Following is a question by the Hon Chan Pui-leung and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (November 23):
 
Question:
 
     Regarding the medical fees owed to the Hospital Authority (HA), will the Government inform this Council:
 
(1) whether it knows, in each of the past five financial years, the following information on cases involving (a) eligible persons and (b) non-eligible persons (NEPs) defaulting on payment of medical fees: (i) the numbers of cases (and their percentages in the total number of attendances in public hospitals), (ii) the total amounts of arrears (and their percentages in the total amount of medical fees charged by public hospitals), (iii) the highest numbers of days in default involving in-patients, (iv) the average numbers of days in-‍patients staying in hospitals, (v) the numbers of write-off cases, and (vi) the total amounts of arrears written off (set out in Table 1);
 
Table 1

	2017-2018		2018-2019		2019-2020		2020-2021		2021-2022
	(a)	(b)	(a)	(b)	(a)	(b)	(a)	(b)	(a)	(b)
(i)
(ii)
(iii)
(iv)
(v)
(vi)

 
(2) whether it knows, in each financial year since the outbreak of the Coronavirus Disease 2019 epidemic in January 2020, (i) the numbers of imported cases of NEPs requiring hospitalisation, and among such cases, the following information of those involving medical fees in arrears: (ii) the numbers of cases (and their percentages in the total number of attendances in public hospitals), (iii) the total amounts of arrears (and their percentages in the total amount of medical fees charged by public hospitals), (iv) the highest numbers of days in default, (v) the average numbers of days of hospitalisation, (vi) the numbers of write-off cases, and (vii) the total amounts of arrears written off (set out in Table 2);
 
Table 2

	2019-2020 (from January 2020)	2020-2021	2021-2022
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)

 
(3) whether it knows, in each of the past five financial years, (i) the total expenditures on arrears recovery incurred by HA and (ii) the amounts of arrears successfully recovered (set out in Table 3); and
 
Table 3

	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022
(i)
(ii)

 
(4) as there are views that some of HA's arrears recovery measures are ineffective or lack deterrence, and may easily lead to defaults on payment, whether the authorities will examine the relevant mechanism and consider adopting new measures to recover arrears (such as stepping up efforts in arrears recovery, as well as requiring defaulters to settle the arrears upon departure, otherwise instituting prosecution against them); if so, of the details; if not, the reasons for that?
 
Reply:
 
President,
 
     In response to the question raised by the Hon Chan Pui-leung, my reply in consultation with the Hospital Authority (HA) is as follows:
 
(1) Details of cases in default of payment of medical fees (i.e. accounts receivable) involving (a) Eligible Persons (EP) and (b) Non-eligible Persons (NEP) in each of the last five financial years are tabulated as follows:

Financial Year	2017-2018 (As at 31/3/2018)		2018-2019 (As at 31/3/2019)		2019-2020 (As at 31/3/2020)		2020-2021 (As at 31/3/2021)		2021-2022 (As at 31/3/2022)
	(a)	(b)	(a)	(b)	(a)	(b)	(a)	(b)	(a)	(b)
(i) No. of cases with accounts receivable (Percentage of total cases in public hospitals)	42,351 (0.3%)	4,837 (0.03%)	42,076 (0.3%)	4,366 (0.03%)	43,398 (0.3%)	4,197 (0.03%)	40,277 (0.3%)	3,704 (0.03%)	41,830 (0.3%)	4,092 (0.03%)
(ii) Total amount of accounts receivable ($Mn) (Percentage of total medical fee income by public hospitals)	33 (0.8%)	70 (1.6%)	32 (0.7%)	73 (1.5%)	37 (0.8%)	65 (1.3%)	37 (0.8%)	79 (1.6%)	36 (0.7%)	86 (1.6%)
(iii) Highest number of days in arrears (Note 1)	4,518	762	4,883	1,127	5,249	961	5,614	1,326	2,631	1,691
(iv) Average length of stay (days)	49	11	50	12	57	10	50	13	57	24
(v) No. of write-off cases	17,786	6,476	16,798	5,369	20,402	5,429	17,743	4,056	16,360	3,781
(vi) Total write-off amount ($Mn) (Note 2)	6	50	7	42	7	55	6	40	7	34

Note 1: Debtors with highest number of days in arrears included four infirmary or psychiatric patients who required extended hospital stay due to medical needs.  Although the hospitals had referred them to medical social workers for briefing on medical fee waiver during their stay, the patients or their families did not actively proceed to apply.  There were also individual cases requiring investigation and verification of patients' identity by the Immigration Department and hence longer time was taken for processing while some of the cases were eventually waived.  For other cases, the HA continued to take debt recovery actions according to the prevailing mechanism.
 
Note 2: The percentages of write-off amount over the fee income in the last five financial years were about 2 per cent to 2.7 per cent.
 
