. Decision Sought 44. Members are invited to

(a) note the report on the operation of the Medical Assistance Programmes in 2017/18; and

(b) approve the draft audited accounts of the four CCF Programmes for the financial period ended 31 March 2018 as set out in Annexes 3 to 6.

45. Subject to the Board’s approval, the audited accounts will be signed by the HA Chairman for submission to FHB and CCF Secretariat together with the auditor’s report.

Hospital Authority HAB\PAPER\275 21 June 2018

Annex 1 to HAB-P275

Annex 1 – Page 1 of 4

Self-financed cancer drugs supported by the

Community Care Fund Medical Assistance Programme (First Phase Programme)

(Seventh year of operation)

項目項目項目項目

Items

藥物藥物藥物藥物

Drugs

指定治療的指定治療的指定治療的指定治療的

癌症類別癌症類別癌症類別癌症類別

Designated types of cancer

指定臨床適應症指定臨床適應症指定臨床適應症指定臨床適應症

Designated clinical indications

1a

舒尼替尼Sunitinib

腎癌

Renal cell carcinoma

後期腎細胞癌的第一線治療 First line treatment for advanced renal cell

carcinoma

1b 腸胃癌

Gastrointestinal

tumour

伊馬替尼(Imatinib)治療無效或不耐受的無法切除或轉移性胃腸道間質瘤 Unresectable or metastatic gastrointestinal

stromal tumour after failure or intolerance

to Imatinib

2

鹽酸多柔比星

脂質體Pegylated

Liposomal

Doxorubicin

卵巢癌

Ovarian cancer

鉑化合物無效後的第二線或後續鉑化合物抗藥的卵巢癌治療 Second-line of platinum refractory or

subsequent treatment of platinum resistant

advanced ovarian cancer

3 拉帕替尼Lapatinib

乳癌

Breast cancer

曾接受蒽環類藥物、紫杉醇及曲妥珠單抗治療的 HER2陽性後期乳癌 HER2+ve advanced breast cancer with

prior therapy including an anthracycline, a

taxane, and Trastuzumab

4 吉非替尼Gefitinib

肺癌

Lung cancer

表皮生長因子受體突變呈陽性的非小細胞肺癌（一線） First line treatment for patients with activating EGFR mutation positive non-small cell lung cancer

5 索拉非尼

Sorafenib

肝癌

Liver cancer

無法手術、移植或局部治療的肝細胞癌 Hepatocellular carcinoma (HCC) : ineligible for resection, transplant or locoregional therapy

6 培美曲塞Pemetrexed

肺癌

Lung cancer

屬腺癌或大細胞癌轉移性非小細胞肺癌(第 IV期)第一線治療 First line treatment of patients with metastatic non-small-cell-lung cancer (stage IV) of adenocarcinoma or large cell carcinoma histology

7 厄洛替尼Erlotinib

肺癌

Lung cancer

表皮生長因子受體突變呈陽性的非小細胞肺癌（一線） First line treatment for patients with activating EGFR mutation positive non-small cell lung cancer

Annex 1 to HAB-P275






Items


Drugs






8a

貝伐珠單抗Bevacizumab

大腸直腸癌

Colorectal cancer

KRAS 突變型結腸癌肝轉移病人配合氟

尿嘧啶類化療使用作第一線治療

First line treatment of KRAS mutated type

colorectal cancer in combination with

fluoropyrimidine based chemotherapy in

metastatic disease confined to the liver

8b

作為第一線治療，配合化療用於需接受強化治療的RAS突變型之轉移性大腸直腸癌患者 First line treatment of RAS mutant metastatic colorectal cancer in combination with chemotherapy in patients indicated for intensive treatment

8c

作為第一線治療，配合化療用於需接受強化治療的RAS野生型之轉移性大腸直腸癌患者，而患者不適合接受西妥昔單抗治療或產生不耐受 First-line treatment of RAS wild type metastatic colorectal cancer in combination with chemotherapy in patients indicated for intensive treatment who are unsuitable for or intolerant to Cetuximab

8d

卵巢上皮癌、輸卵管癌

和原發性腹膜癌 Ovarian/fallopian

tube/primary peritoneal

cancer

與卡鉑和紫杉醇併用於晚期卵巢上皮癌、輸卵管癌和原發性腹膜癌的第一線治療 With carboplatin and paclitaxel for front-line advanced epithelial ovarian/fallopian tube/primary peritoneal cancer

9 帕唑帕尼

Pazopanib

腎癌

Renal cell carcinoma

後期腎細胞癌的第一線治療 First line treatment for advanced renal cell carcinoma

10 阿法替尼

Afatinib

肺癌

Lung Cancer

表皮生長因子受體突變呈陽性的非小細胞肺癌（一線） First line treatment for patients with

activating EGFR mutation positive

non-small cell lung cancer

Annex 1 to HAB-P275






Items


Drugs






11 苯達莫司汀Bendamustine

白血病

Leukaemia

治療無法接受以氟達拉濱(Fludarabine)為本的化療，或以氟達拉濱難治之慢性淋巴細胞白血病病人，即使用氟達拉濱無效或在治療後十二個月内復發的病人 Treatment of CLL in patients who are

