To struggling Hongkongers, rise in healthcare fees just adds to hardship

Few things worry ordinary citizens as much as a surge in healthcare costs. On March 25, the Hong Kong government announced a sweeping overhaul of public healthcare fees, with increases that cannot be ignored. The price of a visit to the accident and emergency department will more than double to HK$400 (US$51.45) from HK$180, specialist outpatient fees will jump to HK$250 from HK$80 and hospital inpatient charges will go up to HK$300 a day from HK$120. For a city already grappling with rising living costs, the move has sent shock waves through society. Government officials, including Secretary for Health Lo Chung-mau, argue that the adjustments are long overdue. The last revision was in 2017, despite a mechanism that recommends a review every two years. The financial burden of public healthcare has been mounting, with the government subsidising an astonishing 97.6 per cent of costs. Even after the price adjustment, subsidies will remain at 94 per cent, with a target of reducing them further, to 90 per cent within five years. In other words, this is only the beginning of a broader shift towards more cost-sharing. The numbers tell a sobering story. Hong Kong’s public healthcare spending has increased significantly over the past decade, from HK$70 billion in the 2015-16 financial year to a projected HK$141 billion for the current financial year. It now accounts for a substantial portion of the government budget, second only to social welfare. Meanwhile, fiscal reserves have declined from a high of over HK$1.1 trillion in 2018-19 to a forecast HK$647.4 billion for 2024-25, squeezed by rising expenditure and declining tax revenue. With Hong Kong’s ageing population and declining birth rate, healthcare costs are expected to continue climbing. The government sees this as an unavoidable course correction but, for many Hongkongers, it feels like yet another financial squeeze. Public transport fares, electricity bills and public housing rents have all gone up in recent months. Now, medical expenses are following suit, compounding the financial pressure on the city’s working class and shrinking middle class. For the city’s lower-income residents, subsidies remain in place, ensuring essential healthcare is accessible. But for the middle class – those who earn too much to qualify for government help but not enough to comfortably absorb rising costs – this reform could be particularly painful. Take, for example, a chronically ill patient who requires monthly specialist check-ups and four prescriptions. Under the new system, the person would pay HK$250 per visit, amounting to HK$3,000 annually. Add occasional A&E visits, hospital stays and diagnostic tests, and the bill could easily approach HK$10,000 a year. While the government has introduced a cap of HK$10,000 per person per year for outpatient and inpatient fees combined, even that amount can be daunting for middle-class families juggling mortgages, school fees and daily expenses. The term “middle class” is often misleading. It can include a family earning HK$200,000 a month and living in an upscale development like Residence Bel-Air, who would be financially insulated from these changes. But it can also include a household making HK$30,000-HK$40,000 a month, living in a small flat in Tuen Mun or Kowloon Bay, who would face a much tougher reality. These families find their budgets stretched thin yet earn too much to qualify for help. An unexpected medical crisis – especially if it affects more than one family member – could push them to the brink of financial hardship. For so-called lower-middle-class families, the new healthcare costs could accelerate what sociologists call downward mobility. If a primary earner falls ill and requires frequent treatment, the dual burden of higher medical expenses and lost income could lead to a rapid financial decline. In a city where property prices remain exorbitant and social mobility is increasingly limited, slipping down the economic ladder is a real risk for many. Defenders of the policy argue that Hong Kong’s public healthcare system remains vastly more affordable than in many other developed regions. In places like the United States, a visit to the accident and emergency department can cost thousands of dollars. Even in mainland China, quality medical care often comes with significant out-of-pocket expenses. In this context, Hong Kong’s fees, even after the increase, are still relatively low. But context does not always bring comfort. The real question is whether this marks the start of a fundamental shift in Hong Kong’s approach to public services. If healthcare subsidies are being gradually reduced, will other essential services follow? And as costs rise, will the middle class – already squeezed by high living costs, stagnant wages and an uncertain economic future – continue to bear the brunt of these changes? For now, the government insists the price hikes are necessary to keep the healthcare system sustainable. But for ordinary Hongkongers, the concern isn’t just about sustainability – it’s about affordability, accessibility and whether a once-reliable safety net is slowly being pulled away.

To struggling Hongkongers, rise in healthcare fees just adds to hardship

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}The government sees the increases as an unavoidable course correction but, for many Hongkongers, it feels like yet another financial squeeze

The government sees the increases as an unavoidable course correction but, for many Hongkongers, it feels like yet another financial squeeze