LCQ7: Implementation of fees and charges reform for public healthcare
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Question:
The various measures under the fees and charges reform for public healthcare have been implemented starting from January 1 this year. However, many members of the public have relayed that the application procedures for medical fee waivers are complicated, which may delay treatment for patients seeking consultation. In this connection, will the Government inform this Council:
(1) whether it knows the respective changes in the numbers of persons seeking consultation under the four triage categories (i.e. "critical", "emergency", "urgent" as well as "semi-urgent and non-urgent") before and after the implementation of the new accident and emergency fees on January 1 this year;
(2) whether it knows the respective current numbers of persons who have applied for medical fee waivers (including full and partial waivers), and the respective percentages of such numbers in the estimated total number of persons eligible to apply for medical fee waivers;
(3) given that applicants for medical fee waivers are required to submit certain documents such as screenshots of the account numbers of e-wallets (e.g. PayMe/Alipay/WeChat Pay), transaction records for the past six months and balance, whether the Government knows whether the Hospital Authority (HA) has compiled statistics on the average number of documents and pages required to be submitted for each application to date;
(4) as it has been reported that HA has indicated that applicants for medical fee waivers may be granted approval as quickly as the same day after submitting all required documents, whether the Government knows (i) the number of cases approved on the same day to date and (ii) its percentage in the total number of applications, as well as (iii) the average time required for approving each case;
(5) whether it knows the current average waiting time for members of the public to submit applications for medical fee waivers at other designated service units such as the Medical Social Services Units of public hospitals/clinics and the Social Welfare Department's Integrated Family Service Centres in their localities; whether HA will consider the inclusion of District Health Centres and District Health Centre Expresses in all 18 districts as designated service units for applications for medical fee waivers; if so, of the details; if not, the reasons for that;
(6) given that while HA allows patients who cannot afford medical expenses to first receive "conditional waivers" for medical fees during the transition period from January to March this year, they need to submit relevant documents within three months, whether the Government knows the number of such applications to date and its percentage in the total number of patients, and under what circumstances HA will extend the transition period;
(7) given that the current maximum validity period for medical fee waivers is 18 months, whether the Government knows whether HA will remind patients to reapply for waivers before expiry of the waiver period; if HA will, of the details; if not, the reasons for that; as HA has indicated that patients reapplying for waivers are only required to confirm no change in household financial condition without resubmitting documents for review, whether HA will conduct random checks on such cases; and
(8) given that many members of the public have expressed the hope to strengthen the monitoring of fees and charges for public healthcare concerning public interests, whether the Government will, with reference to the approach of other legislation relating to government fees and charges, amend section 18 of the Hospital Authority Ordinance (Cap. 113) to set out the medical fees by way of subsidiary legislation, so that this Council can deliberate on matters relating to medical fees and charges; if so, of the details; if not, the reasons for that?
Reply:
President,
In consultation with the Hospital Authority (HA), the reply to the question raised by the Hon Chan Hak-kan is as follows:
The fees and charges reform for public healthcare aims to, through reforming the subsidisation structure, guide the public to make optimal use of healthcare resources, reduce wastage and abuse, and enhance healthcare protection for the four categories of "poor, acute, serious, critical" patients on all fronts, thereby enhancing the sustainability of the healthcare system and strengthening the public healthcare system to cope with the challenges posed by an ageing population, increasing prevalence of chronic diseases, persistent strain on healthcare resources, etc., and serve as a safety net for all. The various measures under the reform have been successfully implemented since January 1, 2026.
(1) Since the implementation of the fees and charges reform for public healthcare, there have been signs of initial success, with an overall decrease in the number of attendances at Accident and Emergency Departments (A&Es) of public hospitals and a significant drop in semi-urgent and non-urgent (Category IV and V) cases. Critical and emergency (Category I and II) cases have been accorded priority in treatment with the service pledge target fully met, despite a rise in the number of such cases. The average waiting time for urgent (Category III) patients to receive treatment has also decreased. Resources at A&Es are more effectively focused on critical and emergency care, resulting in improved efficiency in treating emergency patients.