unable to tolerate Fludarabine-based

chemotherapy OR are refractory to

Fludarabine i.e. not responded to

Fludarabine or relapsed within 12 months

of treatment

12 維莫非尼

Vemurafenib

皮膚癌

Skin cancer

用於成年病人以治療 BRAF V600 突變呈陽性而不能切除的或轉移性黑色素瘤的單一療法 Monotherapy for the treatment of adult

patients with BRAF V600

mutation-positive unresectable or

metastatic melanoma

13 曲妥珠單抗Trastuzumab

胃腺癌

Gastric carcinoma

配合順鉑和卡培他濱或 5-氟尿嘧啶用於未曾接受過針對轉移性疾病治療的HER2過度表達（使用已驗證的檢測方法得到的 IHC2+/FISH+或 IHC3+結果）之轉移性胃腺癌患者 Combined with Cisplatin & Capecitabine

or 5FU for HER2 overexpressed metastatic

gastric disease (IHC2+ and confirmatory

FISH+ result, or IHC3+) in

treatment-naive patients for their

metastatic disease

14 培妥珠單抗Pertuzumab

乳癌

Breast cancer

與曲妥珠單抗(trastuzumab) 及多烯紫杉醇(docetaxel) （紫杉醇類藥物）(taxane)

併用，使用於治療轉移後未曾以抗 HER2或化學療法治療之 HER2 陽性轉移性或局部復發、無法切除的乳癌 In combination with trastuzumab and

docetaxel (taxane) in human epidermal

growth factor receptor 2 protein (HER2)

+ve metastatic or locally recurrent

unresectable breast cancer patients with no

prior anti-HER2 or chemotherapy for their

metastatic disease

Annex 1 to HAB-P275






Items


Drugs






15 阿比特龍Abiraterone

前列腺癌

Prostate cancer

適用於治療藥物或手術去勢抗性的轉移性前列腺癌，並且已使用過多烯紫杉醇(docetaxel)而治療無效者 For metastatic castration resistant prostate

cancer progressed on or after

docetaxel-based chemotherapy regimen

16 恩扎盧胺

Enzalutamide

17 尼伏人單抗 Nivolumab

皮膚癌

Skin cancer

適用於治療 BRAF V600野生型不可切除或轉移性黑色素瘤之單一藥劑治療

Monotherapy for BRAF V600 wild-type

unresectable or metastatic melanoma

18

阿托珠單抗

Obinutuzumab

白血病

Leukaemia

適用於與苯丁酸氮芥（Chlorambucil）併用，治療先前未曾接受過治療，且具有合併症而不適合接受全劑量含氟達拉濱（ Fludarabine）或苯達莫司汀（Bendamustine）治療的慢性淋巴細胞白血病患者 In combination with Chlorambucil for

treatment of previously untreated

chronic lymphocytic leukaemia (CLL) in

adult patients with comorbidities making

them unsuitable for full-dose

Fludarabine or Bendamustine based

therapy

Remarks

• Items 1, 2, 3 and 6 were supported by the First Phase Programme since its implementation in August 2011.

• Items 4 and 5 were introduced into the Programme in its second year of operation (i.e. August 2012).

• Item 6 has the treatment cycles extended from 4 to 6 cycles in the third year of operation (i.e. August 2013).

• Items 7 and 8a were introduced into the Programme in August 2013.

• Item 9 was introduced into the Programme in August 2015.

• Items 10, 11, 12 and 13 were introduced into the Programme in August 2016.

• The clinical guideline of Item 3 was relaxed with effect from August 2016 to enable treatment to be

continued till disease progression, with no pre-set maximum lifetime number of cycle.

• Items 8d, 14, 15 and 16 were introduced into the Programme in August 2017.

• Items 8b and 8c, indications proposed to be revised with effect from 1 August 2018. Thereafter, no more new

cases for 8a.

• Items 17 and 18 are new drugs recommended to be introduced with effect from 1 August 2018.


Application Statistics of CCF Medical Assistance Programme (First Phase Programme)

Items Drugs Designated types of cancer

No. of applications approved & amount of subsidies granted

2017/18 ( 1 April 2017 – 31 March 2018 )

2016/17 ( 1 April 2016 – 31 March 2017 )

2015/16 ( 1 April 2015 – 31 March 2016 )

