Higher fees necessary to nurse public hospitals back to health

In the face of a money crunch, public hospitals are going to charge more for emergency ward visits unless someone is really sick. The idea is simple: keep emergency wards for emergencies so that if someone is dying, it is free; if not, pay more.

The saying is that a two-tier fee plan will be rolled out: free for critical cases like heart attacks but a bill, more than the current HK$180, for less critical, not life-threatening conditions. Patients not in an urgent situation may even have to separately pay for tests and scans. These are all part of an imminent hospital fee reform.

Will this solve the problem?

The city's emergency wards see about 1.8 million visits a year with many showing up with minor issues from runny noses to small cuts. The Hospital Authority runs all 43 public hospitals and spends HK$80 billion a year. Charging more may push people with minor things to clinics and raise a small revenue for hospitals.

This makes sense in principle. But the catch is: private doctors are pricey. Unless the A&E charges for less urgent cases were elevated to the private level, which would need political support, the bet is that people would continue to visit the A&E.

The problem facing health minister Lo Chung-mau is not just about crowded emergency wards but the government is fiscally strapped, on top of a shortage of doctors.

The HA employs 90,000 workers and it is costly to manage the machine with own bosses and offices to keep hospitals operating.

Over in the UK, their prime minister Keir Starmer is attempting something wild scrapping the NHS England - an organization funded by taxpayers but not controlled directly by the central government to deliver national health services - as he accuses it of overlapping roles with Department of Health and Social Care.

In Hong Kong, the HA, Health Bureau and Department of Health do some similar jobs such as hiring doctors and planning for emergencies though the latter makes rules and handle public health matters like vaccines.

Could Hong Kong also ditch the HA, which was created in 1990, if the UK could do away with NHS England?

This would be easier said than done. Starmer's plan is a gamble despite his claims that letting DHSC taking over NHS England's functions that run a 150 billion budget would save money and fix long waits facing patients.

NHS England was created in 2013 under the Health and Social Care Act 2012 to keep politics out of daily decisions as care may be affected for quick fixes in favor of political priorities once politicians start meddling. The British prime minister is betting on a total redo that he has not yet defined clearly.

Hong Kong is plugging the leaks, one by one, instead.

As a matter of fact, hospitals everywhere are cash strapped with authorities responding with different strategies. Germany and the Netherlands rely on decentralized systems with multiple insurers and providers, as opposed to Starmer's centralization. Australia's is akin to Starmer's: a federal authority overseeing state public hospitals but allowing operational autonomy.

When big changes sound too good, they often do not. Instead of a massive shake-up, Hong Kong is responding to its own crisis with small steps. Nonetheless, for now, patients had better bring their wallet just in case.