Hong Kong people should congratulate themselves for having a government that is bold enough to make necessary reforms even though they may not be popular. Yes, reforms to the Health Bureau’s fees and charges, to be implemented on Thursday, are not popular. They are commonly viewed as just a way of raising revenue.
As explained by Dr Wong Yiu-chung, director of cluster services at the Hospital Authority, “The reforms cover a wide range of services, including inpatient, accident and emergency, outpatient, day services, pathology testing services, and radiology imaging, with many new itemized charges introduced.” To the average person, and to patients in particular, any increase in fees and charges is unpopular. The late medical sector legislator Dr Lo Wing-lok told me that he supported my proposal of “excessive burden protection”, which involves raising fees and charges on all services needed for basic and essential healthcare while capping annual expenses at a ceiling that ensures affordability. However, he never openly divulged his support. As an elected legislator, albeit in the medical sector constituency, he faced public pressure. The pressures on legislators elected by the popular vote are clearly much higher.
I first proposed excessive burden protection for healthcare expenses in my 1997 book Health Care Financing and Delivery: A Model for Reform, published by the City University of Hong Kong Press for the Hong Kong Centre for Economic Research. For a long time, I have observed the absurdity in Hong Kong public healthcare of not charging more when patients can afford it, while requiring them to pay when they cannot. I have personally heard many people praise Hong Kong’s extremely low charges for public healthcare services. These people could pay a much higher rate, and yet the government does not charge them more. At the same time, there are many middle-class people who cannot afford to pay the huge fees for essential healthcare that are charged at cost as “privately purchased medical items (PPMI) or new technologies required in the course of medical treatment which are not covered by the standard fees and charges in public hospitals and clinics”. As middle-class people, they are not eligible for exemptions or assistance under the Samaritan Fund. Patients from middle-class families generally cannot pass the household-based financial assessment conducted by medical social workers.
The theory behind excessive burden protection should be clear, and its spirit should be followed through. Public healthcare must be affordable, efficient, and sustainable. An annual cap, reasonably set, could ensure affordability. In principle, for lower-income people, the cap should be lower; for higher-income people, the cap should be higher
The theory behind excessive burden protection should be clear, and its spirit should be followed through. Public healthcare must be affordable, efficient, and sustainable. An annual cap, reasonably set, could ensure affordability. In principle, for lower-income people, the cap should be lower; for higher-income people, the cap should be higher. To make the system simpler to administer, those whose incomes are lower than median could be given a cap at 60 percent of the normal price.
Efficiency requires that both the public and the government prioritize preventive care. Raising the cap with age after 50 should incentivize people to take preventive care at an early age. This is why I proposed that the annual cap be raised from HK$10,000 ($1,286) to HK$30,000 progressively after age 50 (China Daily, March 25, 2025). This would remind young people to adopt a healthy lifestyle so they could save on medical costs when old. The higher ceiling for old people would not be popular, but healthcare costs do rise rapidly with age. To better serve the public, healthcare must be adequately funded for quality and timely access.
The Hong Kong Special Administrative Region government has assured the public that the HK$10,000 cap is not subject to a means test. I hope expenses on PPMI will also be eligible for the cap. These expenses are excessively burdensome for most people, including many middle-class professionals. Because PPMI is needed for essential healthcare, there is no reason to expose middle-class income people to the risk of forced poverty. On the other hand, I do not agree with the government’s generosity in exempting charges on patients triaged as Category I (critical) and II (emergency) at an accident and emergency department (A&E). The urgency of the care of course means that the patient is given priority. But the status of critical or emergency has little to do with affordability. The charges can be collected later. I cannot understand the rationale behind the exemption.
As the proponent of excessive-burden protection, of course I am very happy that Secretary for Health Lo Chung-mau has adopted the idea. I am made even happier by his emphasis on primary care and prevention, and optimizing hospital services. In this regard, the present difficulty of booking an appointment for a public clinic must be addressed. I have personal experience and can testify that booking an appointment using the HA Go app is an extremely arduous exercise. Most days and almost around the clock, clinics across all districts of the city are fully booked. After multiple attempts spanning several days, I was finally able to book an appointment at an outlying island clinic. The problem is so serious that many patients may be forced to attend A&E simply because they cannot successfully book an appointment. Today, many patients attend A&E not because the cost is low but because booking an appointment is so difficult. It appears to me that the Health Bureau may need to enlist some private clinics for public clinic duties.
The author is an honorary research fellow at the Pan Sutong Shanghai-Hong Kong Economic Policy Research Institute, Lingnan University, and an adjunct professor at the Academy for Applied Policy Studies and Education Futures, the Education University of Hong Kong.
The views do not necessarily reflect those of China Daily.