Cases Amount of subsidies

granted 1 Cases

Amount of subsidies granted 1

Cases Amount of subsidies

granted 1

No. As a % of total $M As a %

of total No. As a % of total $M As a %

of total No. As a % of total $M As a %

of total

1 西妥昔單抗 Cetuximab

大腸直腸癌 Colorectal cancer

- - - - 17 1 0.1 0 30 2 1.6 1

2a 舒尼替尼 Sunitinib

腎癌 Renal cell carcinoma

32 2 2.7 2 36 2 2.0 2 40 2 1.5 1

2b 腸胃癌 Gastrointestinal tumour

29 1 2.2 2 24 1 1.9 2 28 2 1.7 1

3 鹽酸多柔比星脂質體 Pegylated Liposomal Doxorubicin

卵巢癌 Ovarian cancer

53 3 2.2 2 41 2 1.6 1 44 2 1.6 1

4 拉帕替尼 Lapatinib

乳癌 Breast cancer

110 6 5.9 5 96 5 5.3 4 66 4 3.4 3

5 吉非替尼 Gefitinib

肺癌 Lung cancer

483 24 24.5 21 502 28 40.6 33 495 30 54.4 44

6 索拉非尼 Sorafenib

肝癌 Liver cancer

299 15 8.8 8 290 16 8.6 7 280 17 10.5 9

7 培美曲塞 Pemetrexed

肺癌 Lung cancer

349 17 0.4 0 391 21 18.8 15 347 21 15.8 13

8 厄洛替尼 Erlotinib

肺癌 Lung cancer

382 19 23.1 20 347 19 34.7 28 298 18 29.0 24

9a

貝伐珠單抗 Bevacizumab

大腸直腸癌 Colorectal cancer

27 1 1.6 1 13 1 0.8 1 14 1 0.4 0

9b

卵巢上皮癌、輸卵管癌和原發性腹膜癌 Ovarian/fallopian tube/primary peritoneal cancer

16 1 4.4 4 - - - - - - - -

10 帕唑帕尼 Pazopanib

腎癌 Renal cell carcinoma

50 3 2.4 2 45 3 4.6 4 27 1 3.3 3

11 阿法替尼 Afatinib

肺癌 Lung Cancer

48 2 5.7 5 20 1 2.7 2 - - - -

12 苯達莫司汀 Bendamustine

白血病 Leukaemia

8 0 1.7 1 2 0 0.5 0 - - - -

13 維莫非尼 Vemurafenib

皮膚癌 Skin cancer

3 0 0.1 0 2 0 0.7 1 - - - -

Annex 2 to HAB-P275

Annex 2 to HAB-P275


14 曲妥珠單抗 Trastuzumab

胃腺癌 Gastric carcinoma

9 0 1.6 1 - - - - - - - -

15 培妥珠單抗 Pertuzumab

乳癌 Breast cancer

48 2 21.4 18 - - - - - - - -

16 阿比特龍

Abiraterone

前列腺癌

Prostate cancer 30 2 4.1 4 - - - - - - - -

17 恩扎盧胺 Enzalutamide

前列腺癌 Prostate cancer

30 2 4.2 4 - - - - - - - -

Total 2,006 117.0 1,826 122.9 1,669 123.2

Remarks

1. The amount has been taken into account the reversal of provisions for subsidies approved in previous years, which was mainly due to early termination of treatments for a number of applications as a result of

change in clinical condition / decease of patients, change of drugs, etc.

2. Item 1 was re-positioned to the Samaritan Fund (SF) on 1 August 2016. All CCF active cases were transferred to the SF, and the remaining drug consumption by beneficiaries would be absorbed by the SF upon

re-positioning.

Audited Accounts

Community Care Fund - Medical Assistance Programmes

For the year ended 31 March 2018

Annex 3 to HAB-P275

Independent Auditor’s Report

To The Board of Hospital Authority Community Care Fund - Medical Assistance Programmes For the year ended 31 March 2018

Page 1 of 8

Opinion

We have audited the accounts of Community Care Fund - Medical Assistance Programmes (the “Programmes”) funded by the Community Care Fund (“CCF”) set out on pages 4 to 8, which comprise the balance sheet as at 31 March 2018, and the income and expenditure account for the year then ended, and a summary of significant accounting policies and other explanatory information.

In our opinion,

(i) the accounts of the Programmes for the year ended 31 March 2018 are prepared, in all material respects,in accordance with the accounting policies of the Programmes as set out in Note 2 to the accounts; and

(ii) the Hospital Authority (“HA”) has complied with the requirements as stipulated by the Food and HealthBureau (“FHB”) and the CCF on implementing the Programmes.

Basis for opinion

We conducted our audit in accordance with Hong Kong Standards on Auditing (“HKSAs”) issued by the Hong Kong Institute of Certified Public Accountants (“HKICPA”). Our responsibilities under those standards are further described in the “Auditor’s responsibilities for the audit of the accounts” section of our report. We are independent of the Programmes in accordance with the HKICPA’s Code of Ethics for Professional Accountants (“the Code”), and we have fulfilled our other ethical responsibilities in accordance with the Code. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Emphasis of Matter – Basis of Accounting and Restriction on Distribution and Use

We draw attention to Note 2 to the accounts, which describes the basis of accounting. The accounts are prepared to assist the HA to meet the requirements of the FHB and the CCF. As a result, the accounts may not be suitable for another purpose. Our report is intended for submission by the HA to the CCF Secretariat and the FHB and for their exclusive usages, and should not be distributed to or used by parties other than the above parties. Our opinion is not modified in respect of this matter.

Annex 3 to HAB-P275



Page 2 of 8

Responsibilities of Management

Management of the HA is responsible for the preparation of the accounts in accordance with the accounting policies of the Programmes as set out in Note 2 to the accounts, and for such internal control as management determines is necessary to enable the preparation of accounts that are free from material misstatement, whether due to fraud or error.

In preparing the accounts, the management is responsible for assessing the Programmes’ ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the management intends to cease operations, or have no realistic alternative but to do so.

The management is responsible for overseeing the financial reporting process.

Auditor’s Responsibilities for the Audit of the Accounts

Our objectives are to obtain reasonable assurance about whether the accounts as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with HKSAs will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these accounts.