The table below sets out the total A&E attendances and the average daily attendances by triage category of the HA for (i) the full year of 2025; (ii) January 1-25, 2025; and (iii) January 1-25, 2026.
| Triage category | A&E attendances | ||||||
| 2025 (Full year) | January 1-25, 2025 | January 1-25, 2026 | Compared with the same period last year | ||||
| Total | Daily average | Total | Daily average | Total | Daily average | ||
| Category I (Critical) | 26 800 | 73 | 2 131 | 85 | 2 201 | 88 | +3.5% |
| Category II (Emergency) | 56 522 | 155 | 4 278 | 171 | 4 518 | 181 | +5.8% |
| Category III (Urgent) | 785 638 | 2 152 | 57 790 | 2 312 | 53 621 | 2 145 | -7.2% |
| Category IV (Semi-urgent) | 993 965 | 2 723 | 72 509 | 2 900 | 57 473 | 2 299 | -20.7% |
| Category V (Non-urgent) | 37 467 | 103 | 2 802 | 112 | 1 920 | 77 | -31.3% |
According to the statistics, from January 1 to 25, 2026, a total of 119 733 patients attended the 18 A&Es under the HA, representing a significant decrease of nearly 15 per cent compared to the same period last year. Among those cases, 6 719 patients were triaged as critical and emergency cases, which despite showing an increase of 4.8 per cent compared to the same period last year, were all accorded priority in treatment in full compliance with the service pledge target (i.e. immediate treatment for critical cases and treatment within 15 minutes for emergency cases). These patients were exempted from A&E fees under the new fees and charges mechanism, which was better off than before the reform where they were required to pay. A total of 53 621 patients were triaged as urgent cases, representing a decrease of 7.2 per cent compared to the same period last year. A total of 59 393 patients were classified as semi-urgent and non-urgent cases, marking a substantial decrease of 21.1 per cent compared to the same period last year.
Moreover, comparing the statistics of HA A&E services from January 1 to 25, 2026 with the figures over the same period last year:
- For patients triaged as urgent cases, the percentage of those being treated within 30 minutes - meeting the service pledge target - increased from 78.3 per cent to 86.9 per cent, with the average waiting time reduced from 25 to 20 minutes;
- Among the five triage categories, the proportion of semi‑urgent and non‑urgent patients decreased from 54.0 per cent to 49.6 per cent; and
- The average waiting time for semi‑urgent and non‑urgent patients decreased from 144 minutes to 120 minutes.
The latest statistics of A&Es indicate that the fees and charges reform for public healthcare can effectively help the "acute" patients among the "poor, acute, serious, critical" patients who are most in need. Resources of A&Es are now better directed towards critical and emergency patients. Directing some non-urgent patients or patients with other medical needs to seek more appropriate healthcare services other than A&Es can also help reduce the overall waiting time and alleviate overcrowding at A&Es, thereby achieving the original intent of the fees and charges reform for public healthcare to concentrate resources and treat patients with urgent medical needs more effectively, as well as improving the clinical environment at A&Es.
(2), (4) and (5) As an essential component of the fees and charges reform for public healthcare, the HA has concurrently expanded its medical fee waiver mechanism. In addition to the some 600 000 people who have been benefiting from medical fee waivers both before and after the reform (including Comprehensive Social Security Assistance recipients, Old Age Living Allowance recipients aged 75 or above and Level 0 Voucher Holders of the Residential Care Service Voucher Scheme for the Elderly), the number of other eligible low-income individuals is estimated to significantly increase from approximately 300 000 to about 1.4 million, i.e. an additional 1.1 million low-income individuals can potentially benefit. This enables limited healthcare resources to be more precisely directed to help the "poor" patients among the "poor, acute, serious, critical" patients who are most in need, while ensuring that no patient is denied medical care due to lack of means.
