Following is a question by the Hon Chan Hak-kan and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (October 7):

Question:

     The various measures under the public healthcare fees and charges reform (the fee reform) have been implemented for nearly one year. In this connection, will the Government inform this Council:

(1) of a comparison of the following data before and after the implementation of the fee reform as compared with the same period last year: (i) the total income and expenditure of the Hospital Authority (HA); (ii) the average waiting times for general outpatient clinic services and specialist outpatient clinic services (including new and existing cases); and (iii) the number of prescriptions issued by public hospitals and clinics under HA for which the patients ultimately did not collect their medication, and the cost of the medication involved;

(2) whether it has monitored or compiled statistics on any fee increases in private healthcare services (such as private clinics and private hospitals) following the implementation of the fee reform; if so, of the details; if not, the reasons for that;

(3) whether it has conducted official surveys or compiled statistics on public satisfaction and feedback regarding the fee reform; if so, of the details; if not, whether it will consider conducting relevant studies;

(4) whether it will consider expanding the coverage of waivers for public healthcare fees and charges, for example, to include elderly persons aged 65 to 74 who are currently receiving Old Age Living Allowance;

(5) with a view to triaging accident and emergency services, whether HA will consider expanding evening and public holiday outpatient clinic services, and setting up a 24-hour telemedicine consultation hotline to answer immediate medical enquiries from members of the public; and

(6) as the authorities indicated in their reply to my question on January 28 this year that the Government currently has no plans to amend the Hospital Authority Ordinance (Cap. 113) (the Ordinance), while there are views that adjustments to healthcare fees and charges concern the interests of the general public and public finances, whether the authorities will reconsider amending the Ordinance to stipulate that all major adjustments to public healthcare fees and charges in the future must be approved by the Chief Executive in Council or scrutinised under the relevant procedures of this Council; 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 first phase of the fees and charges reform for public healthcare came into effect on January 1, 2026. It aims to strategically restructure the highly subsidised public healthcare service framework, enabling the limited financial and manpower resources of the public healthcare system to be redistributed more precisely towards supporting four categories of "poor, acute, serious, critical" patients. The core objective of the reform is to ensure the long-term sustainability of the public healthcare system, making effective use of precious public funds and focusing resources on serving the most vulnerable and those most in need.

     In supporting poor patients, the reform has significantly expanded the coverage of the medical fee waiver mechanism, significantly increasing the potential number of beneficiaries from about 900 000 previously to around 2 million. As of September 30, the HA received a total of 331 951 medical fee waiver applications, of which 300 285 were approved, representing an approval rate of over 90 per cent. The number of persons granted full medical fee waivers has increased from fewer than 14 000 annually in the past to more than 250 000. In addition to the more than 250 000 Comprehensive Social Security Assistance (CSSA) Scheme recipients and about 370 000 Old Age Living Allowance (OALA) recipients aged 75 or above who are already exempted from medical fees, the enhanced arrangement provides free healthcare services to more low-income families, fully demonstrating the policy objective of directing resources to poor patients.

     In handling acute care services, the reform has guided patients to make more reasonable use of Accident and Emergency (A&E) services. In the first nine months of this year, a total of 1 404 504 attendances were recorded across the 18 A&E departments under the HA, representing a decrease of 0.9 per cent compared with the same period last year. Among them, attendances for Triage Category IV (semi-urgent) and Triage Category V (non-urgent) cases decreased by 6.8 per cent, with non-urgent cases even dropping by 17.5 per cent, indicating that the reform has effectively diverted non-urgent patients. At the same time, attendees triaged as Category I and Category II (critical and emergency) are fully exempted from A&E fees under the new fee mechanism and receive priority treatment. The respective treatment time targets were fully met (with critical patients receiving immediate treatment and emergency patients receiving treatment within 15 minutes). The attainment rate of Triage Category III (urgent) cases being treated within 30 minutes (i.e. meeting the service pledge target) also increased from 82.0 per cent to 88.4 per cent, reflecting the improved service efficiency for patients requiring urgent care following the reallocation of resources.