As part of an audit in accordance with HKSAs, we exercise professional judgment and maintain professional skepticism throughout the audit. We also:

Identify and assess the risks of material misstatement of the accounts, whether due to fraud or error, designand perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient andappropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resultingfrom fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentionalomissions, misrepresentations, or the override of internal control.

Obtain an understanding of internal control relevant to the audit in order to design audit procedures that areappropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness ofthe entity’s internal control.

Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimatesand related disclosures made by management.

Annex 3 to HAB-P275



Page 3 of 8

Auditor’s Responsibilities for the Audit of the Accounts (continued)

Conclude on the appropriateness of the management’s use of the going concern basis of accounting and,based on the audit evidence obtained, whether a material uncertainty exists related to events or conditionsthat may cast significant doubt on the Programmes’ ability to continue as a going concern. If we concludethat a material uncertainty exists, we are required to draw attention in our auditor’s report to the relateddisclosures in the accounts or, if such disclosures are inadequate, to modify our opinion. Our conclusionsare based on the audit evidence obtained up to the date of our auditor’s report. However, future events orconditions may cause the Programmes to cease to continue as a going concern.

We communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit.

Certified Public Accountants

Hong Kong,

The engagement director on the audit resulting in this independent auditor’s report is: Or Ming Chiu Practising Certificate number: P04786

Annex 3 to HAB-P275


Income and Expenditure Account For the year ended 31 March 2018

Page 4 of 8

2018 2017 Note HK$ HK$

Income Transfer from Community Care Fund and recognised as income 9 122,919,771 126,567,156 Other income 3 644,682 734,718

123,564,453 127,301,874

Expenditure Subsidies of drug costs to beneficiaries

- First Phase Programme 117,004,027 122,872,261

Staff costs 4 6,528,352 4,398,040

Other administrative fees 5 32,074 31,573

123,564,453 127,301,874

Surplus for the year - -

Annex 3 to HAB-P275


Balance Sheet As at 31 March 2018

Page 5 of 8

2018 2017 Note HK$ HK$

Current Assets Accrued income - Community Care Fund 9 104,226,105 66,561,282 Cash and cash equivalents 6 9,536,517 41,439,140

113,762,622 108,000,422

Current Liabilities Accounts payable 3,752,161 3,022,893 Provisions and accrued charges 7 109,394,237 104,602,434 Amount due to the Hospital Authority 8 616,224 375,095

113,762,622 108,000,422

Net Assets - -

Equity Accumulated fund - -

Total Equity - -

Professor John LEONG, Chi-yan, SBS, JP Chairman, Hospital Authority

Annex 3 to HAB-P275


Notes to the Accounts For the year ended 31 March 2018

Page 6 of 8

1. GENERAL INFORMATION

The Community Care Fund (“CCF”) is a trust fund established under the Secretary for HomeAffairs Incorporation Ordinance. Its main objective is to provide assistance to people facingeconomic difficulties, in particular those who fall outside the social safety net or those within thesafety net but have special circumstances that are not covered. The Hospital Authority (“HA”) is theimplementing agent of the First and Second Phases of the CCF Medical Assistance Programmes(“the Programmes”) under the supervision of the Food and Health Bureau (“FHB”). These accountsreflected the financial performance of the Programmes for the year ended 31 March 2018 whichwere implemented by the HA.

The First Phase Programme was implemented on 1 August 2011. It provides financial assistance toHA patients to purchase a list of self-financed cancer drugs that have not yet been brought into theSamaritan Fund (“SF”) safety net but have been rapidly accumulating medical scientific evidenceand with relatively higher efficacy.

The Second Phase Programme was implemented on 16 January 2012. It was targeted to providesubsidies to needy patients who marginally fall outside the SF safety net for the use of the SFsubsidised drugs. The Second Phase Programme has been incorporated into the Government’sregular assistance programme i.e. the SF, with effect from 1 September 2012. Upon regularisation,the Second Phase Programme ceased its operation on 31 August 2012.

2. PRINCIPAL ACCOUNTING POLICIES

(a) Basis of preparation

The principal accounting policies adopted in the preparation of accounts for the Programmesare set out below. The accounts have been prepared on a going concern and accrual bases,and under the historical cost convention.

(b) Revenue recognition

Provided it is probable that the economic benefits will flow to the Programmes and therevenue and costs, if applicable, can be measured reliably, revenue is recognised in theincome and expenditure account as follows:

Funds from the CCF

(i)

(ii)

Funds from the CCF are recognised as income when there is reasonable assurancethat they will be received and that the Programmes will comply with the conditionsattaching to them.

Funds from the CCF relating to income are deferred and recognised in the income and expenditure account over the period necessary to match them with the costs they are intended to compensate.

Annex 3 to HAB-P275



Page 7 of 8

2. PRINCIPAL ACCOUNTING POLICIES (CONTINUED)

(c) Expenditure

Expenditure is recognised on an accrual basis.

(d) Cash and cash equivalents

Cash and cash equivalents comprise cash at bank, demand deposits, and other short-termhighly liquid investments that are readily convertible to a known amount of cash and aresubject to an insignificant risk of changes in value, having been within three months ofmaturity when acquired.

(e) Accounts payable

Accounts payable are recognised initially at fair value and subsequently measured atamortised cost using the effective interest method.

