公院改革首季：急症分流見效 議員轟專科加價「太狠」 罕見病藥與夾心階層成焦點 晚期醫療新法7月底生效

立法會衞生事務委員會5月8日召開會議，由主席林哲玄議員主持，審議公營醫療收費改革首季成效，以及將於2026年7月31日生效的《維持生命治療的預作決定條例》。會議討論氣氛激烈、嚴重超時，原定的中大醫院議程被迫押後。

Public Hospital Reform – First Quarter Review: A&E Triage Shows Results; Lawmakers Slam Specialist Fee Hike as “Too Harsh”; Rare-Disease Drugs & the Sandwich Class in Focus;

New End-of-Life Legislation to Take Effect End of July

【１分鐘重點內容】

立法會衞生事務委員會5月8日召開會議，聚焦兩大議題：

公院收費改革首季成效——盧寵茂局長指改革「不改革只會死路一條」。首季急症室危殆病人增3.9%、費用減免批出逾24萬宗、免費病人比例由14%升至27.9%。惟議員炮火密集：陳凱欣轟專科加至250元「加得太狠」、陳恒鑌批資產審查有損尊嚴、黃國揭只取藥也被收費的執行漏洞，罕見病藥及夾心階層支援亦成焦點。

《維持生命治療的預作決定條例》7月31日生效——條例貫徹「慎入易出」原則，設立AMD及DNACPR兩大工具。議員聚焦四大議題：家屬無權推翻病人指示、跨院轉移銜接、獨居長者「持久授權書」法律盲點（律政司正研擴展至醫療決定），以及地區康健中心參與簽立程序的限度。

會議嚴重超時，中大醫院議程押後。

1 Minute Highlights

The Legislative Council Panel on Health Services convened on 8 May 2026, focusing on two major agenda items:

First-quarter outcomes of the Public Healthcare Fees and Charges Reform — Secretary for Health Prof Lo Chung-mau declared that “without reform, there is only a dead end.” In the first quarter, critically ill A&E patients increased by 3.9%, more than 240,000 medical fee waivers were granted, and the proportion of fee-exempt patients rose from 14% to 27.9%. Yet legislators fired heavy criticism: Hon Chan Hoi-yan blasted the specialist outpatient fee increase to HK$250 as “too harsh”; Hon Chan Han-pan criticised the means-test as undignified; Hon Wong Kwok exposed an enforcement loophole where patients were charged simply for collecting medication. Rare-disease drugs and support for the “sandwich class” also drew significant attention.

Advance Decision on Life-sustaining Treatment Ordinance to take effect on 31 July 2026 — The Ordinance embodies the “cautious making, easy revoking” principle, establishing two key instruments: the Advance Medical Directive (AMD) and the Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) order. Legislators focused on four issues: family members having no right to override a patient’s directive; cross-hospital transfer continuity; the legal blind spot for solitary elders under the Enduring Power of Attorney (the Department of Justice is studying its extension to medical decisions); and the limits of District Health Centres’ involvement in the signing process.

The meeting overran significantly, and the agenda item on the CUHK Medical Centre was deferred.

改革首季：分流見效　議員炮火密集

醫務衞生局局長盧寵茂以「不改革只會死路一條」定調改革迫切性。首季數據顯示，急症室第一、二類危殆及危急病人增加3.9%，非緊急個案明顯減少，資源可更集中投放在中風中心等搶救體系；醫療費用減免首季批出逾24萬宗，免收費病人比例由14%升至27.9%。

儘管數字亮麗，會上議員質疑不止。植潔鈴議員點出1萬元「封頂」機制仍需病人自行申請，缺乏「幸福感」。醫管局行政總裁李夏茵回應，達標未申請者約佔兩成（約3000宗），系統已有提示，遲申請仍可退款，保留程序是防止「院霸」濫用。

