Waiving Mechanism of Public Hospitals


Introduction

Application for medical fee waiver It has always been the Government’s fundamental philosophy that no one will be denied adequate medical care due to lack of means. To ensure that this principle will continue to be upheld after the fee revamp in April 2003, recipients of Comprehensive Social Security Assistance (CSSA) will be waived from payment of public health care expenses1 upon presentation of identity proof and claim their waiver eligibility status each time they register for consultation and their waiver status could be confirmed through online eligibility checking. To assist the three vulnerable groups in the community, i.e., the low income group, chronically ill patients and elderly patients who have little income or assets but who are not CSSA recipients, the medical fee waiver mechanism has been enhanced at that time to provide them with effective protection from undue financial burden.

The following guiding principles were taken into account when the waiver mechanism was enhanced in 2003: (1)Public funds should be channeled to the vulnerable groups and to services which carry major financial risks ; (2)There should be a set of objective and transparent criteria to assess a patient's eligibility for exemption from payment of public medical fees. At present, both financial and non-financial factors should be considered; and (3)The enhanced mechanism should facilitate accessibility to services, while maintaining low administrative and operating cost of the existing mechanism.

Non-CSSA recipients who could not afford medical expense at the public sector can apply for a medical fee waiver at the Medical Social Services Units of public hospitals and clinics or the Integrated Family Service Centres and the Family and Child Protective Services Units of Social Welfare Department (IFSCs/ FCPSUs of SWD). Medical Social Workers (MSWs) or Social Workers (SWs) of IFSCs/ FCPSUs of SWD would assess the application with due consideration given to the financial, social and medical condition of applicants on a household basis.

Starting from 15 Jul 2017, the medical fee waiver for public healthcare services has been extended to cover Old Age Living Allowance (OALA) recipients meeting the eligibility criteria and from 1 Jun 2018, the medical fee waiving arrangement is also applicable to Higher OALA recipients aged 75 or above. Eligible OALA recipients will be waived for the standard fees and charges for public healthcare services upon presentation of the identity proof and claim their waiver eligibility status each time they register for consultation and their waiver status could be confirmed through online eligibility checking.

1With effective from March 2017, Level 0 Voucher Holders of the Pilot Scheme on Residential Care Service Voucher for the Elderly are also waived from payment of public health care expenses.

Financial consideration

Patients who meet both of the following two financial criteria are eligible to apply for a medical fee waiver under the enhanced mechanism (patients who do not meet these criteria could provide other non-financial factors for the consideration of MSWs or SWs of IFSCs/ FCPSUs of SWD):

(a) The patient's monthly household2 income does not exceed 75% of the Median Monthly Domestic Household Income (MMDHI) applicable to the patient's household size, and
(b) The value of the patient's household2 asset is within a certain limit applicable to their household size. It should be noted that the first flat (self-owned or rented) resided in together by the patient's household will not be counted towards this asset limit, and households with elderly members will enjoy a higher asset limit than those without (taking into account the fact that most elderly citizens will no longer earn any income and have to depend on personal savings).

2Household includes patient and his/her core family members living under the same roof, i.e. patient’s parents, children, spouse and dependent siblings – siblings aged below 18, aged between 18-25 receiving full-time education or disabled adult siblings (i.e. receiving disability allowance under the SSA scheme or standard rates for 100% disabled or requiring constant attendance under the CSSA scheme).

Median Monthly Domestic Household Income (MMDHI)(HK Dollar)
By Household Size - 2nd Quarter 2018
Household Size Median Monthly Domestic Household Income 75% of the MMDHI 50% of the MMDHI
1 $8,300 $6,225 $4,150
2 $19,900 $14,925 $9,950
3 $30,100 $22,575 $15,050
4 $40,800 $30,600 $20,400
5 $52,500 $39,375 $26,250
6 or above $56,800 $42,600 $28,400
Source: General Household Survey, Census and Statistics Department, HKSAR Government
(The above figures were updated in September 2018)


Asset Limit for Waiving of Medical Charges(HK Dollar)
Household Size Asset Limit (with no elderly member) Asset Limit(with 1 elderly member) Asset Limit(with 2 elderly members)
1 $41,500 $209,500 -
2 $85,000 $253,000 $421,000
3 $127,500 $295,500 $463,500
4 $170,000 $338,000 $506,000
5 $212,500 $380,500 $548,500
Note: The asset limit is raised by $168,000 for each elderly member (i.e. age = or >65) in the patient's family.

Patients whose monthly household income do not exceed 50% of the MMDHI applicable to their household size and pass the asset limit test will be considered for full waiving of medical fees at public hospitals/clinics.

