untitled

Size: px

Start display at page:

Download "untitled"

蓬念白
7 years ago
Views:

1 立體焦點貧窮問題一直困擾香港, 其中長者貧窮問題最為嚴重,2010 年上半年的貧窮率達 33.9%, 人數近 30 萬, 即每 3 名長者便有 1 名生活於貧窮住戶由於經濟能力低, 許多長者無法承擔支持基本生活需要的開支, 牙科服務便是其中一項 2010 年的統計處報告的數據引證了這一點, 報告指只有 17% 每月住戶入息少於 5,000 元的人士曾於過去 1 年接受牙醫診治 ; 相反, 有 45% 住戶月入超過 4 萬元的人士曾接受牙醫診治曾於過去 1 年接受牙醫診治的人士佔該住戶每月入息組別比率 (%) > $40, % $30,000 - $39,999 $25,000 - $29,999 $20,000 - $24,999 $15,000 - $19,999 $10,000 - $14,999 $5,000 - $9,999 < $5, % 31.0% 28.4% 24.7% 19.5% 19.3% 17% 為了更深入了解基層長者的牙齒健康狀況及對政府牙科門診服務的需求, 香港社會服務聯會 ( 社聯 ) 於 2010 年底至 2011 年初展開基層長者牙科服務需要調查, 向 13 間長者地區中心的基層長者 (65 歲或以上及每月收入等於或少於 3,300 元 ) 發出問卷, 最終收回 328 份有效問卷 3

2 結果顯示,33.1% 被訪者只剩 1 至 10 隻真牙, 而 25.1% 則已沒有真牙然而, 即使絕大部分被訪者均脫去不同數量的真牙, 但表示正使用假牙的被訪者只有七成再者, 超過六成被訪者表示過去一年遇到牙科問題, 按比率最多排序為牙痛牙齒冷熱敏感牙齒鬆動蛀牙流牙血及牙瘡牙科問題影響他們的身體健康, 最常見的是咀嚼食物有困難 (67.9%) 不能進食多種食物 (66.4%) 發音不清楚 (48.2%),24.1% 表示嚴重至不能入睡此外, 也有被訪者因牙科問題而影響社交及心理健康, 例如感到煩惱 (59.3%) 感到尷尬 / 不好意思 (38.9%) 牙科問題對日常生活的影響 (%) 情況有效百分比 (%) 發音不清楚 48.2 不能進食多種食物 66.4 咀嚼食物有困難 67.9 進食時感不適 55.6 進食途中需整理牙齒 44.9 於人前感到尷尬 / 不好意思 38.9 感到煩惱 59.3 不能入睡 % 被訪者表示過去一年曾接受牙科診治, 但有 44.7% 被訪者過去三年也沒有接受牙科診治, 更有 5.6% 表示從未看過牙醫有接受牙科診治的被訪者主要光顧本地私家牙醫診所 (52.0%), 亦有長者選擇往價錢較香港便宜的內地牙醫診所接受治療 (15.5%) 他們上次接受牙科診療的費用中位數為 1,000 港元, 遠高於整體香港市民的平均 300 元 (* 政府統計處主題性住戶統計調查第 45 號報告書 ), 反映長者往往待情況惡化才接受深入治療被訪者對本地牙科服務的認知有限,66.8% 被訪者不知道最近的政府牙科街症服務診所地點及所提供的服務種類 ( 只提供止痛及脫牙服務 ) 再者, 正領取綜援的受訪者中,54.5% 不知道可以向政府申請牙科治療費用津貼 4 基層長者對牙科服務需求十分殷切香港大學牙醫學院盧展民教授批評, 長者對預防和及早治理牙病的意識不足, 可能與本港欠缺完善的牙科醫療政策有關, 而限時和限量的牙科急症服務仍與整個醫療政策脫節

3 盧展民教授批評本港欠缺完善的牙科醫療政策事實上, 現時政府只提供有限度的牙科急症服務, 全港只有 11 間政府牙科街症服務診所, 未能覆蓋所有區域, 東區南區灣仔深水黃大仙油尖旺葵青及沙田區均沒有政府牙科診所, 而港島更只有一間位於西區堅尼地城的診所, 居於其他區域的長者更要跨區求診這些診所每周派籌數量及診症時間各異, 大部分診所每星期只開一節上午時段此外, 診所每次只限剝一隻牙, 如果需要剝多隻牙, 就要多次輪候服務牙科街症服務診所服務時間區域所在地區政府牙科街症服務時間最高派籌量服務診所九龍九龍城李基政府牙科診所星期一 ( 上午 ) 84 星期四 ( 上午 ) 42 觀塘觀塘賽馬會牙科診所星期三 ( 上午 ) 84 港島西區堅尼地城社區綜合大樓牙科診所星期一 ( 上午 ) 84 星期五 ( 上午 ) 84 新界粉嶺粉嶺健康中心牙科診所星期二 ( 上午 ) 50 西貢方逸華牙科診所星期四 ( 下午 ) 42 大埔大埔王少清牙科診所星期四 ( 上午 ) 42 荃灣荃灣牙科診所星期二 ( 上午 ) 84 星期五 ( 上午 ) 84 屯門仁愛牙科診所星期三 ( 上午 ) 42 元朗元朗賽馬會牙科診所星期二 ( 上午 ) 42 星期五 ( 上午 ) 42 離島大澳大澳牙科診所每月第二個 32 星期四 ( 上午 ) 長洲長洲牙科診所每月第一個 32 星期五 ( 上午 ) 5