(2) Details of hospitalisation cases of Non-eligible Persons (NEP) (Note 3) infected with Coronavirus Disease 2019 (COVID-19) since January 2020, and the number of cases with accounts receivable among them are tabulated as follows:

Financial Year	2019-20 (As at 31/3/2020) (Note 4)	2020-21 (As at 31/3/2021) (Note 4)	2021-2022 (Note 5)
			(1/4/2021 – 31/12/2021)	(1/1/2022 – 31/3/2022)
(i) NEP requiring in-patient treatment	200	691	236	66 (imported cases)
(ii) No. of cases with accounts receivable (Percentage of total cases in public hospitals)	49 (0.0003%)	155 (0.0012%)	24 (0.0002%)	43 (0.0003%) (imported cases)
(iii) Total amount of accounts receivable ($Mn) (Percentage of total medical fee income by public hospitals)	1 (0.01%)	6 (0.1%)	1 (0.02%)	2 (0.04%) (imported cases)
(iv) Highest number of days in arrears	51	66	105	88 (imported cases)
(v) Average length of stay (days)	4	7	13	10 (imported cases)
(vi) No. of write-off cases	-	164	191	-
(vii) Total write-off amount ($Mn)	-	5	7	-

Note 3: The classification of NEP is based on the latest information as of September 2022.
 
Note 4: As far as statistics on medical fees is concerned, the HA had not classified NEP into imported or locally infected cases before December 31, 2021.
 
Regarding the fee charging policy of NEP confirmed or suspected to be infected with COVID-19, the Government and the HA have been making adjustments in response to developments of the epidemic situation and balancing various factors including medical needs of infected persons, preventing transmission of virus to the community and overall public finance burden.  The original fee charging policy of the HA was not to charge NEP for medical fees relating to designated communicable diseases (including COVID-19).  In response to the COVID-19 situation in Hong Kong and other regions at the time and in order to prevent persons who may have been infected with COVID-19 from seeking medical services in Hong Kong due to the original charging policy, the Government required the HA to charge NEP who met the COVID-19 reporting criteria from January 29, 2020 onwards.  This applied to all imported or locally infected cases, confirmed or suspected.
 
Note 5: In light of the situation in the fifth wave of the epidemic, medical fees for treatment of COVID-19 would be waived for NEP who have been infected during their stay in Hong Kong from December 31, 2021 (i.e. start of the fifth wave).  This arrangement does not apply to NEP who are imported cases.
 
(3) The (i) total debt recovery costs and (ii) total amount recovered by the HA in the last five financial years as listed below:

Financial Year	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022
(i) Total debt recovery costs ($Mn)	4.1	4.4	4.3	4.1	4.4
(ii) Total amount recovered ($Mn) (Note 6)	47	50	56	61	54

Note 6: During debt recovery process, some of the patients may apply for fee waiver due to financial difficulties.  The HA will handle according to the established mechanism.  If fee waiver applications are subsequently approved, debt recovery procedures will terminate. The above figures include the amounts settled and the amounts waived up to November 14, 2022.
 
(4) It is the HA's policy to give priority of public health services to Hong Kong citizens, and NEP will only be provided with emergency care.  The HA has established mechanism to minimise the outstanding medical fees. The related measures included:
 
(a) The HA will issue interim bills every three days to NEP during their hospital stay (every seven days for EP) and remind patients or their families to settle them.  Besides, NEP are required to pay a specified amount of deposit upon admission.
 
(b) HA will issue final bills to patients upon discharge or mail the bills to patients' registered local or overseas addresses.  If the bills remain outstanding at the patients' discharge, the patients or their families members will be reminded through telephone calls to settle the bills with monthly statements mailed to their registered local or overseas addresses.  Administrative charges will be imposed if patients fail to settle the bills within a specified time period.
 
(c) If the bills remain outstanding after the above actions have been taken, the HA will undertake legal actions where appropriate, including filing claims to the Small Claims Tribunal or issuing demand letters through lawyers for debt recovery.
 
(d) For those NEP not requiring hospitalisation after treatment but need assistance with the discharge arrangement, the HA will contact the Social Welfare Department or the relevant Consulates or Mainland authorities through the Immigration Department to arrange discharge accordingly.  If their bills have not been settled, apart from taking legal actions as far as practicable, the HA will also notify the Consulates to assist on debt recovery.
 
(e) The HA will from time to time review the prevailing debt recovery mechanism and keep in view the payment modes commonly used in the market.  The HA has been actively implementing electronic payment service in recent years.  Patients can settle fees and charges conveniently through HA's mobile application "HA Go" and one-stop multi-function electronic kiosks.  In future, the HA will continue to enhance the functions of the existing electronic payment services and explore the feasibility of various payment methods, with a view to facilitating payment through various means by patients so as to reduce outstanding fees.

Ends/Wednesday, November 23, 2022
Issued at HKT 14:40

NNNN