Low-income patients call for more help as steeper Hong Kong hospital fees loom

Hong Kong’s public hospitals will raise a range of charges from January 1, while anxious lower-income patients who face higher bills but do not qualify under new fee waiver thresholds are calling for more government help.\nFrom Thursday, patients will need to pay more in general, but the safety net will also be widened to support the neediest, with an annual HK$10,000 cap on medical fees introduced and the current fee waiver scheme expanded to cover an extra 1.1 million people.\nHowever, some underprivileged residents have fallen through the cracks, facing as much as a fourfold rise in medical bills while being ineligible for subsidies due to a broad definition of income and assets, which includes annuity and family members’ income.\nThe changes include higher fees in areas ranging from hospital stays and outpatient clinic visits to imaging scans and tests. For example, patients requiring overnight hospital treatment will be charged HK$200 to HK$300 per day for a bed, depending on the type, instead of the current HK$100 or HK$120.\nThe authorities said the fees reform was intended to ensure the “sustainable development” of the city’s healthcare system.\n“Some elderly people have assets, but they do not have a job and still need to pay rent,” Ivan Lin Wai-kiu, a community organiser at the Society for Community Organisation, said on Tuesday.\n“Can the government further adjust the asset limit for those not living in public housing and still renting homes, to support the sandwich-class elderly?”\nHe urged authorities to reconsider fee waiver thresholds.\n“The Social Welfare Department counts annuity payouts as income, but [the premium] doesn’t count as an asset for the Old Age Living Allowance to encourage people to buy an annuity. Can the Hospital Authority consider such an arrangement as well?” he added.\n\n\n\n\nRetiree Tse Suk-nui said her medical costs would quadruple to HK$8,000 a year after the new fees took effect.\nThe 76-year-old retired driver, who lives alone, applied for a fee waiver but was rejected because she has an annuity plan that pays her HK$11,000 a month, which is mostly spent on rent for a 200 sq ft flat in a tenement building.\n“I listened to the government and bought an annuity plan, which became the reason they decided to stop taking care of me,” she said. “We’ve spent our whole lives contributing to society, why did the government take away that small benefit from me?”\nThe income threshold for the fee waiver is currently set at 75 per cent of the median monthly household income, but it will be raised to 150 per cent of the median figure for one-person households. The asset limit will also be raised to match that of public rental housing applicants.\nBecause the annuity counted towards Tse’s income and assets, her application failed.\nTse currently takes more than 10 types of drugs for diabetes and a knee injury. She visits hospital regularly for consultations with three specialists as well as for physiotherapy, hydrotherapy and occupational therapy sessions.\n“I will deplete my savings very soon if I am to pay the new fees, and I don’t know how much time I have left,” Tse said. “I hope the government can consider my case and waive my medical costs too … otherwise I might need to stop my therapy.”\nAn electric wheelchair user who gave her name as Ah Yan faces a 36.4 per cent increase in her medical expenses annually after the fee increases, as her chronic illnesses require at least seven hospital check-ups or consultations.\n\n\nThe 1st Step Association, an NGO that supports people with severe physical disabilities resulting from work-related injuries, said Ah Yan’s salary and assets both exceeded the threshold for the fee waiver.\nThe 30-year-old earns HK$20,000 a month and has assets of HK$300,000. Her annual medical and illness-related expenses will rise from HK$101,830 to HK$138,890 after the fee reforms.\nHer fees for specialty outpatient clinic visits will increase from HK$400 to HK$1,250 and for hospitalisation to HK$390 to HK$400.\nEvery year, she makes two visits to specialty clinics for neurosurgery and one each to respiratory medicine, orthopaedics and cardiology, in addition to two check-ups that require hospitalisation.\n\nTang Hiu-yan, a registered social worker at the association, said Ah Yan’s condition had been deteriorating, meaning she had to use special multifunctional wheelchairs, such as those that allowed her to lie down.\n“She has tried very hard to support herself economically so that she does not have to rely on the government,” Tang said. “If her condition worsens, it will mean more consultations with the doctors and more visits to accident and emergency wards – translating into a heavier financial burden.”\nThe association conducted a survey between September 5 and 26, collecting 110 effective responses on the impact of the price increases on wheelchair users, and found that 86.3 per cent of respondents had an income of HK$9,999 or less despite significant medical or rehabilitation expenses.\nNearly half, or 48.2 per cent, said they were not qualified for the Comprehensive Social Security Assistance (CSSA) Scheme because the threshold was calculated by household, which included family members’ salaries and assets.\nThe association proposed financial assistance for expenses such as helpers and rehabilitation supplies for those who were not recipients of CSSA. CSSA receivers are now entitled to such assistance under “special grants”.\n