陳恒鑌議員火力最猛，批評改革未經立法會充分討論，形容資產審查是「掀開個肚皮俾人睇」，有損尊嚴，並憂私營加價的「漣漪效應」。盧寵茂反駁，曾有400萬資產市民申請減免，必須嚴格把關；流失至私營的病人僅佔市場約1%，影響微弱。

陳凱欣議員則炮轟專科門診由80元加至250元，「加得太狠」，強調癌症覆診、心臟排期等專科病人「無得揀」，並非浪費資源。黃國議員更揭示執行漏洞——有市民僅為覆診拿藥、未見醫生也被收250元，醫管局即場澄清該情況不應收診症費，承諾跟進。

夾心階層與罕見病：治療連續性的隱憂

何敬康議員為夾心階層發聲，盧寵茂強調1萬元封頂無須經濟審查——確診大腸癌的中產在職人士，化療及手術期間開支易累積至封頂，其後近乎免費。楊永杰議員建議參考內地醫保，盧寵茂指內地保費人均每月數百至上千元人民幣，相對新制香港市民仍享95%政府資助。

罕見病及創新藥議題成焦點。莊豪鋒議員追問肺動脈高壓新藥的納入安全網進度，關注患者能否及時用上治療新選擇，並反映有市民一次領8星期藥囤積造成浪費。陳文宜議員警告4星期派藥令長者藥費倍增，恐放棄領藥，並特別反映軟骨發育不全症等罕見病患者在治療路徑上面對的表達與溝通困境，促請加快罕見病藥評估。會上亦有就基因治療的提問與回應，醫管局指目前已有基因治療藥物獲納入資助，屬於新引入的高端治療選項之一。醫管局整體回應：專家團隊每三個月評估20至30種新藥，近期11項創新藥入名冊，肺動脈高壓等相關新藥亦在持續評估中。

另有議員關注藥物需求下降，醫管局澄清病人不領藥比例比去年降5%，減少領取多屬「看門口」備用藥（其中便秘藥降約43%），屬減少浪費。

First Quarter of Reform: Triage Effective; Legislators Open Fire

Secretary for Health Prof Lo Chung-mau set the tone with the slogan “without reform, there is only a dead end,” underscoring the urgency of change. First-quarter data show that Category I (Critical) and Category II (Emergency) A&E patients increased by 3.9%, while non-urgent cases dropped markedly, allowing resources to be channelled more squarely into life-saving systems such as stroke centres. More than 240,000 medical fee waivers were approved in the quarter, lifting the proportion of fee-exempt patients from 14% to 27.9%.

Despite the encouraging figures, legislators raised numerous concerns. Hon Chik Kit-ling Elizabeth pointed out that the HK$10,000 annual cap still requires patients to apply on their own, lacking a sense of “well-being.” Hospital Authority Chief Executive Dr Libby Lee Ha-yun responded that around 20% of qualifying patients (about 3,000 cases) had not yet applied; the system already issues prompts, late applications can still be refunded, and retaining the procedure helps prevent abuse by “bed-blockers.”

Hon Chan Han-pan mounted the fiercest critique, complaining that the reform had not been thoroughly discussed in the Legislative Council. He likened the means-test to “lifting one’s belly for everyone to inspect,” calling it undignified, and warned of a “ripple effect” of fee hikes spilling into the private sector. Prof Lo countered that some applicants for fee waivers had assets of HK$4 million, making strict gatekeeping essential, and that the proportion of patients drifting to the private sector represents only about 1% of the market — a marginal impact.

Hon Chan Hoi-yan took aim at the specialist outpatient fee, which has risen from HK$80 to HK$250, branding it “too harsh.” She stressed that cancer follow-ups and cardiac patients on waiting lists “have no choice” and are not wasting resources. Hon Wong Kwok went further, exposing an enforcement loophole: members of the public who attended only to collect refill medication — without seeing a doctor — were nonetheless charged HK$250. The Hospital Authority clarified on the spot that no consultation fee should be levied in such circumstances and pledged to follow up.