Non-financial consideration

MSWs or SWs of IFSCs/ FCPSUs of SWD would also consider the following non-financial factors, apart from the financial factors of household income and asset:

(a) The patient's clinical condition as defined by the patient's frequency of use of different public medical services, and severity of illness;
(b) Whether the patient is a disabled person, single parent with dependent children, or from other vulnerable groups;
(c) Whether a medical fee waiver could provide incentive and support to solve the patient's family problems;
(d) Whether a patient has any special expenses that make it difficult to pay for his/her medical fees at public hospitals/clinics; or
(e) Other justifiable social factors.

MSWs or SWs of IFSCs/ FCPSUs of SWD would consider the above factors to ensure elderly or chronic patients who are frequent users of public medical services could obtain a medical fee waiver if needed. This list is not exhaustive and the MSWs or SWs of IFSCs/ FCPSUs of SWD will exercise discretion to grant waivers, where appropriate, to a patient with special difficulties (even if he/she fails to meet the financial criteria) on a case-by-case basis. The waiving mechanism and guidelines will be regularly reviewed to ensure needy patients of adequate medical care.

Validity period of waiving

A medical fee waiver granted by the MSWs or SWs of IFSCs/ FCPSUs of SWD after assessment will either be one-off or valid for a period of time. The MSWs or SWs of IFSCs/ FCPSUs of SWD have the discretion to decide the exact period based on a patient's actual needs and conditions (the longest period being twelve months). For convenience of patients, the MSWs or SWs of IFSCs/ FCPSUs may in advance grant medical fee waiver to a chronically ill patient who frequently needs Specialist Out-patient (SOP) service, which the waiver will be valid for a defined period of time for the SOP service he/she needs. To make the system more user-friendly, the waiver issued by MSWs is not only applicable to the institution he/ she is admitted, attends or obtains the waiver, but is also applicable to other public institutions (i.e. the Hospital Authority or the Department of Health) that provide the same service, including in-patient service, out-patient services and community services etc.

Application for a fee waiver

Patients who have financial difficulties in paying medical expenses could apply for medical fee waiving. Applicants can bring along original and copy of relevant documents as follows and approach MSWs or SWs of IFSCs/ FCPSUs of SWD during office hours for assessment:

(a) Proof of Household member component(patient and core family members living together) (b) Proof of Household Income(patient and core family members living together) (c) Proof of Household Assets(patient and core family members living together) (d) Proof of Household Major Expenses(patient and core family members living together) Remarks:
  1. Core family members include patient's parents, spouse, children and dependent siblings (i.e. siblings aged below18, aged between 18-25 receiving full-time education or disabled adult siblings).
  2. The documents listed above only serve as reference. According to individual case merit, Medical Social Workers may request for other documents or contact the patient's family member(s) for clarification and verification of information when necessary.
  3. The Medical Fee Waiving Mechanism provides a safety net for needy patients. The patient/ applicant and household member(s) must provide complete, accurate, up-to-date and true information to the Hospital Authority/ Social Welfare Department for assessment. The Hospital Authority established the Post Approval Checking Mechanism that will periodically conduct checks on approved medical fee waiver applications to confirm accuracy of information provided.

Enquiries


Post Approval Checking Mechanism

In the application of medical fee waiving, applicants are required to provide complete, accurate, true and up-to-date information to Medical Social Workers/ Social Workers of Social Welfare Department for assessment and verification. In order to maintain integrity of the medical fee assistance systems and avoid these systems from being abused, the Hospital Authority established Investigation Section (Fee Assistance Application) in March 2007 (renamed as Medical Fee Assistance Section in 2008) for the purposes of: To accomplish the purposes, a Post Approval Checking Mechanism has been put in place at hospital clusters and the Hospital Authority Head Office to conduct:

Medical fee assistance demands your honesty

Poster for Medical fee assistance demands your honesty Medical Fee Waiving and Samaritan Fund are provided only for needy patients. The Checking Units of the Hospital Authority conduct checks on approved applications regularly. The patient/ applicant and household member(s) must provide complete, accurate, true and up-to-date information and has to report to the Hospital Authority/ Social Welfare Department any changes in the particulars in the application within the validity period of the financial assistance.

Don't break the law

Acquiring Medical Fee Waiving by deception is a Criminal Offence. In addition to the consequence of being ineligible for the Medical Fee Waiving, the patient/ applicant/ patient's household member(s) shall be liable on conviction upon indictment to imprisonment of 10 years under the Theft Ordinance (Chapter 210 of the Laws of Hong Kong).

Information Pamphlet

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(Click to view)

Video

Video Icon Waiving of Medical Charges
Part 1 - Can I get help if I could not afford medical expense? Part 2 - Eligibility for medical fee waiver and application procedures
Part 1 - Can I get help if I could not afford medical expense? Part 2 - Eligibility for medical fee waiver and application procedures

Duration : 1:37min

Duration : 07:25min


Hospital Authority
June 2018
(with MMDHI figures updated in September 2018)