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 has 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 fees can apply for a fee waiver at the Medical Social Workers of public hospitals and clinics. The Medical Social Workers 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 fee waiver under the enhanced mechanism (patients who do not meet these criteria could provide other non-financial factors for the consideration of Medical Social Workers): -

(a) 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
(b) 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 - 4 th Quarter 2007
Household Size Median Monthly Domestic Household Income 75% of the MMDHI 50% of the MMDHI
1 $6,700 $5,025 $3,350
2 $14,000 $10,500 $7,000
3 $18,100 $13,575 $9,050
4 $22,000 $16,500 $11,000
5 $29,300 $21,975 $14,650
6 $30,700 $23,025 $15,350
7 $37,100 $27,825 $18,550
8 or above $33,400 $25,050 $16,700


Asset Limit for Waiving of Medical Charges
Household Size Asset Limit(with no elderlymember) 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 >65) in the patient's family.

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

Non-financial consideration

Medical Social Workers would also consider the following non-financial factors besides 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 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.


Medical Social Workers would consider the above factors to ensure elderly or chronic patients who are frequent users of public medical services could obtain a fee waiver if needed. This list is not exhaustive and the Medical Social Workers 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 take into consideration of the changing needs of patients and family members.

A fee waiver granted by the Medical Social Workers will either be one-off or valid for a period of time. The Medical Social Workers have the discretion to decide the exact period (the longest period being one year) based on a patient's actual needs and conditions. For the convenience of patients, the Medical Social Workers may in advance grant 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 is not only applicable to the institution he/ she 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.

Application for a fee waiver

Patients who have financial difficulties in paying medical fees could apply for fee waiving. Applicants can bring along relevant documents as follows and approach Medical Social Workers during office hours for assessment:

(a) Proof of Household member component (patient and family members under the same roof)

Tenancy agreement of public housing unit

(b) Proof of Household Income (patient and family members under the same roof)

Employed persons: Bank passbooks (showing updated balance) 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 (patient and family members under the same roof)

Bank passbooks (showing updated balance), bank statements, time deposit receipts, foreign currency accounts, shares, insurance policy (cash value and dividend), proof of property ownership (including those in Hong Kong, the Mainland and overseas), etc.
(d) Proof of Household Major Expenses (patient and family members under the same roof)

Documents of mortgage payments, rental receipts, debit notes, bills of medical expenses, etc.
Remarks:
i. The above list of documents is for reference only. The Medical Social Worker may decide what documents should be required for assessment on case-by-case basis.
ii. The patient's family members, including the patient's parents, spouse, siblings and children, are all subject to financial assessment and investigation. Where necessary, the Medical Social Worker may contact the persons concerned to clarify the information.
iii. The Hospital Authority/Social Welfare Department would conduct random checks on the information provided by the patient/applicant in the medical fee waiver application to confirm the information provided is accurate.
Investigation Section (Fee Assistance Application)

In the application of medical fee waiving and Samaritan Fund, 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 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, Investigation Section conducts:

  -  in-depth investigation on suspected fraud cases of medical fee assistance
  -  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 Departments, banks and other organizations
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Medical fee assistance demands your honesty

Medical fee waiving and Samaritan Fund are provided only for needy patients. Investigation Section conducts checks on the approved applications regularly. Applicant 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 or Samaritan Fund by deception is a criminal offence. Apart from the consequence of being ineligible for medical fee assistance, the applicant shall be liable on conviction upon indictment to imprisonment of 10 years under the Theft Ordinance (Cap 210 of the Law of Hong Kong).

Hospital Authority
August 2007
(with MMDHI figures updated in March 2008)