(f) Provisions

Provisions are recognised when, at the time the applications are approved by the HA, theProgramme has a present constructive obligation as a result of past events and it is probablethat an outflow of resources will be required to settle the obligation, and a reliable estimateof the amount can be made.

3. OTHER INCOME2018 2017 HK$ HK$

Excess of patient contributions received over the costs of drug after discounts 136,752 157,196

Subsidies recovered after post-approval checking, financial re-assessment and adjustment by medical social workers 507,930 577,522

644,682 734,718

4. STAFF COSTS2018 2017 HK$ HK$

Salaries, gratuities and other allowances 6,073,064 4,105,405 Contributions to Mandatory Provident Fund and

defined contribution schemes 455,288 292,635

6,528,352 4,398,040

Annex 3 to HAB-P275



Page 8 of 8

5. OTHER ADMINISTRATIVE FEES2018 2017 HK$ HK$

Audit fee 31,800 30,900 Bank charges 184 673 Probate search and caveat filing fee 90 -

32,074 31,573

6. CASH AND CASH EQUIVALENTS

Cash and cash equivalents represent bank balance.

7. PROVISIONS AND ACCRUED CHARGES2018 2017 HK$ HK$

Provisions for approved subsidies to beneficiaries - First Phase Programme 109,193,742 104,503,686 Contract gratuity accrual 168,681 67,831 Accrued audit fee 31,800 30,900 Accrued bank charges 14 17

109,394,237 104,602,434

8. AMOUNT DUE TO THE HOSPITAL AUTHORITY

Amount due to the Hospital Authority represents expenditure paid through the HA’s bank accountand is unsecured, interest-free and has no fixed term of repayment.

9. ACCRUED INCOME – COMMUNITY CARE FUND


Administrative fees Total

HK$ HK$ HK$

Balance at 31 March 2016 and 1 April 2016 64,124,924 (97,186) 64,027,738 Funds received from CCF during the year (119,674,683) (4,358,929) (124,033,612) Transfer to income and expenditure account on

recognition of income 122,137,543 4,429,613 126,567,156

Balance at 31 March 2017 and 1 April 2017 66,587,784 (26,502) 66,561,282 Funds received from CCF during the year (78,453,870) (6,801,078) (85,254,948) Transfer to income and expenditure account on

recognition of income 116,359,345 6,560,426 122,919,771

Balance at 31 March 2018 104,493,259 (267,154) 104,226,105

Accrued income represents funds to be received from the CCF after the financial year-end for meeting the outstanding liabilities.

Annex 3 to HAB-P275

Audited Accounts

Community Care Fund - “Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)”

For the period from 1 August 2017 (date of establishment)

to 31 March 2018

Annex 4 to HAB-P275


To The Board of Hospital Authority Community Care Fund – “Subsidy for Eligible Patients to Purchase Ultra-expensive

Drugs (Including Those for Treating Uncommon Disorders)” For the period from 1 August 2017 (date of establishment) to 31 March 2018

Page 1 of 8

Opinion

We have audited the accounts of Community Care Fund - “Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)” (the “Programme”) funded by the Community Care Fund (“CCF”) set out on pages 4 to 8, which comprise the balance sheet as at 31 March 2018, and the income and expenditure account for the period then ended, and a summary of significant accounting policies and other explanatory information.

In our opinion,

(i) the accounts of the Programme for period from 1 August 2017 (date of establishment) to31 March 2018 are prepared, in all material respects, in accordance with the accounting policies of theProgramme as set out in Note 2 to the accounts; and

(ii) the Hospital Authority (“HA”) has complied with the requirements as stipulated by the Food and HealthBureau (“FHB”) and the CCF on implementing the Programme.

Basis for opinion

We conducted our audit in accordance with Hong Kong Standards on Auditing (“HKSAs”) issued by the Hong Kong Institute of Certified Public Accountants (“HKICPA”). Our responsibilities under those standards are further described in the “Auditor’s responsibilities for the audit of the accounts” section of our report. We are independent of the Programme in accordance with the HKICPA’s Code of Ethics for Professional Accountants (“the Code”), and we have fulfilled our other ethical responsibilities in accordance with the Code. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.



Annex 4 to HAB-P275




Page 2 of 8


Management of the HA is responsible for the preparation of the accounts in accordance with the accounting policies of the Programme as set out in Note 2 to the accounts, and for such internal control as management determines is necessary to enable the preparation of accounts that are free from material misstatement, whether due to fraud or error.

In preparing the accounts, the management is responsible for assessing the Programme’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the management intends to cease operations, or have no realistic alternative but to do so.








Annex 4 to HAB-P275




Page 3 of 8


Conclude on the appropriateness of the management’s use of the going concern basis of accounting and,based on the audit evidence obtained, whether a material uncertainty exists related to events or conditionsthat may cast significant doubt on the Programme’s ability to continue as a going concern. If we concludethat a material uncertainty exists, we are required to draw attention in our auditor’s report to the relateddisclosures in the accounts or, if such disclosures are inadequate, to modify our opinion. Our conclusionsare based on the audit evidence obtained up to the date of our auditor’s report. However, future events orconditions may cause the Programme to cease to continue as a going concern.



