Editorial | Hospital fee reform must balance social fairness with budgetary needs

A major overhaul of public hospital fees comes into effect in the new year. If it achieves its goal, it will improve public health services while reducing the government’s healthcare subsidy from 97 per cent to 90 per cent over five years. Those are worthy targets. But to achieve them, some charges are bound to rise. Rightly, the reform has attracted close scrutiny. It is important that it strikes a balance between social fairness and value for spending on public health.

After a transition period, patients using non-urgent radiology services will also have to settle payments at least 14 days in advance to secure appointments to cut down on “no-shows”. At present, the government fully subsidises all radiology services at public hospitals. After the fee reform, it will still cover 90 per cent of the total cost, according to Dr Michael Wong Lap-gate, the authority’s quality and safety director. But only standard X-rays will remain free. Fluoroscopy, ultrasound scans and mammograms will cost HK$250 each. The authority estimates that about 60 per cent of CT scan users will still not need to pay under the new system.

The corresponding proportions will be 20 per cent for ultrasound scans and 10 per cent for an MRI. “We learned that a big part of radiology services required by patients was X-rays, so we will keep it free,” said Dr Elaine Kan Yee-ling, chairwoman of the authority’s Coordinating Committee in Radiology. The overhaul will help expand the medical expenses waiver scheme to cover an additional 1.1 million residents. The proceeds are to be used to subsidise patients with severe illnesses or facing hardship. It is estimated that it could generate HK$3 billion a year. Health Secretary Lo Chung-mau has said the ultimate aim is to enhance the sustainability of a public healthcare system used by most Hongkongers. But reform must be monitored closely to detect and remedy any unintended hardship.