4 長者凌晨時段以雜物為記於牙科診所門外輪候調查隊伍於 2010 年 12 月至 2011 年 1 月期間, 在清晨時分八次落區視察四間牙科診所的輪候情況, 發現人口密集區域的服務供不應求於觀塘診所門外輪候的長者表示, 雖然診所早上 7 時半派籌, 但有長者早於凌晨三時已在診所輪候, 亦有長者表示曾經因為較遲到達診所輪候而未能取籌 79 歲梁伯於清晨 6 時便到觀塘診所門外輪籌剝牙, 曾多次到牙科街症脫牙的梁伯十分認識牙科街症的運作及輪候情況, 他說許多長者凌晨三四時便到診所輪候, 差不多日日如是, 即使天氣寒冷, 也有長者冒著風寒排隊, 有些長者因為遲來而無法取得配額, 唯有強忍牙痛, 無奈離開社聯業務總監 ( 政策倡議及社會企業 ) 蔡海偉表示, 基層長者普遍出現各種牙科問題, 但礙於資訊不足和政府提供的服務有限, 許多長者都無法獲得適當治療政府必須正視公共牙科服務嚴重不足, 全面加強相關服務 6 牙科急症服務限時和限量, 無法滿足長者需要

5 有見及此, 政府於今年財政預算案提出推出為期三年的長者基礎牙科服務先導計劃, 由非政府機構為居於安老院舍或接受日間護理中心服務的長者, 免費提供基礎牙科及口腔護理外展服務, 包括牙齒檢查洗牙, 以及任何其他所需的止痛和緊急牙科治療將有 17 間非政府機構參加先導計劃, 在計劃推行的三年期內透過 27 支外展服務隊, 提供超過 10 萬人次牙科服務, 當局會在明年底作中期檢討再者, 生署亦將於今年 5 月至明年 2 月期間進行全港口腔健康調查, 持續監察市民口腔健康狀況, 以及評估市民口腔健康行為和習慣不過, 政府的計劃未有包括為長者鑲牙及補牙, 蔡海偉認為單靠檢查及洗牙未必可以解決長者牙齒問題政府必須盡快增加牙科街症服務診所數目及名額, 延長診症時間, 並且增加公共牙科服務種類, 增設可負擔的洗牙補牙及鑲牙等服務長遠而言, 政府應制訂一套清晰及全面的牙科醫療政策, 為長者的牙齒健康制訂清晰的政策目標, 效法先進國家的做法, 如日本政府早於 1989 年起便提倡 8020 運動, 即年屆 80 歲的長者仍能保持 20 顆真牙的目標, 以確保基層長者得到全面的牙科服務鑑於長者對牙科服務的需求殷切, 不少社會服務機構開始開展相關服務, 例如基督教家庭服務中心推出長者流動牙科服務, 由註冊牙醫主理, 按預約時間前往有關長者服務單位提供服務服務內容包括..口腔檢查洗牙補牙簡單脫牙及活動牙托至於香港聖公會麥理浩夫人中心也開辦一站式外展牙科服務隊, 透過安排專業的牙科護理人員親臨長者經常聚集的地方, 例如長者活動中心長者鄰舍中心政府護老院私家護老院長者住屋偏遠的區域如荃灣老圍村光板田村和芙蓉山村等, 提供免費口腔檢查及個人牙齒護理諮詢服務, 個別有較複雜的口腔護理問題, 亦會轉介至牙科診所跟進, 藉以鼓勵他們養成定期檢查牙齒的習慣除了治療性服務外, 機構亦積極推行各項教育性工作, 包括深入荃灣葵涌青衣及深水區舉辦巡迴牙齒健康諮詢站, 一方面以展覽形式介紹各項牙齒健康資訊, 另一方面亦會安排專業的牙科護理人員即場解答社區人士的疑問, 提升社區人士對牙齒健康的關注 7

