Deep Dive: How expanding Hong Kong’s healthcare voucher scheme could affect elderly residents, local businesses

Elderly Hongkongers will soon be able to use government healthcare vouchers at seven additional hospitals and dental clinics in the Greater Bay Area. This could happen at the earliest by the third quarter of this year.

The health authority said the expansion of the voucher scheme aimed to help elderly Hongkongers who retire in the bay area. It could also benefit those living in Hong Kong who might want to use dentists across the border.

The Elderly Health Care Voucher Pilot Scheme was first launched in 2009 and became a recurrent programme in 2014. It aimed to influence more people to use private medical services.

It provides an annual voucher of HK$2,000 per person. The amount is allowed to build up to HK$8,000. People aged 65 or over with a Hong Kong identity card or Certificate of Exemption issued by the Immigration Department are eligible for the scheme.

Residents have been able to use the vouchers to receive outpatient services at the University of Hong Kong-Shenzhen Hospital (HKU-SZ) and its designated clinics or departments since 2015, and at the related Huawei Li Zhi Yuan Community Health Service Centre since last April.

Government data showed that the number of times the vouchers were used at the HKU-SZ Hospital has increased over the years. Visits rose from 2,287 in 2015 to 38,462 in 2023. Over 15,700 people have used the vouchers and have spent HK$51.8 million.

Deputy Secretary for Health Eddie Lee Lik-kong said eight criteria were used in selecting healthcare facilities: location, service quality, operational experience, service scope, service capacity, knowledge about the elderly healthcare voucher scheme, the level of charges, and their strengths.

“We have asked mainland authorities to confirm that the institutions had no records of serious breaches, and the department to ensure that those that had joined the voucher scheme did not commit any breaches,” he said.

Charges in the mainland were likely to be cheaper than for similar services in Hong Kong, he said. Lee cited a reference price of HK$309 on average per case at the HKU-SZ Hospital. For dental services, the costs for services such as scaling, fillings and extractions would likely range from about 180 yuan (HK$196) to 500 yuan, he added.
Staff writers

Question prompts:

1. Which of the following statements about the elderly healthcare voucher scheme are false?
(1) People aged 60 or over with a Hong Kong identity card are eligible.
(2) The scheme provides an annual voucher of HK$2,000 per person.
(3) Location and operation experience are two of the criteria that the government used to choose facilities for the scheme.
(4) The scheme encourages participants to use the city’s public medical services.

A. (1) and (2) only
B. (2) and (3) only
C. (1) and (4) only
D. (2) and (4) only

2. List TWO reasons the government is expanding the voucher scheme.

3. Are the vouchers becoming more or less popular at the HKU-SZ Hospital? Explain TWO possible reasons for this trend using News, Glossary and your own knowledge.

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Question prompts:

1. List TWO observations from the chart.

2. Based on News, how do you think the expansion of the voucher scheme could affect these numbers?

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• Patient advocacy groups have voiced concerns about how elderly Hongkongers can raise disputes when using healthcare vouchers at facilities over the border

• The Hong Kong Dental Association says the scheme’s expansion could hurt the city’s economy

Patient advocacy groups and the Hong Kong Dentist Association have expressed concerns regarding the expansion of healthcare vouchers in the Greater Bay Area.

Alex Lam Chi-yau is a lawyer and chairman of the advocacy group Hong Kong Patients’ Voices. He acknowledged that the scheme could help reduce the burden on the city’s public healthcare system while providing more choice for residents.

But he asked authorities to ensure that the mainland institutions’ services were up to standard and to prevent abuse as the voucher scheme involved taxpayer money. He also urged the government to explain how residents could file complaints and claims.

“[The city’s government] said they would ensure there would be a complaint mechanism. But after their complaints, if it involves claims or compensation, or even insurance, what are the procedures?” Lam said.

He added that in Hong Kong, patients could seek help from the Medical Council or the Dental Council over unsatisfactory services, and they could also bring a court case by themselves or with a lawyer’s help. But this does not apply to mainland medical institutions.

Linda Tsang Chi-man is the executive director of the Hong Kong Federation of Trade Unions’ bay area branch. She said the government should have more promotional and educational efforts for the expanded scheme.

Tsang said: “We suggest that those institutions set up counters designated for Hongkongers or appoint service ambassadors to teach them how to use the vouchers.”

The city’s Dental Association has said it is concerned that expanding the voucher scheme to more hospitals and dental clinics in the Greater Bay Area could deal a blow to business and the economy, despite assurances from authorities that local dentists will remain competitive given the quality of service.

