【明報專訊】PLANS for reforming public healthcare fees have been unveiled. The authorities stressed that the reform aims to restructure the subsidy framework to better allocate resources to critically ill patients and emergency cases. While the general direction is correct, there are concerns about whether private medical services would take the opportunity to raise fees, further worsening medical inflation.
The government has reviewed public healthcare fees and will increase charges for some services, including A&E, outpatient and inpatient care, pathology examinations, non-urgent radiographic scans, etc. The changes aim to guide the public to change their habits of using medical services and reduce the misuse of high-cost treatments.
Health Secretary Lo Chung-mau said that the general principle of the fee reform is to make those who have the financial ability and those who have mild illnesses share the cost. Under the current public medical fee waiver mechanism, recipients of the Comprehensive Social Security Assistance (CSSA) and recipients of the Old Age Living Allowance aged 75 and above are exempt from charges. Those with financial difficulties can also apply for a waiver. The reform plan proposed three measures, including loosening income and asset restrictions for the fee waiver mechanism, increasing the number of eligible people from the current 300,000 to over one million; accelerating the introduction of innovative drugs and devices and relaxing the criteria for eligible subsidy applicants; introducing an annual cap of $10,000 for outpatient and inpatient service charges (excluding self-financed drugs and devices).
The government subsidises more than 97% of public healthcare services, and even services like CT scans and MRIs are free. The fee reform can prevent misallocation of funding and avoid situations like people with mild illnesses requiring a lot of medical care and minor cases clogging up A&E wards.
Fee hikes are never popular, but since everyone is potentially at risk of sudden or acute illnesses, improving resource allocation may even benefit oneself in the future. For example, the current self-financed drugs for cancer and rare diseases are costly. Easing the criteria for subsidy application would allow more middle-income patients to afford expensive life-saving drugs. Many patients with chronic or serious illnesses frequently visit public hospitals or specialist outpatient clinics, so the $10,000 cap is also very important protection for them.
The general direction and principle of the reform are good and reasonable, but it is not guaranteed that other problems will not arise. With A&E charges more than doubled, the price level will be similar to that of private clinics. Currently, A&E patients are divided into five categories: critical, emergency, urgent, semi-urgent and non-urgent. According to government data, 57.8% of A&E cases belong to category four or five. Only about 5% fall into the first two categories. It is hoped that the new fees could significantly reduce the number of category five cases. However, the problem is that nearly 40% of cases are in the third category—with the substantial fee increase, one cannot rule out that some grassroots patients would be deterred from seeking medical help, which could delay treatment and worsen their conditions.
Raising A&E fees will "thrust" non-urgent patients to private clinics. It is possible that some private clinics and doctors may take advantage of the situation and raise prices. The private healthcare fee system in Hong Kong lacks transparency, and medical inflation has remained at a high level of 8% per year in the past three years. Some may even charge higher fees depending on whether patients have medical insurance. The authorities said that the A&E charges of public hospitals should not be compared with the medical fees of private clinics, but rather with the emergency service charges of private hospitals. This inevitably gives the impression that the authorities have not fully addressed the possibility of exacerbating medical inflation.
明報社評 2025.03.26：公營收費改革雖有理 醫療通脹問題須留神
公營醫療收費改革方案出爐，當局強調今次是改革資助架構，將資助更好地運用在危急重症病人身上，大方向正確，然而私營醫療服務會否趁勢加價，進一步推高醫療通脹，令人關注。
政府檢討公營醫療收費，提高部分服務收費，涉及急症室、住院、門診、病理檢驗、非緊急放射造影等，引導市民改變使用模式，減少濫用高成本服務。
醫衛局長盧寵茂表示，收費改革大原則是能者共付、輕症共付。根據現行公營醫療費用減免機制，綜援和年滿75歲長津受惠人可豁免收費，有經濟困難者亦可申請減免。改革方案提出3項措施，包括放寬收費減免機制的收入及資產限額，合資格受惠人數由目前30萬增至百多萬；加快引入創新藥械並放寬資助申請資格；增設住院門診全年收費上限，每人每年1萬元，自費藥械除外。
政府補貼公營醫療服務比例逾97%，電腦掃描和磁力共振等服務更屬免費。收費改革可以改善資助錯配，避免小病大醫、輕症個案堵塞急症等情况。
任何加費都不會受歡迎，然而每個人都有可能得急病、重病，資源運用更精準，他朝受益的說不定是自己。舉例說，目前癌症和罕見病的自費藥物價格高昂，放寬藥費資助申請資格，意味更多中等收入病人可獲資助購買救命貴藥；不少長期病人及重病患者經常出入公院或看專科門診，封頂1萬元同樣是非常重要的保障。
今次收費改革，大方向正確，大原則也合理，然而並不保證不會衍生其他弊端。急症室加價超過一倍，收費水平與現時私家診所相若。現時急症室會將病人分流為危殆、危急、緊急、次緊急及非緊急5類。根據當局數據，57.8%急症室診症分類屬第四及第五類，屬於首兩類只有5%左右，新收費可望令第五類顯著減少。問題在於佔比近四成的第三類病人，收費大增下，不排除一些基層病人對求醫有猶豫，導致延誤醫治，病情惡化。
急症室收費上調將非緊急病人「推向」私家診所，不排除有私家診所和醫生趁機加價。本港私營醫療收費缺乏透明度，醫療通脹近3年一直維持在每年8%的高水平，部分甚至會視乎病人有否買醫保，收取更高費用。當局表示，公院急症室收費，不應與私家診所比較，應該跟私院急症相比，難免令人覺得當局未有正視醫療通脹加劇的可能。
/ Glossary生字 /
waiver：a document that prevents or allows an action that is different from the usual thing
eligible：a person who is eligible for sth or to do sth, is able to have or do it because they have the right qualifications
clog sth (up)：to block sth or to become blocked