The “charge and cap” proposal announced last week is a major step toward providing timely, reliable, and better coverage healthcare services in the Hong Kong Special Administrative Region. As Secretary for Health Lo Chung-mau explained, the proposal should not be seen just like a fare increase for public transport. It is a major reform designed to rationalize the charges without undermining affordability while improving the government’s ability to provide better healthcare to the public. This is the rationale behind “excessive burden protection”: No one will have to face being excessively burdened, because there will be a cap on how much one will need to pay on eligible healthcare services each year.

Public healthcare services must be timely, i.e., available to each patient readily without excessive waiting. If services are free but patients need to wait a long time to get them, they may never get the services. Patients with means may have to pay whatever private providers demand to stay alive. Patients without means will have to face the hard consequences of missing the opportunity for effective treatment.

Public healthcare services must also be dependable, i.e., of a good quality, which must be supported with skilled and devoted staff and supported by good medical equipment and with sufficient funds. Financial sustainability is of paramount importance.

Public healthcare services must cover services that are important to people’s well-being. It is heartbreaking to see our affluent city unable to offer basic dental services to the public. Even though the University of Hong Kong’s dentistry department is rated among the best in the world (QS World University Rankings by Subject 2025: Dentistry rated HKU second in the world), our public dental services are limited to pain relief and tooth extraction and are scantily provided.

To ensure affordability to low-income people, I have proposed halving the annual cap and charging half the normal fees for those who pass a means test. Rather than asking patients to see a medical social worker to enjoy these benefits, I would prefer that residents apply for the qualification that is good for, say, two years. The government through the Inland Revenue Department can identify those whose incomes are less than median and inform them that they are qualified.

I would also propose that spending in private hospitals and private clinics should count toward the annual cap at the rate charged in public hospitals and public clinics. Private providers typically charge much higher fees. The charges beyond the benchmark charges for publicly provided services must not count. Without counting the equivalent charges toward the annual cap, many people who can afford private healthcare may flock to the public facilities.

I find the exemption from charges for those who fall under the “crucial and emergency cases” when visiting accident and emergency units of public hospitals inconsistent with the principle of “excessive burden protection”. Whether or not a case falls under the “crucial or emergency” category has nothing to do with affordability. If someone still had a long way to go before reaching the cap, which is the limit for affordability, we should charge. Similarly, I cannot understand why we would not charge for X-ray services.

According to the government, the “charge and cap” arrangement will benefit about 70,000 patients who face life-threatening conditions or costly treatment. I would argue that the arrangement will benefit all residents, who will have the peace of mind from knowing that Hong Kong’s healthcare system will provide timely and reliable care when they need it.

It is reported that the medical fee waiver program will be expanded with relaxed income and asset limits, and will include an extra 1.1 million people, bringing the total to 1.4 million. To me, there is no rationale for a total fee waiver for anyone. Following the “excessive burden protection” philosophy, when eligible expenses add up to the cap, all expenses beyond the cap will be waived. But if expenses fall below the cap, why waive them?

It is very important that we position the public healthcare system as the backbone of Hong Kong’s healthcare system. If such a backbone system exists, and offers timely and reliable care, and covers all basic and essential care, including particularly dental care, then the public will have some bargaining power and will not be subject to unreasonable charges that may be arbitrarily imposed by private medical institutions on helpless patients who cannot wait for or who think public healthcare is not up to the mark.

To build this backbone, we must charge more reasonable fees. I would advise charging the fees at cost (without counting overheads) for all services in general but halving the charges for those who pass the means test.

Some people worry that the proposed HK$400 ($51.40) for accident and emergency services could discourage people from attending the accident and emergency departments and thus missing the opportunity for timely treatment that could be lifesaving. I doubt people who know about the annual cap would skip visiting accident and emergency units and thus risk their lives. Some people also worry that raising medical fees in the public healthcare system would ignite another round of medical fees increases among private healthcare providers. In my view, given that the public healthcare system will be in a better position to provide timely and reliable care, residents are in a better position to bargain with private providers, who are more likely to reduce their charges rather than raise them.

The author is a former director of Pan Sutong Shanghai-Hong Kong Economic Policy Research Institute, Lingnan University, and adjunct professor, Education University of Hong Kong.

The views do not necessarily reflect those of China Daily.