     In supporting patients with serious and critical illnesses, the reform introduced an annual spending cap of $10,000 without financial assessment, providing more comprehensive protection for members of the public suffering from serious or chronic illnesses unfortunately and preventing impoverishment due to illness. As of September 30, the number of patients with approved applications reached 20 655. At the same time, the reform has also strengthened subsidies for innovative drugs and medical devices for critically ill patients. Over the past nine months, the HA has added 16 new drugs into its Drug Formulary (including seven targeted therapy drugs for cancers). Of these, six are listed under the Special Drugs category, allowing patients to pay only the standard drug fees (i.e. $20 every four weeks) when prescribed under specific clinical applications. Another five are self-financed items with safety net coverage. The estimated additional annual expenditure involved amounts to $134 million. During the same period, 27 proposals for new drugs and medical devices/relaxing clinical indications (including 14 proposals for cancer drugs), as well as 26 self-financed medical devices were included under the subsidy scope of the Samaritan Fund (SF), involving an estimated additional annual expenditure of $120 million.

     The reform has also relaxed the SF means test criteria, strengthening the support for critically ill patients, including those from middle-income families, in terms of drugs and medical devices. From January 1, 2026 (the first day of implementation of the relaxation measures) to September 30, 2026, a comparison with the same period last year shows that the approved subsidy amounts for drug and non-drug items under the SF increased by about 21 per cent and 14 per cent to $2 billion and $328 million respectively. The number of applications for drug and non-drug items involving non-CSSA recipients increased by about 19 per cent and 14 per cent to about 7 030 and 3 180 cases respectively. Among them, the patients' contribution in about 1 670 drug subsidy cases decreased due to the relaxed eligibility criteria, and about 125 non-drug subsidy cases which would not have qualified prior to the relaxation became eligible for subsidies. 

     In addition, the reform has also proven effective in reducing wastage of resources. Following the implementation of the advance payment arrangement for examination appointments in mid-April this year, the numbers of default appointments for computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography examinations between April and September this year fell by approximately 29 per cent, 41 per cent and 36 per cent respectively compared with the same period last year. Preliminary estimates suggest that these improvements are equivalent to annual savings of around 6 000 CT appointments, 2 500 MRI appointments and 9 000 ultrasonography appointments respectively, broadly corresponding to the annual service capacity of one CT scanner, one MRI scanner and two ultrasound scanners. Patients' patterns of use for certain medications to be taken on an as-needed basis have also changed. Between January and September 2026, the consumption of several commonly used "as needed" medications (such as artificial tears and analgesic ointments) generally decreased by around 18 per cent compared with the same period last year. These figures demonstrate that the reform has effectively guided patients towards making more rational use of healthcare services, reducing default appointments and resource wastage, thereby freeing up more resources for patients in need.

(1)(i) After the fees and charges reform for public healthcare, the Government's commitment to public health remains unchanged. All the additional revenue arising from the reform will be wholly utilised for public healthcare services. Following the implementation of the reform, the Government maintains a subsidisation rate as high as 95 per cent for public healthcare services, with members of the public co-paying a very low proportion of the costs. Although the fees and charges reform will generate additional revenue, this is partially offset by the substantial increase in medical fee waivers and the annual spending cap mechanism at the same time. As the reform has been implemented for less than a year, especially the full impact of the annual spending cap on patients' service utilisation and payment behaviour remains to be seen, it is difficult to comprehensively and accurately assess the overall fiscal impact on the HA by the reform at this juncture. 

(ii) The Government has all along been committed to improving the waiting situation at specialist out-patient clinics (SOPCs). The 2026 Policy Address set a clear target for the HA to shorten the 90th percentile waiting time for stable new cases in specified specialist out-patient services by half within five years, with the waiting time to be reduced by 10 per cent in 2027‑28 in the first phase. To this end, through the strategy of "narrowing upstream, collaborating downstream, diverting midstream", the HA will avoid unnecessary referrals, divert stable follow-up cases to primary healthcare, etc, as well as expand multi-disciplinary integrated clinical services, optimise appointment arrangements and continuously enhance service capacity. 

