The Department of Health is currently reviewing the fees for public healthcare services, including the potential adjustment of fees for emergency rooms and other public healthcare services. Various community organizations, the Joint Committee on Health Reform for Chronic Patients, and the Hong Kong Association for the Rights of Elderly People believe that increasing these fees may impact the economic burden on grassroots citizens, the elderly, chronic patients, and people with disabilities. They suggest that before implementing any fee adjustments, it is important to understand the opinions of these groups. The organizations advocate for any fee hikes to be kept within a 10% increase and for strengthened subsidies to prevent healthcare-related poverty.
During the period from April 24 to May 26, these organizations collected a total of 229 valid questionnaires from grassroots citizens, chronic patients, and elderly individuals through online and physical surveys. Nearly half of the respondents (49.3%) receive disability allowances, while around a quarter (23.1%) receive comprehensive social security assistance or do not receive any allowances.
Overall, 57.2% of the respondents do not support adjusting the fees for public healthcare services, while 42.8% do. If the government decides to raise these fees, more than half of the respondents (53.7%) can only afford an increase of less than 10%, and about 18.5% already have exemptions and do not have to worry.
The majority of respondents (81.5%) believe that the most important principle in reviewing public healthcare costs is to “ensure that citizens lacking financial means can access appropriate public healthcare services,” followed by the necessity to “increase corresponding medical services for patients if emergency room fees are raised” (53.2%) and to “improve medical fee reduction systems if fees for public healthcare are increased” (43.2%).
The organizations noted that public healthcare services, heavily subsidized, generally have lower out-of-pocket costs for patients. However, the survey found that a minority of respondents face significant medical expenses. Among respondents not receiving comprehensive social security assistance, nearly 14.2% spend over 1,000 Hong Kong dollars on medical expenses, with an average of 577 Hong Kong dollars, and the highest reported at 8,133 Hong Kong dollars. The organizations pointed out that these respondents have weaker family support, mostly coming from the middle to lower-income brackets with a median household income of 12,000 Hong Kong dollars, lower than more than half of the median household income in Hong Kong. Although nearly 70% of them are not engaged in economic activities, only a quarter receive comprehensive social security assistance.
Concerning medical fee reductions, about 64.2% of respondents were unaware that individuals not receiving comprehensive social security assistance could apply for fee waivers. However, around 39.8% of respondents expressed dissatisfaction (including “very dissatisfied”) with the medical fee reduction system, with 63.7% finding the application process cumbersome, followed by considerations like “the hassle of having all family members undergo financial screening” (56.0%) and inadequate promotion of fee waiver mechanisms (52.7%), while 45.1% felt that the approval period for fee waivers was too short.
The organizations suggested that the income and asset thresholds for the medical fee reduction system are relatively low, especially for elderly members. They argued that in considering adjusting public healthcare fees, the government should also take into account the economic difficulties of non-comprehensive social security assistance recipients to prevent financial hardship due to medical expenses. One suggestion includes improving the medical fee reduction system to protect non-comprehensive social security assistance recipients and promoting its mechanisms more widely.
The organizations are concerned that an increase in public healthcare fees may lead to parallel hikes in private healthcare costs, contributing to overall inflation in medical expenses and potentially turning away public healthcare seekers without compensation. If the government decides to raise public healthcare fees, any increase should be kept within 10%.
On another front, the organizations recommended introducing a category for “qualifying individuals for medical fee exemptions,” including recipients of disability allowances and employed family members receiving allowances; increasing the quotas for general outpatient clinic appointments; establishing channels between emergency rooms, general outpatient clinics, private family doctors, and district health centers to refer patients to suitable medical institutions; and studying additional support and subsidies for a minority of patients who do not receive comprehensive social security assistance but face significant economic pressures due to illness, to prevent healthcare-induced poverty.