Hong Kong’s extremely low healthcare charges have been an enigma to me for a long time. I have always wondered why Hong Kong doesn’t charge more when patients can afford it, but denies them much needed services or charges them unaffordable fees when they cannot.
Dental care is a case in point. At present, Hong Kong provides comprehensive dental services to civil servants and school children, while offering others scant services on ration that include only pain relief and tooth removal. I cannot understand this, because toothache and the inability to chew food seriously undermine a patient’s well-being.
Our neighbor, Singapore, offers subsidized dental services. Singapore also charges much higher fees for clinic visits and for hospital stays, and charges for surgery and other fees separately. Hong Kong is very generous. The inpatient charge of HK$120 ($15) is inclusive of three meals daily and all medical costs, including surgery fees, with the exception of items that are very expensive, such as cardiac pacemakers and intraocular lenses and drugs not included in the Hospital Authority (HA) Drug Formulary.
I have been advocating for raising our publicly provided basic healthcare fees since 1997 and capping eligible healthcare costs paid by patients annually. But somehow we opted to offer virtually free services “when the public purse can afford”, and we left patients to fend for themselves unless they are on Comprehensive Social Security Assistance (CSSA) or qualify for help under the Samaritan Fund program. The fact is, however, that healthcare costs can be very onerous even for those who do not need the CSSA and who fail the means test for assistance under the Samaritan Fund.
Given the huge number of patients that the Hospital Authority serves, the small amounts that patients now pay, when they are set at a more reasonable level, could amount to a level such that we would be in a better position to provide timely and needed care. For the more expensive but necessary medical services, patients would pay as long as these expenses are still below the yearly cap
The Hong Kong Special Administrative Region government may think that for items that are not too costly, the public purse can afford it. However, given the huge number of patients that the HA serves, the small amounts that patients now pay, when they are set at a more reasonable level, could amount to a level such that we would be in a better position to provide timely and needed care, including dental services. For the more expensive but necessary medical services, patients would pay as long as these expenses are still below the yearly cap. The government should shoulder all expenses that exceed the annual limit, and patients should again pay the share up to the cap in the following year.
As I pointed out in a 2023 article, the dental services provided by the Department of Health mainly serve the needs of civil servants and retired civil servants, and have very little to do with the public. Indeed they border on being nonexistent in the eyes of the public. Hong Kong’s dental clinics with general public sessions only offer emergency cases involving pain relief and teeth extraction.
It is now expected that in the months to come, the government will conduct significant reforms to Hong Kong’s healthcare subsidy model. While charges will be raised in many cases, the government promises to improve the healthcare safety net for the neediest patients who have to face huge costs to treat cancer and rare diseases.
I of course welcome the change. However, I still think it is far better to use the “excessive burden protection” model that can be summarized as “charge at cost, and cap annual eligible expenses”. I also propose that the annual cap be raised from HK$10,000 to HK$30,000 progressively with age. This schedule would increase in line with expected healthcare costs as one ages. The rising annual cap also mirrors the increasing cost of health insurance with age. The difference is that if a person adopts a healthy lifestyle and rarely needs medical care, the rising cap does not automatically translate into higher medical expenses. The rising cap, indeed, serves as a reminder for young people that they had better adopt a healthy lifestyle if they want to avoid having to pay much more for healthcare when they get old.
The annual cap, of course, should also vary with people’s incomes. For poor people, the annual cap should be lower. For those on CSSA and particularly those suffering some disability, the government can put the annual cap at HK$5,000 while at the same time offering them an increase in the annual living allowance of the same amount. This way they would not shoulder any additional net burden, because they need at most pay only HK$5,000, which they would have received as an additional income through the year. If they take good care of themselves and have little need for medical care, they will have additional money left.
On reflection, I think the earlier Voluntary Health Insurance Scheme is not a good idea. There is usually a moral hazard effect following health insurance, as suppliers of medical services may recommend more services and charge higher fees. Private practices and private hospitals earn more and are better able to attract experienced doctors, therapists, and nurses from public hospitals. Private hospitals also tend to take patients who are less seriously ill, leaving those with more complicated medical issues in public hospitals. As a result, the public sector has to spend more.
Only when the public healthcare sector can provide timely and dependable healthcare can patients visiting private hospitals and practitioners have any bargaining power. The public healthcare system should charge more, but ensure affordability.
The author is former director of Pan Sutong Shanghai-HK Economic Policy Research Institute, Lingnan University, and adjunct professor, Education University of Hong Kong.
The views do not necessarily reflect those of China Daily.