     The fees and charges reform for public healthcare aims to guide the public in making rational use of healthcare resources and reduce resource wastage, instead of deterring patients with clinical needs from seeking medical advice. On the other hand, the reform helps encourage patients to use healthcare services rationally and attend consultations on time, reducing default appointments and resource wastage, thereby improving the utilisation efficiency of healthcare resources. As mentioned above, the improvement in default appointment situation across various imaging examinations has allowed patients in need to undergo examinations much sooner.

     However, waiting time for SOPCs hinges on a multitude of complex factors, including service demand, patients' clinical conditions, ageing population and the increasing burden of diseases. It is therefore difficult to directly determine the specific impact of the fees and charges reform on waiting time. Although waiting time is not a direct indicator for assessing the effectiveness of the fees and charges reform, the Government and the HA will continue to closely monitor service streamlining efforts and progress of reduction in waiting time, and remain firmly committed to achieving the waiting time reduction targets set out in the Policy Address.

     Regarding Family Medicine Out-patient (FMOP) services, members of the public currently utilising the services of the HA's Family Medicine Clinics (FMCs) are generally non-urgent cases, therefore appointment booking in advance is required. Patients with episodic illnesses may reserve consultation timeslots in the next 24 hours through the HA's FMC Telephone Appointment System or the "Book FMC" function in the HA's one-stop mobile application, HA Go. For chronic disease patients, the next appointment would be arranged by clinic staff after consultation based on clinical needs, thus the patients do not need to make separate bookings. As the booking system allocates consultation timeslots to episodic patients immediately, there is no waiting list or new case waiting time for FMOP services. 

     To cater the consultation needs of underprivileged groups, the HA introduced the Family Medicine Out-patient Services Priority Groups Pilot Scheme under its FMOP services in November last year, enhancing the FMOP priority booking arrangement to extend coverage to more designated priority groups in need of public primary healthcare services. Through the appropriate allocation of appointment quotas, they may make priority bookings for FMOP episodic consultations upon medical needs. Individuals belonging to the priority groups can register as District Health Centre members and select their respective priority group via the eHealth mobile application to make priority bookings when needed. The pilot scheme has been operating smoothly since its rollout. 
      
(iii) The HA has been prescribing medications strictly based on patients' clinical needs. In recent years, it has further encouraged healthcare personnel to communicate with patients regarding their medication usage, so as to make appropriate arrangements and reduce unnecessary overstocking and wastage of medications. In the course of consultation and drug prescription, doctors will communicate with patients to understand their medication habits and the quantity of medications kept at home. In general, if patients already have a sufficient quantity of medications at home, for example, long-term medications for chronic diseases or "as needed" medications, doctors will discuss with patients and advise them not to collect the medications from the pharmacy again, so as to reduce wastage caused by overstocking of medications. Nevertheless, for the sake of maintaining complete medical records, doctors will still make a prescription entry in the medical record to document that the patient has followed their medical advice, continued treatment and has appropriate follow-up arrangements in place.

     According to the analysis on HA's statistics, the unfilled prescriptions prescribed by doctors after consultation has consistently remained at a low level (accounting for only a few percentage points). The vast majority of unfilled prescription records arise from cases where doctors made prescription entries for the sake of complete medical records after patients had confirmed that they possessed sufficient medications at home and therefore did not need to collect the medications again. During the relevant period in 2026, the consumption of some commonly used "as needed" medications (such as analgesics and artificial tears) decreased compared with the corresponding period in 2025, further corroborating the above trend. As the HA encourages more active communication between patients and healthcare personnel regarding medication usage, the number of unfilled prescriptions will increase.

     According to the prevailing record system, such prescription records are also counted under the category of unfilled prescriptions. Since a portion of the unfilled prescriptions does not involve actual expenditure, it is not possible to itemise and quantify the specific drug expenditure involved. The current data should not also be directly used to assess the effectiveness of the fees and charges reform. The HA is exploring how to exclude unfilled prescriptions that do not require repeat collection from the statistics, so as to more accurately reflect the actual patterns of prescription and medication utilisation, and to assess the practical effectiveness of reducing medication wastage caused by overstocking.  