Hong Kong,


Annex 4 to HAB-P275


Income and Expenditure Account For the period from 1 August 2017 (date of establishment) to 31 March 2018

Page 4 of 8

Note HK$

Income Transfer from Community Care Fund and recognised as income 10 33,597,463

Expenditure Subsidies of drug costs to beneficiaries 3 32,940,946

Staff costs 4 183,348

Other administrative fees 5 473,169

33,597,463

Surplus for the period -

Annex 4 to HAB-P275



Page 5 of 8

Note HK$

Current Assets Accrued income - Community Care Fund 10 13,620,429 Other receivable 6 2,640,642 Cash and cash equivalents 7 7,818,258

24,079,329

Current Liabilities Accounts payable 778,850 Provisions and accrued charges 8 23,178,918 Amount due to the Hospital Authority 9 121,561

24,079,329

Net Assets -

Equity Accumulated fund -

Total Equity -


Annex 4 to HAB-P275


Notes to the Accounts For the period from 1 August 2017 (date of establishment) to 31 March 2018

Page 6 of 8


The Community Care Fund (“CCF”) is a trust fund established under the Secretary for HomeAffairs Incorporation Ordinance. Its main objective is to provide assistance to people facingeconomic difficulties, in particular those who fall outside the social safety net or those within thesafety net but have special circumstances that are not covered. The Hospital Authority (“HA”) is theimplementing agent of the CCF programme “Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)” (the “Programme”) under thesupervision of the Food and Health Bureau (“FHB”). These accounts reflected the financialperformance of the Programme for the period from 1 August 2017 (date of establishment) to31 March 2018 which was implemented by the HA.

The Programme was implemented on 1 August 2017. It provides financial assistance to needy HApatients who meet specific clinical requirement to use those ultra-expensive drugs which have notyet been brought into the Samaritan Fund safety net.



The principal accounting policies adopted in the preparation of accounts for the Programmeare set out below. The accounts have been prepared on a going concern and accrual bases,and under the historical cost convention.


Provided it is probable that the economic benefits will flow to the Programme and therevenue and costs, if applicable, can be measured reliably, revenue is recognised in theincome and expenditure account as follows:

Funds from the CCF

(i)

(ii)

Funds from the CCF are recognised as income when there is reasonable assurancethat they will be received and that the Programme will comply with the conditionsattaching to them.


(c) Expenditure


Annex 4 to HAB-P275



Page 7 of 8






(f) Provisions


3. SUBSIDIES OF DRUG COSTS TO BENEFICIARIESHK$

Approved subsidies to beneficiaries 35,581,588 Discount on drug costs from supplier (2,640,642)

32,940,946

4. STAFF COSTSHK$

Salaries, gratuities and other allowances 167,279 Contributions to Mandatory Provident Fund and

defined contribution schemes 16,069

183,348

5. OTHER ADMINISTRATIVE FEESHK$

Computer system development expenses 451,139 Audit fee 22,000 Bank charges 30

473,169

Annex 4 to HAB-P275



Page 8 of 8

6. OTHER RECEIVABLE

The amount represents discount on drug costs receivable from the supplier.



8. PROVISIONS AND ACCRUED CHARGESHK$

Provisions for approved subsidies to beneficiaries 23,153,540 Contract gratuity accrual 3,372 Accrued audit fee 22,000 Accrued bank charges 6

23,178,918



10. ACCRUED INCOME – COMMUNITY CARE FUND



HK$ HK$ HK$

Funds received from CCF during the period (19,276,333) (700,701) (19,977,034) Funds transferred between subsidies to beneficiaries and administrative fees 190,500 (190,500) -

Transfer to income and expenditure account on recognition of income

32,940,946 656,517 33,597,463

Balance at 31 March 2018 13,855,113 (234,684) 13,620,429

Accrued income represents funds to be received from the CCF after the financial year-end for meeting the outstanding liabilities.

Annex 4 to HAB-P275

Audited Accounts

Community Care Fund - “Subsidy for Eligible Patients of Hospital Authority to Purchase Specified Implantable Medical Devices for Interventional Procedures”

For the period from 1 August 2017 (date of establishment)

to 31 March 2018

Annex 5 to HAB-P275


To The Board of Hospital Authority Community Care Fund – “Subsidy for Eligible Patients of Hospital Authority to Purchase Specified Implantable Medical Devices for Interventional Procedures” For the period from 1 August 2017 (date of establishment) to 31 March 2018

Page 1 of 8

Opinion

We have audited the accounts of Community Care Fund - “Subsidy for Eligible Patients of Hospital Authority to Purchase Specified Implantable Medical Devices for Interventional Procedures” (the “Programme”) funded by the Community Care Fund (“CCF”) set out on pages 4 to 8, which comprise the balance sheet as at 31 March 2018, and the income and expenditure account for the period then ended, and a summary of significant accounting policies and other explanatory information.

In our opinion,

(i) the accounts of the Programme for the period from 1 August 2017 (date of establishment) to31 March 2018 are prepared, in all material respects, in accordance with the accounting policies of theProgramme as set out in Note 2 to the accounts; and

(ii) the Hospital Authority (“HA”) has complied with the requirements as stipulated by the Food and HealthBureau (“FHB”) and the CCF on implementing the Programme.