6 Dental Service for Grassroots Elderly in Great Demand n I order to investigate the oral health status and the demand for government dental consultations from the grassroots elderly, the Hong Kong Council of Social Service conducted a survey on the needs for dental services from the grassroots elderly during December 2010 to January Questionnaires had been sent to 13 District Community Elderly Centres with members aged 65 or above with monthly income of HKD3,300 or below, with 328 valid questionnaires in return. From this survey, it was found that 33.1% of the respondents had only 1 to 10 permanent teeth; 25.1% had no teeth at all and only 70% of the respondents had dental prostheses. More than 60% of the respondents experienced oral health problems during last year, including toothache, tooth sensitivity to cold and hot, mobile teeth, decayed tooth, bleeding gums and abscess etc. Oral health problems have adverse effect on the overall health condition of the elderly, such as ``have difficulty in chewing food'' (67.9%), ``unable to eat a variety of food'' (66.4%), ``poor pronunciation'' (48.2%), and even ``insomnia'' (24.1%). Their social life and mental health were being affected too, feeling ``upset'' (59.3%) and ``embarrassed'' (38.9%). 8 Among the respondents, 32.7% received dental service in last year, 44.7% received no dental service in the past three years and 5.6% had not visited a dentist ever. Among those who have received dental service, 52% of them went to private dental clinics in Hong Kong whereas 15.5% went for cheaper services in Mainland China. The median net consultation fee of their last dental consultation is HKD1,000, much higher than that of the average dental consultation fee in Hong Kong, which is HKD300 (according to the Thematic Household Survey Report No. 45 of the HKSAR Census and Statistics Department). This implies that most elderly people choose not to go for dental consultations until their oral health become really worst.

7 Respondents have limited knowledge on local public dental health care services. 66.8% of them had no ideas about the location and service type of nearby dental clinics. Out-patient services of dental clinics only provide pain relief and tooth extraction. In addition, among the respondents who are CSSA recipients, 54.5% of them were not aware that they are eligible for a special grant for dental treatment. Professor Edward LO Chin Man from Faculty of Dentistry, University of Hong Kong said that the low awareness of preventing dental diseases of the elderly in Hong Kong might be due to the lack of a sound dental health care policy. The insufficient emergency dental services fall short of the great demand. Currently, the Government only provides limited out-patient emergency dental services in 11 dental clinics, not covering districts including Eastern, Southern, Wan Chai, Sham Shui Po, Wong Tai Sin, Yau Tsim Mong, Kwai Tsing and Sha Tin. In Hong Kong Island, there is only one government dental clinic in Kennedy Town. Elderly people have to travel a long way to other districts to go for public dental services. The service capacity and service hours of these clinics vary, but most of them offer only one morning session per week and patients can get tooth extraction for only one tooth at a time. The survey team of the captioned study visited 4 government dental clinics early in the morning for 8 times during the period from December 2010 to January Since service capacity is limited, some elderly people had to queue up for a queuing ticket at 3:00 am whereas the tickets are supposed to be distributed at 7:30 am. The demand for dental services is far exceed the supply especially in the populated districts. In view of the service gap, the Government will roll out a Pilot Project, in partnership with non-government organizations (NGOs) for a period of three years starting from April 2011, to provide elderly people residing in residential care homes (RCHEs) or receiving services in day care centres (DEs) with outreach primary dental care and oral health care services free of charge, including dental check-up, scaling, polishing and any other necessary pain relief and emergency dental treatments. 17 NGOs will participate in the Pilot Project providing more than 100,000 attendances through 27 outreach teams benefiting some 80,000 elderly in RCHEs and DEs over the three-year pilot period. CHUA Hoi Wai, Business Director of HKCSS (Policy Advocacy and Social Enterprise) expressed that the Government should provide sufficient and appropriate oral health care services for the elderly in need through increasing the service capacity and extending the service hours of out-patient service of government dental clinics. The service scope should extend to teeth scaling, polishing, filing and prosthesis treatment at an affordable level, not limited to pain relief and tooth extraction only. In the long run, there should be a comprehensive dental health care policy in Hong Kong, setting a clear policy direction with reference to developed countries. For instance, Japan has launched the ``8020'' Campaign since 1989 to keep elderly people aged 80 or above to have 20 teeth. 9

港島地域 Hong Kong Island Region 香港童軍總會 Scout Association of Hong Kong 執行處支部名單 List of User Units (as at 2013/4/30) 執行處支部 1 港島地域 Hong Kong Island Region 2

港島地域 Hong Kong Island Region 香港童軍總會 Scout Association of Hong Kong 執行處支部名單 List of User Units (as at 2013/4/30) 執行處支部 1 港島地域 Hong Kong Island Region 2 柴灣區 Chai Wan District 3 港島南區 Hong Kong Southern District