Leung points out that the checklist on the third page of the assessment form provides more guidelines for doctors. The checklist states that being unable to work in the original occupation due to visceral disability is equivalent to “100 per cent loss of earning capacity”. Since ESRD patients’ working ability is lowered due to kidney failure, Leung thinks that ESRD patients’ applications should be approved.
“The doctors fill in the forms by themselves,” Leung says. “[They] often don’t have enough time to read the third page.”
Leung sent a letter to doctors in December 2013, and reminded them that patients with severe disability, like ESRD patients, may be eligible for the allowance even though they are employed. However, Leung’s letter did not bring significant improvement. Many patients still fail in their applications for disability allowance.
Daniel Chan Tak-mao, the chief of the Nephrology Division of the University of Hong Kong, says he has not read Leung’s letter. Chan says doctors will only consider medical factors and whether the disability has caused the 100 per cent loss of working ability in assessing the applications.
Chan says the aim of dialysis treatment is to help patients to recover, and that receiving treatment is not equivalent to disability. While he says he understands that ESRD patients need to receive frequent dialysis treatments, and have difficulty in finding jobs due to this, he asks: “But is this a social factor or a medical factor? This is a grey area.”
He explains that some applications were approved because the patients suffer from other diseases, such as heart disease, in addition to kidney disease. He thinks these other conditions may justify their applications.
However, Chan concedes a doctor’s judgment is subjective, and the definitions in the form are unclear. “If your kidneys lose 70 per cent functioning capacity, is it equivalent to disability?” he asks.
Legislator Fernando Cheung Chiu-hung, who has been working on the issue with renal disease patients’ organisations, says some developed countries consider “disability” from both a medical perspective and a social one.
He understands that doctors may not have enough time to assess social factors and thinks a “multi-professional assessment would be more comprehensive.” He suggests that a panel, including doctors, social workers and therapists should be set up to assess an application.
In a meeting of the Panel on Welfare Services in the Legislative Council in 2006, the government said such a panel review would lengthen the time to process applications. Instead it stressed patients could appeal, and the Medical Assessment Board would reassess their applications.
However, the board only consists of a doctor from the Hospital Authority and two representatives from the Hong Kong Medical Association. Its decisions are final and from 2013 to 2014, 67 appeal cases against medical decisions were successful, accounting for 25 per cent of 263 disability allowance appeals.
Cheung proposes a more immediate solution to the issue. He says the government should follow the suggestion of the Office of the Ombudsman in 2009 to delete “100 per cent loss of earning capacity” as an eligibility criterion. Cheung says as the policy objective of the disability allowance is simply to help patients meet the special needs caused by their disability, ESRD patients should be entitled to the allowance to subsidise the heavy cost of dialysis treatment.