Basis for opinion

We conducted our audit in accordance with Hong Kong Standards on Auditing (“HKSAs”) issued by the Hong Kong Institute of Certified Public Accountants (“HKICPA”). Our responsibilities under those standards are further described in the “Auditor’s responsibilities for the audit of the accounts” section of our report. We are independent of the Programme in accordance with the HKICPA’s Code of Ethics for Professional Accountants (“the Code”), and we have fulfilled our other ethical responsibilities in accordance with the Code. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.



Annex 5 to HAB-P275



Page 2 of 8


Management of the HA is responsible for the preparation of the accounts in accordance with the accounting policies of the Programme as set out in Note 2 to the accounts, and for such internal control as management determines is necessary to enable the preparation of accounts that are free from material misstatement, whether due to fraud or error.

In preparing the accounts, the management is responsible for assessing the Programme’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the management intends to cease operations, or have no realistic alternative but to do so.








Annex 5 to HAB-P275



Page 3 of 8


Conclude on the appropriateness of the management’s use of the going concern basis of accounting and,based on the audit evidence obtained, whether a material uncertainty exists related to events or conditionsthat may cast significant doubt on the Programme’s ability to continue as a going concern. If we concludethat a material uncertainty exists, we are required to draw attention in our auditor’s report to the relateddisclosures in the accounts or, if such disclosures are inadequate, to modify our opinion. Our conclusionsare based on the audit evidence obtained up to the date of our auditor’s report. However, future events orconditions may cause the Programme to cease to continue as a going concern.



Hong Kong,


Annex 5 to HAB-P275


Income and Expenditure Account For the period from 1 August 2017 (date of establishment) to 31 March 2018

Page 4 of 8

2017 Note HK$


Expenditure Subsidies of medical items to beneficiaries 7,864,214

Staff costs 3 266,663


8,155,886


Annex 5 to HAB-P275



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Note HK$

Current Assets Cash and cash equivalents 5 4,832,509

Current Liabilities Accounts payable 272,500 Provisions and accrued charges 6 4,411,731 Amount due to the Hospital Authority 7 27,233 Deferred income - Community Care Fund 8 121,045

4,832,509

Net Assets -


Total Equity -


Annex 5 to HAB-P275



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The Community Care Fund (“CCF”) is a trust fund established under the Secretary for HomeAffairs Incorporation Ordinance. Its main objective is to provide assistance to people facingeconomic difficulties, in particular those who fall outside the social safety net or those within thesafety net but have special circumstances that are not covered. The Hospital Authority (“HA”) is theimplementing agent of the CCF Programme “Subsidy for Eligible Patients of Hospital Authority toPurchase Specified Implantable Medical Devices for Interventional Procedures” (the “Programme”)under the supervision of the Food and Health Bureau (“FHB”). These accounts reflected thefinancial performance of the Programme for the period from 1 August 2017 (date of establishment)to 31 March 2018 which was implemented by the HA.

The Programme was implemented on 1 August 2017. It provides financial assistance to needy HApatients to have early access to specified implantable medical devices for interventional procedureswhich have not yet been incorporated as part of the HA’s standard services due to the need foraccumulating further evidence for cost-effectiveness.



The principal accounting policies adopted in the preparation of accounts for the Programmeare set out below. The accounts have been prepared on a going concern and accrual bases,and under the historical cost convention.


Provided it is probable that the economic benefits will flow to the Programme and therevenue and costs, if applicable, can be measured reliably, revenue is recognised in theincome and expenditure account as follows:

Funds from the CCF

(i)

(ii)

Funds from the CCF are recognised as income when there is reasonable assurancethat they will be received and that the Programme will comply with the conditionsattaching to them.


(c) Expenditure


Annex 5 to HAB-P275



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(f) Provisions


3. STAFF COSTSHK$

Salaries, gratuities and other allowances 254,021 Contributions to Mandatory Provident Fund and


266,663


Audit fee 25,000 Bank charges 9

25,009



Annex 5 to HAB-P275



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6. PROVISIONS AND ACCRUED CHARGESHK$

Provisions for approved subsidies to beneficiaries 4,386,729 Accrued audit fee 25,000 Accrued bank charges 2

4,411,731



8. DEFERRED INCOME – COMMUNITY CARE FUND



HK$ HK$ HK$

Funds received from CCF during the period 7,993,773 283,158 8,276,931 Transfer to income and expenditure account on recognition of income (7,864,214) (291,672) (8,155,886)

Balance at 31 March 2018 129,559 (8,514) 121,045

Annex 5 to HAB-P275

Audited Accounts

Community Care Fund – Dementia Community Support Scheme For the period from 1 February 2017 (date of establishment)

to 31 March 2018

Annex 6 to HAB-P275


To The Board of Hospital Authority Community Care Fund – Dementia Community Support Scheme For the period from 1 February 2017 (date of establishment) to 31 March 2018

Page 1 of 8

Opinion

We have audited the accounts of Community Care Fund - Dementia Community Support Scheme (the “Scheme”) funded by the Community Care Fund (“CCF”) set out on pages 4 to 8, which comprise the balance sheet as at 31 March 2018, and the income and expenditure account for the period then ended, and a summary of significant accounting policies and other explanatory information.