“With 500,000 Hongkongers residing in Greater Bay Area cities and 90,000 of them eligible to use the Elderly Health Care Voucher ... some HK$100 million, or up to HK$200 million, will be snatched from the local economic system,” said Dental Association president Spencer Chan Chiu-yee.

Chan also said the scheme’s expansion would encourage residents to visit dentists on the mainland, adding that some local private dental clinics suffered a 20 to 30 per cent drop in business after the city’s border with Shenzhen reopened last year.
Staff writers

Question prompts:

1. What concerns regarding the voucher scheme expansion are mentioned in Issue?
(1) insufficient number of institutions in Shenzhen that accept the healthcare voucher
(2) lack of information about filing complaints against mainland healthcare facilities
(3) inadequate education for the elderly on how to use the voucher scheme in the bay area
(4) impact on the business of local practitioners

A. (1), (2) and (4) only
B. (2), (3) and (4) only
C. (1), (2) and (3) only
D. all of the above

2. Suggest THREE measures to tackle the concerns mentioned above.

3. To what extent do you agree that “local dentists will remain competitive given the quality of service”? Explain using News, Issue and your own knowledge.

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Question prompts:

1. What group is represented by the people in this illustration? What might the piggy bank and stethoscope symbolise?

2. Based on your answers above, explain how the voucher scheme could help address this group’s concerns.

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• Certificate of Exemption: issued by the Immigration Department for the aged, the blind, or the infirm. They must show that their personal attendance for registration of Hong Kong identity cards will injure their health or the health of others, so they are not required to register or apply for the issue or renewal of an identity card.

• Elderly Health Care Voucher Pilot Scheme: aims to supplement existing public healthcare services by incentivising the elderly to choose private services that best suit their needs, including preventive care. It provides an annual HK$2,000 voucher to use private primary care services. It is for Hong Kong elderly persons aged 65 or above and holding a valid Hong Kong Identity Card or Certificate of Exemption issued by the Immigration Department. The unspent voucher amount can be carried forward and accumulated for use in subsequent years, subject to a ceiling of HK$8,000.

• Greater Bay Area: comprises the two Special Administrative Regions of Hong Kong and Macau, and the nine municipalities of Guangzhou, Shenzhen, Zhuhai, Foshan, Huizhou, Dongguan, Zhongshan, Jiangmen and Zhaoqing in Guangdong province. As of 2022, the total population in the Greater Bay Area is over 86 million.

• University of Hong Kong-Shenzhen Hospital (HKU-SZ): a major comprehensive public hospital built by the Shenzhen municipal government and run according to a modern management model supported by the University of Hong Kong. Opened in 2012, it aims to cater to locals, cross-border Hong Kong citizens, and expatriates.

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News
1. Answer: C
2. The government hopes to benefit elderly Hongkongers retiring in the bay area, as well as those living in Hong Kong who want the choice of using dentists across the border.
3. The vouchers are becoming more popular at the HKU-SZ Hospital. Possible reasons include: charges there are cheaper compared to similar services in Hong Kong / the hospital is more familiar for Hongkongers since it has the University of Hong Kong’s management model and caters to cross-border patients / more people are now aware of the voucher scheme and its benefits (any two)

Chart
1. The voucher amount claimed for optometry services has decreased since 2019. / Medical practitioners and Chinese medicine practitioners have the highest voucher amounts claimed among the listed services. (accept other reasonable answers)
2. By including more healthcare facilities in the Greater Bay Area, the scheme offers individuals a wider range of options for accessing healthcare services. This increased availability can attract more people to participate in the scheme.

Issue
1. Answer: B
2. Establish a mechanism for Hongkongers to file complaints about mainland healthcare facilities. Design courses to teach the elderly how to use the voucher in the Greater Bay Area. Provide resources and subsidies for Hong Kong practitioners to help them remain competitive. (accept other reasonable answers)
3. I disagree. According to Spencer Chan, the reopening of the city’s border with Shenzhen has already resulted in a significant decline for local dental businesses. For many elderly, price is often a major consideration rather than the quality of service. Therefore, the expansion of the scheme would likely have a further impact on local private dental businesses, as senior patients will have more affordable options available to them outside of Hong Kong. (accept other reasonable answers)

Illustration
1. These people represent elderly Hongkongers. The piggy banks represent their savings, while the stethoscopes represent healthcare services.
2. The illustration suggests that elderly Hongkongers are concerned about the affordability of healthcare services. The voucher scheme can provide more options for individuals to use private medical services in the city or the mainland. By offering vouchers that cover a portion of the cost of private healthcare, the scheme can make healthcare services more affordable and accessible for this group.