Since the implementation of the fees and charges reform for public healthcare, the number of medical fee waiver applications approved by the HA has significantly increased by multiple times compared with the past. As at January 25, 2026, less than one month since the fees and charges reform, the HA has approved 107 865 medical fee waiver applications (including 104 365 full waivers and 3 500 partial waivers). This figure far exceeded the annual number of approximately 14 000 patients who were approved to receive medical fee waivers in the past. In other words, at least an additional of over 93 000 patients to date have already benefitted from the safety net under the enhanced medical fee waiver mechanism, from having to pay the fees and charges in full before the reform to now receiving fee waivers, demonstrating that the reform has effectively strengthened support for low-income families and underprivileged groups. Recent data show that the HA receives an average of about 4 800 medical fee waiver applications per day, down from the peak of over 5 900 applications per day.
Public hospitals have deployed additional manpower, including service ambassadors, designated teams and volunteers, to assist with arrangements such as answering patient inquiries, triaging and processing the medical fee waiver applications. According to approval records at various designated service units, the application process could be completed for most cases within the same day. So far on average approximately 82 per cent of applications were successfully approved on the same day of application, with some hospital clusters reaching over 90 per cent. Medical fee waiver certificates for these cases were issued on the same day.
To facilitate eligible patients in obtaining medical fee waiver certificates before their appointments, the HA advises patients to begin the application process approximately one to two months before their scheduled appointments. The HA is accordingly now accepting applications for medical fee waivers from patients with scheduled appointments within two months. Citizens with scheduled appointments beyond two months or without any appointments do not need to apply pre-maturely at this stage.
Currently, public officers from the HA or the Social Welfare Department are authorised to approve applications for medical fee waivers. Upon assessment, the HA is of the view that such an arrangement is sufficient to handle the existing demand for such applications. As the handling of medical fee waiver applications involves personal data, financial circumstances, medical records and health conditions of patients and their family members, and concerns the use of public fund, utmost care and caution must be exercised. District Health Centres (DHCs) are operated by various non-governmental organisations, with different missions and service scopes. There is no need at this stage to consider utilising DHCs for processing medical fee waiver applications.
(3) The medical fee waiver mechanism aims to provide assistance to patients with financial difficulties and healthcare needs, ensuring they are not denied medical care due to lack of means. Financial assessment is therefore required and, as a matter of fact, not everyone will be eligible. The HA must handle each application with due diligence for proper use of public funds. Patients also have the responsibility to provide complete, accurate, truthful and appropriate information for assessment and verification to help ensure that assistance reaches patients truly in need. While ensuring that no patient is denied medical care due to lack of means, it is also essential for the HA to uphold the principle of prudent use of resources to prevent the limited and precious public resources from being abused.
Medical fee waiver applications are assessed on a household basis. In general, patients and the family members included in the means test are required to submit documents including proof of identity, proof of residence, proof of income and proof of asset. The number of documents required for each application varies depending on factors such as the number of family members and the financial and asset situation of the patient and that of the family members included in the means test. For example, applicants with multiple bank accounts or more complex asset structure and distribution may need to submit more documents. In general, those who have financial difficulty and are eligible for medical fee waivers are from low-income families with relatively simple asset structure. The assessment process for those persons is not complicated.
Apart from expanding the medical fee waiver mechanism to assist the "poor" patients among the "poor, acute, serious, critical" patients who are most in need, all additional resources generated from the fee and charges reform for public healthcare will be wholly utilised to enhance public healthcare services. This includes increasing support for the "serious" and "critical" patients of the "poor, acute, serious, critical" patients, such as introducing a cap on fees and charges at $10,000 to provide an additional layer of protection for patients with multiple chronic or severe illnesses requiring long-term hospitalisation or frequent hospital services. Concurrently, the HA will continue expanding the HA Drug Formulary to include new cost-effective drugs and increase subsidies for standard medical devices and consumables. The Government will also include safe and effective innovative drugs and medical devices into the safety net, providing additional financial assistance through the Samaritan Fund to patients who are unable to afford expensive treatments.