In our opinion,

(i) the accounts of the Scheme for the period from 1 February 2017 (date of establishment) to31 March 2018 are prepared, in all material respects, in accordance with the accounting policies of theScheme as set out in Note 2 to the accounts; and

(ii) the Hospital Authority (“HA”) has complied with the requirements as stipulated by the Food andHealth Bureau (“FHB”) and the CCF on implementing the pilot Scheme.

Basis for opinion

We conducted our audit in accordance with Hong Kong Standards on Auditing (“HKSAs”) issued by the Hong Kong Institute of Certified Public Accountants (“HKICPA”). Our responsibilities under those standards are further described in the “Auditor's responsibilities for the audit of the accounts” section of our report. We are independent of the Scheme in accordance with the HKICPA’s Code of Ethics for Professional Accountants (“the Code”), and we have fulfilled our other ethical responsibilities in accordance with the Code. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.



Annex 6 to HAB-P275



Page 2 of 8


Management of the HA is responsible for the preparation of the accounts in accordance with the accounting policies of the Scheme as set out in Note 2 to the accounts, and for such internal control as management determines is necessary to enable the preparation of accounts that are free from material misstatement, whether due to fraud or error.

In preparing the accounts, the management is responsible for assessing the Scheme’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the management intends to cease operations, or have no realistic alternative but to do so.





Identify and assess the risks of material misstatement of the accounts, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.

Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control.

Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management.

Annex 6 to HAB-P275



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Hong Kong,


Annex 6 to HAB-P275

Community Care Fund – Dementia Community Support Scheme

Income and Expenditure Account For the period from 1 February 2017 (date of establishment) to 31 March 2018

Page 4 of 8

Note HK$


Expenditure

Staff costs 3 8,208,623

Programme costs 4 178,519


8,677,684


Annex 6 to HAB-P275



Page 5 of 8

Note HK$

Current Asset Bank balance 1,592,480

Current Liabilities Accounts payable 59,520 Accrued charges 6 45,260 Amount due to the Hospital Authority 7 680,380 Deferred income – Community Care Fund 8 807,320

1,592,480

Net Assets -


Total Equity -


Annex 6 to HAB-P275


Notes to the Accounts For the period from 1 February 2017 (date of establishment) to 31 March 2018

Page 6 of 8


The Community Care Fund (“CCF”) is a trust fund established under the Secretary for HomeAffairs Incorporation Ordinance. Its main objective is to provide assistance to people facingeconomic difficulties, in particular those who fall outside the social safety net or those within thesafety net but have special circumstances that are not covered. On 31 August 2016, the Commissionon Poverty approved the CCF funding for the implementation of a two-year pilot scheme named asDementia Community Support Scheme (the “Scheme”).

The Scheme was implemented on 1 February 2017. The primary objective of the Scheme is todevelop a medical-social collaboration platform in providing community support services to elderlypersons with mild to moderate dementia in District Elderly Community Centres so as to enhancetheir functioning and quality of life and to provide better support for their carers at the communitylevel.

The Scheme is steered by a Task Force led by the Food and Health Bureau (“FHB”) and theHospital Authority (“HA”) is one of the services providers. These accounts reflected the financialperformance of the Scheme for the period from 1 February 2017 (date of establishment) to31 March 2018.



The principal accounting policies adopted in the preparation of accounts for the Scheme areset out below. The accounts have been prepared on an accrual basis and under the historicalcost convention.


Provided it is probable that the economic benefits will flow to the Scheme and the revenueand costs, if applicable, can be measured reliably, revenue is recognised in the income andexpenditure account as follows:

Funds from the CCF

(i)

(ii)

Funds from the CCF are recognised as income when there is reasonable assurancethat they will be received and that the Scheme will comply with the conditionsattaching to them.


Annex 6 to HAB-P275



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(c) Expenditure

Staff costs, programme costs and other administrative fees including furniture, computerrelated equipment and accessories as disclosed in notes 3 to 5, are recognised as expenditureon an accrual basis.

(d) Accounts payable


3. STAFF COSTS

4. PROGRAMME COSTS

Programme cost represents expenditure incurred for the delivery of direct services for theprogramme such as staff travelling expenses and assessment instruments / tools (e.g. standardisedassessment forms and treatment aids, etc.) .


Furniture and maintenance 106,476 Computer related equipment, accessories and

maintenance 103,752 Audit fee 29,000 Others 51,314

290,542

HK$

Salaries, gratuities and other allowances 8,066,628 Contributions to Mandatory Provident Fund and


8,208,623

Annex 6 to HAB-P275



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6. ACCRUED CHARGESHK$

Accrued audit fee 29,000 Accrued travelling expenses 9,530 Contract gratuity accrual 4,630 Others 2,100

45,260



8. DEFERRED INCOME – COMMUNITY CARE FUND

Staff costs

Programme costs


HK$ HK$ HK$ HK$

Funds received from CCF during the period 8,935,477 233,340 316,187 9,485,004 Transfer to income and expenditure account on recognition of income (8,208,623) (178,519) (290,542) (8,677,684)

Balance at 31 March 2018 726,854 54,821 25,645 807,320

Annex 6 to HAB-P275

Documents

HAB-P275 (Annual Report on Community Care Fund) · Transcatheter Aortic Valve Implantation (TAVI) for severe aortic stenosis and MitraClip System for severe mitral regurgitation