Since the public healthcare pricing reform took effect at the start of the year — with accident and emergency fees, for example, rising from HK$180 ($23) to HK$400 — the Hospital Authority (HA) has been overwhelmed by a flood of applications for waivers from the higher charges. Since vetting these applications requires going through various documents, it is quite tedious for both medical social workers and patients. Many patients went to the Social Welfare Department to ask for help. Notwithstanding the huge number of applicants, it is reported that up to Jan 19, over 91,479 exemptions were granted, including 47,051 applications being given a conditional waiver. For these cases, the applicants have to first sign a declaration about their financial circumstances to benefit from relief for three months. Any extension will be subject to further vetting.

In principle, it is better that all patients pay a charge. In my earlier commentary pieces, I recommended halving the charges and the cap for those who pass a means test. I also recommended that even those on the Comprehensive Social Security Allowance (CSSA) should be under a charge and cap mechanism, which I had called “excessive burden protection”.

In order to leave them no worse off than before, and even potentially better off, I would give those on CSSA an increase in the annual payout by HK$5,000 — which is the lower cap for them and for other eligible people — which works out to roughly HK$420 per month. If their accumulated eligible medical expenses fall short of HK$5,000, they will end up having some extra money to spend. In any case, although their status has changed from having to pay nothing to having to pay something, they will never have to pay more than the additional income that they receive. This proposal will increase their incentive for adopting a healthy lifestyle and taking preventive measures to reduce their healthcare spending.

Apart from incentivizing prevention, the new system aims to improve the quality of healthcare, making it timelier and providing better care. These desirables should be seen so the public appreciates the immediate benefits. Government-provided dental services for the public are currently quite limited. Whereas civil servants enjoy a full range of dental services except for dentures and dental appliances as provided for in the Civil Service Regulations, dental services for the public are limited to relief of pain or tooth extraction, and even these services are difficult to book. If the HA or the Department of Health were to extend general dental services to the public, there would be an immediate benefit achieved under the new pricing arrangement.

Instead of offering waivers to those who find the latest charges unaffordable, it is much better to offer a 50 percent discount and 50 percent cut to the annual spending cap. There is then an imperative for everybody to pay what they can afford. In principle, I would also support introducing a higher cap for wealthier patients

Other improvements that the Hong Kong Special Administrative Region government should aim at delivering include:

• Improving the public clinic booking system, so that the public can more easily book an appointment.

• Extending the list of drugs that are covered by the HA Drug Formulary.

• Reducing the waiting time for the first appointment for specialist clinics and for diagnostic tests.

There is a need to educate the public about preventive care. Visiting a clinic to get proper medical attention and advice must not be delayed for cost considerations. Since costs are capped, affordability is ensured. There may be a tendency to look at the percentage increase, which admittedly is quite large. However, the charges are not at all high compared with those in other jurisdictions.

In Singapore, for a patient who needs a one-time surgery for appendicitis staying in a Standard Ward Type B1 (up to five beds in a room), the estimated cost as per the Ministry of Health would be S$9,911 ($7,820). Type B1 beds are generally much more costly than Type C or Type B2 beds, whereas in Hong Kong the daily charge of HK$300 covers consultation, examinations, general prescriptions, vaccines, general nursing and meals, and even the cost of surgery except itemized charges. Singapore charges extra for these services. However, Singaporeans are typically covered by MediShield Life, a basic health insurance plan, administered by the Central Provident Fund Board, although copayments would still be necessary. The estimated cost for the same one-time surgery for appendicitis in a private hospital in Singapore is around S$30,544.

In my view, instead of offering waivers to those who find the latest charges unaffordable, it is much better to offer a 50 percent discount and 50 percent cut to the annual spending cap. There is then an imperative for everybody to pay what they can afford. In principle, I would also support introducing a higher cap for wealthier patients. If this is the way the government can get the resources to protect them, they will be absolved from the need to pay for increasingly burdensome private health insurance.

It is clear that the old system is not sustainable, as the need for healthcare services is rising rapidly with the population aging and with medical science and technology continuing to advance. In order for the public to accept this as the way forward, it is imperative that the government take action to show the benefits to members of the public, so they realize that the fees and charges increase is strictly for their own good. Offering waivers to individuals will defeat the purpose of the annual spending cap and will be very costly to society over the long run.

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.