(6) To handle the additional medical fee waiver applications, the HA has adopted special flexible arrangements during the transition period from January to March 2026 to provide "conditional waivers" for full or partial medical fees for patients with financial difficulty who require immediate or urgent medical services but are unable to provide the required documentation for financial assessment. Such patients need only sign a declaration form and state their approximate financial circumstances to be granted a "conditional waiver" for full or partial medical fees valid for three months, allowing immediate access to fee reduction. This ensures that no patient is denied adequate medical care due to lack of means. As at January 25, 2026, among the 107 865 medical fee waiver applications approved, 56 862 are "conditional waivers".
Eligible patients need to submit relevant documents within three months to receive official medical fee waiver certificates upon passing the assessment. If patients fail to submit the required documents within the three-month deadline or do not meet the relevant eligibility criteria, they will be required to settle all applicable fees (if any). To ensure the appropriate use and prevent abuse of healthcare resources, the HA will conduct regular random reviews of approved cases.
The HA will closely monitor the application situation of medical fee waivers and review the transitional arrangements.
(7) Under the medical fee waiver mechanism after the implementation of the fees and charges reform for public healthcare, the maximum validity period of fee waivers will be extended from 12 to 18 months, reducing the number of times patients need to re-apply. To further facilitate the public, the HA will reduce the need for repeated verification of patients' income and asset information. For re-applications within a maximum period of 18 months, patients will only be required to sign a declaration confirming that there is no change to their household financial situation, without having to re-submit financial documents for assessment.
As aforementioned, the medical fee waiver mechanism aims to provide assistance to patients with financial difficulties and healthcare needs, ensuring they are not denied adequate medical care due to lack of means. Whether a patient is required to re‑apply upon the expiry of the waiver period depends on the patient's prevailing medical needs and financial circumstances. Patients may refer to the validity period indicated on the medical fee waiver certificate and review their financial situation and medical needs upon expiry of the validity period to decide whether a further application is required prior to their next appointment.
As the medical fee waiver mechanism involves the use of public fund, patients have the responsibility to provide complete, accurate, truthful and appropriate information for the HA's assessment and verification to ensure that assistance reaches those truly in need. In the event of any changes in the financial or family circumstances of the patients' household following the submission of an application or declaration, and during the validity period of the medical fee waiver certificate, which may affect the eligibility for medical fee waiver, patients must forthwith inform the HA and provide all relevant information for re‑assessment of their eligibility.
To ensure the integrity of the medical fee assistance system and prevent abuse, the HA will conduct regular reviews of approved cases. This includes both the aforementioned cases where re-assessment is required due to changes in the financial or family circumstances of the patient's household, as well as re-application cases within 18 months where no financial assessment is required upon the patient signing a declaration confirming no change in their household financial situation.
(8) Under sections 4 and 18 of the Hospital Authority Ordinance (Cap. 113), the HA shall recommend to the Secretary for Health appropriate policies on fees for the use of hospital services by the public, having regard to the principle that no person should be prevented, through lack of means, from obtaining adequate medical treatment. The Secretary for Health may give directions to the HA in relation to the exercise of its powers concerning the determination of fees, and the HA shall comply with those directions. Fees determined under section 18 shall be published in the Gazette. The Government and the HA have been actively engaging stakeholders on the fees and charges reform for public healthcare, and are committed to enhancing transparency. Since the announcement of the proposal for the fees and charges reform on March 25, 2025, the Health Bureau (HHB) and the HA have, in addition to briefing the Legislative Council Panel on Health Services in April 2025, proactively met with various political groups, professional bodies, healthcare personnel, patient groups and relevant advisory bodies to provide detailed explanations and exchange views. The authorities also held District Council briefings in April and December 2025 respectively, and produced dedicated webpages, information kits, videos and publicity materials to help the public understand the new arrangements. Furthermore, the HHB and the HA will conduct a review every two years on the implementation and effectiveness of the fees and charges reform and monitor the progress of the reform in accordance with the established mechanism. The Government currently has no plan to amend the provisions of the Hospital Authority Ordinance (Cap. 113) in relation to the arrangements regarding fees for hospital services.
Ends/Wednesday, January 28, 2026
Issued at HKT 17:13
Issued at HKT 17:13
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