Following is a question by the Hon Holden Chow and a reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (March 18):

Question:

     Many members of the public are concerned that the increased medical fees will pose a long-term financial burden on people in need following the implementation of the fees and charges reform for public healthcare, and they consider the current procedures under which medical fee waiver applications are processed with the assistance of medical social workers complicated. In this connection, will the Government inform this Council:

(1) as the Government has earlier on indicated that it will continuously review the age and eligibility of elderly persons who are automatically waived from payment of public medical fees, whether the Government has formulated a specific mechanism and timetable in this regard, including assessing the number of additional beneficiaries and public expenditure involved if the automatic waiver eligibility is extended to Old Age Living Allowance recipients aged 65 or above; if not, the reasons for that;

(2) apart from extending the scope of fee waivers, whether the authorities will put in place other measures to further alleviate the financial burden on those in need of public healthcare services; if so, of the details; and

(3) as there are views pointing out that the number of persons who are currently automatically waived from payment of public healthcare service fees is limited, whether the Government will consider extending the relevant eligibility to other eligible persons with financial difficulties, while stepping up publicity and explanation to society on the application procedures for medical fee waivers; if so, of the details; if not, the reasons for that?

Reply:

President,

     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 and reduce wastage and abuse. At the same time, the reform adopts the principle of "co-payment by those who can afford and co-payment by those with mild conditions" and enhances healthcare protection for the four categories of "poor, acute, serious, critical" patients on all fronts, thereby enhancing the sustainability of the healthcare system to cope with the challenges posed by an ageing population, increasing prevalence of chronic diseases, etc, and strengthening its role as a safety net for all. The various measures under the reform have been smoothly implemented since January 1, 2026. After the implementation of the reform, the Government maintains a very high level of subsidisation of up to 95 per cent for public healthcare services, with citizens co-paying a very low proportion of the cost.

     As an essential component of the fees and charges reform for public healthcare, the Hospital Authority (HA) has expanded its medical fee waiver mechanism. The number of eligible low‑income individuals who could potentially benefit is estimated to increase significantly to about 2 million, meaning more than one out of four citizens are entitled to fee waivers, with most of them entitled to full waivers. This ensures that no patient is denied from medical care due to lack of means. 

     Financial assessment is a key component in medical fee waiver applications. Persons who have financial difficulty and are eligible for medical fee waivers are in general from low-income families who have relatively simpler income and asset structure. For most cases, the application process could be completed with fee waiver approved within the same day, exemplifying that the assessment process is not complicated. Within a short period of some two-month period from January 1, 2026, to March 13, 2026, medical fee waiver has already been approved for nearly 200 000 people, far exceeding the annual approval number of around 14 000 in the past. Among the approved cases, over 130 000 are elderly persons aged 65 to 74. The fact that a large number of waivers have already been successfully approved for patients within these two months or so exemplifies that the application procedures for medical fee waiver is not complicated for patients including elderly persons. The application procedures are even simpler for Old Age Living Allowance (OALA) recipient aged 65 to 74 as the HA will make reference to the financial assessment already completed for their OALA applications and exempt them from submitting part of the required documents, thereby significantly facilitating their applications for medical fee waivers when they have healthcare needs. 

(1) and (3) The OALA and the medical fee waiver are fundamentally different in nature. The former is a cash welfare for elderly persons, the aim of which is to supplement the daily living expenses of elderly persons and assessment is in place to determine the eligibility for the allowance. The latter is a medical safety net, which aims to support patients who, despite heavy subsidisation from the Government, are still unable to afford public healthcare charges due to financial difficulties. The aim of the assessment is to determine the ability of individuals concerned to meet healthcare expenditure.

     The medical fee waiver mechanism covers all age groups, specifically targeting protection of the "poor" patients among the four categories of "poor, acute, serious, critical" patients, who have the greatest medical need. The assessment criteria, including the income and asset limits, are different from those under the OALA and therefore we must separate the application and assessment.

     Following the principle of progressive and orderly implementation, the Government will review the arrangements under the fees and charges reform for public healthcare every two years. However, when considering whether to expand the beneficiaries of automatic medical fee waivers, the Government must carefully assess the impact of such measures on the long‑term sustainability of the healthcare system amid the challenges posed by an ageing population, as well as the allocation of healthcare resources. Hong Kong currently has over 1.8 million people aged 65 or above, accounting for 24 per cent of the total population. Among them, around 45 per cent, i.e. over 820 000 persons, are OALA recipients. With the further ageing of Hong Kong's population, the number of people aged 65 or above is projected to increase to about 2.74 million in the next 20 years, representing 36 per cent of the total population. By that time, the number of OALA recipients will also drastically rise correspondingly.

     If the Government adopts a one-size-fits-all approach to automatically grant full medical fee waivers to all OALA recipients aged 65 to 74, regardless of patients' income or asset levels, the number of individuals eligible for automatic full waivers will immediately increase by nearly 450 000. Such an expansion will further intensify the pressure that an ageing population has already been placing on the sustainability of the public healthcare system, running counter to the Government's intention to address the challenges brought about by an ageing population through the fees and charges reform for public healthcare.

     Since the announcement of the fees and charges reform in March last year, in addition to briefing the Legislative Council Panel on Health Services in April last year, the Health Bureau and the HA have proactively met with various political groups, professional bodies, healthcare personnel, patient organisations and relevant advisory structures to provide detailed explanations and exchange views, as well as holding District Council (DC) briefing sessions in April and December last year, and producing dedicated webpages, information kits, videos and publicity materials to help the public understand the relevant arrangements. In addition, different clusters of the HA have organised briefings and workshops for different stakeholders, including DC members, patient groups and volunteers, to disseminate the relevant information to the community. The HA will continue to collaborate with local stakeholders to organise more workshops and seminars in order to enhance public understanding of the various reform measures, including the medical fee waiver.

(2) In addition to expanding the medical fee waiver mechanism to cover a total of around two million "poor" patients across Hong Kong, the fees and charges reform for public healthcare has also introduced a second safety net for "acute, serious and critical" patients, including: (i) waiving the charges for Accident and Emergency services for Categories I and II Critical and Emergency patients; (ii) introducing an annual cap of $10,000 on public healthcare service charges, which is not subject to financial assessment and all 7.5 million Hong Kong residents can potentially benefit. As at March 13 this year, the annual cap of $10,000 has already been approved for 1 674 patients who will no longer be required to pay any further charges for inpatient and outpatient services within the year; and (iii) the HA has strengthened the protection of "critical" patients in terms of drugs and medical devices by relaxing the eligibility criteria of the safety net of the Samaritan Fund and accelerating the introduction of more effective innovative drugs and devices. These measures enable more middle or low-income patients to receive more subsidies for self-financed drugs and devices. Among the over 2 000 cases approved under the Samaritan Fund as at end of February this year, around 30 cases has become fully subsidised under the Fund following the relaxation of eligibility criteria. Furthermore, there are also around 330 cases where patients' drug co-payment amount has reduced. This includes a patient whose annual drug co‑payment amount has reduced from around $52,600 last year to only around $9,800 this year, which accounts for a significant decrease of over 80 per cent, demonstrating that the reform measures have helped strengthen protection for the "serious" and "critical" among the "poor, acute, serious, critical" patients.

     ​Thank you, President.

Ends/Wednesday, March 18, 2026
Issued at HKT 15:30

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