Waiving Mechanism of Public Hospitals
(Information Leaflet)



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 be upheld after the fee revamp, recipients of Comprehensive Social Security Assistance (CSSA) will continue to be waived from payment of their public health care expenses. 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 existing medical fee waiver mechanism has been enhanced to provide effective protection from undue financial burden to them.

The following guiding principles have been taken into account to enhance the waiver mechanism: (1) Public funds should be channeled to the vulnerable groups and to services which carry major financial risks to patients; (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. As at present, both financial and non-financial factors should be considered; and (3) The enhanced mechanism should facilitate accessibility to services, while maintaining the 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 Services Centres & the Family and Child Protective Services Units of the Social Welfare Department (IFSCs/ FCPSUs of SWD). The 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 the applicants on a household basis.

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):

The patient's monthly household income does not exceed 75% of the Median Monthly Domestic Household Income (MMDHI) applicable to the patient's household size, and

The value of the patient's household asset is within a certain limit applicable to their household size. It should be noted that the residential property owned and occupied 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 their personal savings).

Median Monthly Domestic Household Income (MMDHI)
By Household Size - 3 rd Quarter 2009
Household Size Median Monthly Domestic Household Income 75% of the MMDHI 50% of the MMDHI
1 $6,500 $4,875 $3,250
2 $13,500 $10,125 $6,750
3 $18,000 $13,500 $9,000
4 $22,300 $16,725 $11,150
5 $29,000 $21,750 $14,500
6 or above $33,600 $25,200 $16,800

Source: General Household Survey, Census and Statistics Department


Asset Limit for Waiving of Medical Charges
Household Size Asset Limit (with no elderly member) Asset Limit(with 1 elderlymember) Asset Limit(with 2 elderlymembers)
1 $30,000 $150,000 -
2 $60,000 $180,000 $300,000
3 $90,000 $210,000 $330,000
4 $120,000 $240,000 $360,000
5 $150,000 $270,000 $390,000

Note: The asset limit is raised by $120,000 for each elderly member (i.e. age = or >65) in the patient's family.


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

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 the different public medical services, and severity of the 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 clinics/ hospitals; 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 their 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 the 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

  • Tenancy agreement of public housing unit
(b) Proof of Household Income

  • Employed persons:
    • Bank passbooks and/or statements (showing updated balance with at least the last 6 months' transaction record), salary statements, tax statements, employer's certifications, Mandatory Provident Fund (MPF) Scheme pay records, or other proof of income.
  • Self-employed persons:
    • Tax statements, income undertakings or other proof of income.
(c) Proof of Household Assets

  • Bank passbooks and/or statements (showing updated balance with at least the last 6 months' transaction record) relating to all the individual and joint accounts, including saving deposit, time deposit, foreign currency deposit, investment, shares and securities services, current account and integrated account, etc.
  • Insurance policies with investment or saving element (e.g. investment-linked insurance policies, cash value and dividend provided by life insurance)
  • Documentary evidence of stock, shares, funds, bonds and other investments owned
  • Proof of property ownership (including those in Hong Kong, the Mainland and overseas), etc.
(d) Proof of Household Major Expenses

  • Documents of mortgage payments, rental receipts, debit notes, bills of medical expenses, etc.
Remarks:
1. Household Member(s) means family member(s) living with patient under the same roof, such as the patient's parents, spouse, siblings and children etc.
2. The documents listed above only serve as reference. According to individual case merit, the 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 those 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 checking on approved medical fee waiver applications to confirm the accuracy of the information provided.
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 the integrity of the medical fee assistance systems and protect them against 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:

  - preventing and detecting the occurrence of fraud and abuse of medical fee waiving and Samaritan Fund
  - taking appropriate action against suspect who commits deception relating offence
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:

  -  in-depth investigation on suspected fraud cases of medical fee assistances
  -  regular checks of approved cases selected on random basis
  -  checking of cases with high risk factors for fraud and abuse
  -  data matching within Hospital Authority, with Government Department, bank, employee and other parties
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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 conducts checks on the 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/ the applicant/ the 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).

Hospital Authority
February 2010