(2) Private healthcare services generally operate under a market mechanism. Their fee levels are determined by the service providers and are subject to factors including service delivery models, service positioning, operating costs, manpower supply, geographical service distribution, as well as market supply and demand. At this stage, the Government has not observed any specific data indicating that fees in the private healthcare market have generally increased due to adjustments to public healthcare fees. In fact, the Government has noted that some private healthcare facilities have successively lowered their fees for individual service items over the past few months. 

     Apart from continuing to monitor the operation of the healthcare market, the Government will formulate and implement a regulation and Codes of Practice to enhance the price transparency of private healthcare services by requiring relevant private healthcare facilities to provide price information and budget estimates and to publish billing statistics. These measures will help members of the public make informed decisions when selecting private healthcare services, and enable the Government to better understand and analyse the relevant fee statistics.

(3) and (6) The Government and the HA deeply value the feedback from members of the public and stakeholders regarding the fees and charges reform for public healthcare. Since the announcement of the fees and charges reform package on March 25, 2025, the Health Bureau (HHB) and the HA have, in addition to briefing the Panel on Health Services of the Legislative Council (LegCo), engaged with LegCo Members at various meetings to address reform-related topics. Engagement with and briefings for different political groups, professional bodies, healthcare personnel, patient organisations and relevant advisory bodies are still ongoing.

     The HA has organised approximately 200 sessions of various activities, including briefing sessions and workshops, for District Council members, patient organisations and volunteers, etc. The HA has also collaborated with local community stakeholders to organise activities to enhance public understanding of various reform measures, including the fee waiver. Furthermore, in respect of different service areas and issues of concern to service users, the HA has proactively conducted explanations through multiple channels, including media briefings, press releases, the Internet, social media and instant messaging channels. It has also developed a dedicated webpage, information kits, videos and publicity materials to reach out to the community through different channels and help the public understand the relevant arrangements under the reform.

     The HA has not conducted any dedicated formal survey or statistical compilation on public satisfaction regarding the fees and charges reform for public healthcare. The HA has all along been collecting patients' feedback on services through patient experience surveys and routine feedback channels, and will collate feedback relating to the reform to review its implementation and identify arrangements requiring improvement. For instance, in response to public feedback on the application arrangements for medical fee waivers, the HA expanded the function for the application of medical fee waivers under the HA Go feature "Medical Fee Assistance" in July 2026, allowing eligible patients to complete medical fee waiver applications, upload documents and book Medical Social Services via the application, thereby reducing their trips to and from hospitals for application purposes. The HA will continue to collect feedback through existing channels and has no plan to launch a separate dedicated satisfaction survey on the reform at this stage. 

     As regards the mechanism for determining fees and charges for public healthcare, according to 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 from obtaining adequate medical treatment through lack of means. 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 HHB and the HA will review the implementation and effectiveness of the reform every two years in accordance with the prevailing mechanism. Currently, the mechanism for determining relevant fees functions fully within the statutory framework, with arrangements for regular reviews and extensive consultations in place. Considering that the existing mechanism has proven effective and can flexibly respond to changes in medical needs and societal conditions, the Government has no plan to amend the arrangements related to fees for hospital services under the Hospital Authority Ordinance at this juncture. 

(4) The medical fee waiver mechanism is designed to accurately identify and support patients who are unable to afford fees and charges for public healthcare due to financial hardship in medical context. It specifically targets the protection of the "poor" among the four categories of "poor, acute, serious, critical" patients. The mechanism covers persons of all age groups, and its assessment criteria (including income and asset limits) are determined based on an individual's ability to meet medical expenses. This is fundamentally different in nature from the OALA, which is a cash welfare benefit intended to help elderly persons meet their daily living expenses. The two measures differ in their policy objectives, assessment criteria and forms of assistance.

     The Government must carefully consider any proposal to extend automatic medical fee waivers to OALA recipients aged below 75. As at mid-2025, Hong Kong had close to 1.8 million elderly persons aged 65 or above, accounting for nearly one-quarter of the total population. Among them, around 46 per cent (i.e. more than 830 000 persons) were OALA recipients. With the further ageing of population, the number of people aged 65 or above is projected to increase to about 2.74 million in 2046, representing more than one-third of the overall population. If the HA adopts a one-size-fits-all approach to automatically grant full medical fee waivers to all OALA recipients aged 65 to 74 without conducting any additional eligibility assessment, over 450 000 additional persons would immediately qualify for automatic full exemption. Such an expansion would further intensify the pressure exerted by population ageing on the sustainability of the public healthcare system, and run counter to the original objective of the reform to target limited resources more precisely towards those most in need.

