Hong Kong A&E fee rise

Summary

• Hong Kong's public hospitals are run by the Hospital Authority and paid for mostly from tax.
  • Until 2026 the government covered up to 97.6% of the cost, and patients paid small flat fees.
• The government's worry was that accident and emergency departments (A&E) were being used as a cheap clinic.
  • In 2025 more than half of A&E patients were graded semi urgent or non urgent by the triage nurse, who sorts patients by urgency.
  • Economists call this moral hazard, the tendency to use more of a service when someone else pays for it.
  • The Hospital Authority's chief executive said public hospitals employ half the city's doctors and treat 90% of its patients.
• On 1 January 2026 the standard A&E fee rose from HK$180 to HK$400, which is about £39.
  • Patients graded critical or emergency, the top two of five triage categories, pay nothing. Before the reform they paid as well.
  • Fees for clinic visits and hospital beds went up on the same day.
  • People on low incomes can apply to have their fees waived, and standard fees are capped at HK$10,000 a year.
• Critics worry about patients who earn too much for a waiver, and about the paperwork a waiver needs.
  • Patient groups want the effect on middle income patients monitored.
  • One lawmaker called the paperwork "mission impossible" for the elderly.
• A&E visits fell by nearly 15% in the first 25 days. The fall was 3.9% over six months and 0.9% over nine, though non urgent visits were still down 17.5%.
  • The Hong Kong government will review the fees every two years.
• A&E in the NHS is free. The NHS Constitution says access is "based on clinical need, not an individual's ability to pay".

Dig deeper

• Patients normally pay when they register, and a triage nurse grades them afterwards. Anyone graded critical or emergency has the fee refunded or taken off their hospital bill.
• Urgent patients, the third category, pay the same HK$400 as non urgent ones. In the first 25 days their visits fell 7.2%, while critical and emergency visits rose 4.8%.
• Urgent patients are meant to be seen within 30 minutes. Over the nine months the share who were rose from 82.0% to 88.4%.
• In the evening 24 of the Hospital Authority's 75 clinics are open, and most private clinics are closed at night.
• Just after midnight on 6 January 2026, non urgent patients at one hospital faced a wait of up to 11 hours.
• By 30 September 2026 the Hospital Authority had approved 300,285 waiver applications, more than 90% of those it received.
  • Before the reform fewer than 14,000 people a year got a full waiver.
• A waiver needs proof of income and assets. Bill Tang, a Hong Kong lawmaker, called that "mission impossible" for elderly people who may have no printer at home.
  • The Hospital Authority says the application process "is neither complicated nor difficult".
• Tim Pang of the Society for Community Organization, one of the groups pressing the government, asked it to monitor how the fees affect middle income patients.
• The government's share of the cost is now about 95%, and its target is 90% within five years.
• It has run no dedicated survey of patients about the reform, and says it is too early to assess the effect on hospital finances.
• Hong Kong first charged for A&E on 29 November 2002, at HK$100.
• The fee rose to HK$180 on 18 June 2017. Over the next year total visits fell 4.4% and non urgent visits fell 17.6%.
  • The average wait for urgent patients went from 24 minutes to 26.
• In the UK, Sajid Javid, a former health secretary, argued in January 2023 for means tested charges, which vary with income, for GP and A&E visits.
  • The UK government said it was not considering them.
• Azeem Majeed, a professor of primary care and public health at Imperial College London, examined charging for GP visits in 2023.
  • The idea assumes patients can tell necessary care from unnecessary care, he wrote.
  • He expected exemptions to leave only a small part of the population paying.
• England charges £9.90 for each prescription item. Majeed put the share of GP prescriptions dispensed free at about 90%.
• The UK government's 10 Year Health Plan for England keeps the NHS "free at the point of delivery".
• In England, corridor care happens when the wards are full and patients who need a bed cannot leave A&E.

Ethical issues

Interview questions

• What do you know about the A&E fee rise in Hong Kong in 2026?
• Why did the Hong Kong government raise the fee, and why did critics object?
• Should the NHS charge patients for attending A&E, and what is the case for each side?
• You are a medical student in a Hong Kong A&E. A woman with a sprained ankle is angry at paying HK$400 and asks why the man who came in after her pays nothing. What do you say?
• A patient learns their triage category only after arriving. Is it fair to base the fee on it?
• What evidence would tell you whether the fee rise has worked?
• How would you make sure a fee waiver reaches the people it is meant for?
• England already charges for prescriptions. Is charging for A&E any different?