     The current mechanism already provides appropriate support for elderly persons with financial needs. The reform has enhanced the medical fee waiver mechanism by relaxing both the income and asset limits, and set higher asset limit for households with elderly members (aged 65 or above), with the asset limit increased by $168,000 for every elderly individual. At the same time, the HA has simplified and expedited the application process for OALA recipients aged below 75. Effective from August 31, 2026, staff members can utilise an electronic data-interchange system integrated with the Social Welfare Department to facilitate the assessment of medical fee waiver applications, thereby further facilitating eligible persons seeking the support they need.

     Following the principle of progressive and orderly implementation, the Government will review various arrangements under the fees and charges reform for public healthcare every two years. The Government will continue to assess whether the existing mechanism is effective in achieving the policy objective of directing subsidies more precisely towards poor patients, while ensuring the long-term sustainability of the healthcare system in the face of the challenges brought about by an ageing population.

(5) Hong Kong's primary healthcare system operates on a dual-track system encompassing the public and private sectors. In fact, the primary healthcare needs of the vast majority of the public are currently taken care by the private medical sector, while the public healthcare system has served as an essential safety net for the population (in particular the underprivileged groups).

     Regarding public primary healthcare services, the HA currently operates 24 FMCs that offer evening out-patient services. Meanwhile, a total of 15 clinics offer FMOP services on Sundays and public holidays. The FMCs are primarily positioned to prioritise the care of low-income individuals and underprivileged groups, patients with chronic diseases in stable medical conditions (such as diabetes and hypertension), as well as patients with episodic illnesses with relatively mild symptoms (such as influenza and cold). The FMCs are not intended for the provision of emergency services. Emergency cases require the support of multiple specialties and other ancillary facilities of hospitals. Patients with severe and acute symptoms should seek care at A&E departments of hospitals where the appropriate staffing, facilities and ancillary services are in place to provide appropriate treatment and comprehensive care. The existing daytime and evening FMOP services are already capable of meeting the demand for outpatient consultations arising from episodic illnesses effectively and efficiently.

     To cope with the increasing service demand, the HA has been committed to strengthening FMOP services and enhancing consultation capacity, including evening out-patient and public holiday out-patient services. The HA is gradually increasing 25 000 evening consultation slots starting from the second quarter of this year, covering districts including Tuen Mun, North, Tai Po, Sha Tin, Sham Shui Po, Kwai Tsing and Kwun Tong. Among them, the North Kwai Chung FMC has regularised its consultation services until 10pm from Wednesdays and Thursdays only, to Mondays through Fridays with effect from October 2, 2026. To further expand the service volume, the 2026 Policy Address also announced that FMOP service quotas would be increased by about 220 000 each year from next year onwards based on district demand, including around 10 000 quotas for evening out-patient service. The Government understands that members of the public, especially underprivileged groups, have a certain demand for the HA's evening out-patient services. Therefore when planning the increase in evening consultation slots, factors including the population size of the districts, the waiting time at A&E departments and the availability of private family doctor services are taken into account. The HA and the Primary Healthcare Commission will continuously review the service needs in different districts, particularly the service needs of underprivileged groups, and will further strengthen out-patient services by deploying manpower and resources to increase consultation slots in districts with greater demand.

     Having regard to the effective utilisation of FMOP resources, the introduction of late-night or overnight outpatient services is not a cost-effective option, and will also pose further pressure on healthcare manpower. As for the establishment of a 24-hour telehealth consultation hotline to assess conditions through telephone or electronic platforms, it may not be possible to obtain the clinical information required for face-to-face assessments. Telehealth assessment also involves considerations such as service quality, patient safety and cost-effectiveness, while it may possibly involve violation of professional ethics. The HA has no plan to establish relevant services at this stage. 

Ends/Wednesday, October 7, 2026
Issued at HKT 17:30

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