The Sandwich Class and Rare Diseases: Concerns Over Continuity of Care

Hon Edmund Ho King-hong spoke up for the sandwich class. Prof Lo emphasised that the HK$10,000 annual cap requires no means-test — a working middle-class person diagnosed with colorectal cancer would easily reach the cap during chemotherapy and surgery, after which care becomes virtually free. Hon Yang Wing-kit suggested drawing reference from the Mainland’s medical insurance scheme; Prof Lo replied that Mainland premiums average several hundred to over a thousand RMB per person per month, whereas under the new Hong Kong regime, citizens still enjoy a 95% government subsidy.

Rare diseases and innovative drugs became a focal point. Hon Chong Ho-fung pressed for an update on the inclusion of new pulmonary arterial hypertension medication in the Safety Net, expressing concern over patients’ timely access to new treatment options, and noting reports of citizens hoarding waste by taking eight weeks’ worth of medication at once. Hon Chan Man-yi warned that the four-week dispensing arrangement could double medication costs for the elderly and deter them from collecting their drugs. She specifically highlighted the expression and communication difficulties faced by patients with rare diseases such as achondroplasia along their treatment journey, urging an acceleration of rare-disease drug assessments. Questions and responses were also raised regarding gene therapy; the Hospital Authority noted that gene-therapy drugs have already been included on the subsidy list as part of the newly-introduced high-end treatment options. The HA’s overall response: an expert team evaluates 20 to 30 new drugs every three months; 11 innovative drugs were recently added to the Drug Formulary, and new agents for pulmonary arterial hypertension and related conditions remain under continuous assessment.

Other legislators raised concerns over a drop in drug demand. The Hospital Authority clarified that the proportion of patients not collecting medication has fallen by 5% year-on-year, and that the reduction is largely confined to “just-in-case” reserve drugs (e.g. constipation medication, down by about 43%) — representing a reduction in waste rather than denial of care.

《維持生命治療的預作決定條例》7月31日生效

會議下半場轉入《維持生命治療的預作決定條例》。盧寵茂宣布，法例將於2026年7月31日正式生效，確立「預設醫療指示」及「不作心肺復甦術命令」的法律框架，貫徹「慎入易出」原則。病人可在精神清醒時預先拒絕特定維生治療，指示未來分階段電子化，但院外急救用的「不作心肺復甦術命令」仍維持紙本，方便救援人員即時辨識。

管浩鳴議員關注沒有近親的病人，能否透過「持久授權書」委託信任人士代作醫療決定。盧寵茂坦言現行法律的持久授權書僅適用於財產事務，不能延伸至醫療決定，但律政司正研究擴展可行性。邵家輝及陳凱欣則追問病人轉院或陷入昏迷後的操作細節，醫管局強調家屬法律上無權推翻病人清醒時簽立的指示，但團隊會盡早溝通以減少矛盾。

Advance Decision on Life-sustaining Treatment Ordinance Takes Effect 31 July 2026

The second half of the meeting turned to the Advance Decision on Life-sustaining Treatment Ordinance. Prof Lo announced that the Ordinance will formally come into operation on 31 July 2026, establishing the legal framework for the Advance Medical Directive (AMD) and the Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) order, in line with the “cautious making, easy revoking” principle. Patients may, while mentally competent, refuse specified life-sustaining treatments in advance. AMDs will be electronically enabled in phases, but the DNACPR order — used in out-of-hospital emergency rescues — will remain in paper form for instant identification by rescuers.

Hon Peter Koon Ho-ming raised concerns about patients without close relatives, asking whether an Enduring Power of Attorney (EPA) could be used to entrust a trusted person to make medical decisions on their behalf. Prof Lo acknowledged that the existing EPA regime applies only to property and financial matters and cannot be extended to medical decisions, but the Department of Justice is currently studying the feasibility of expansion. Hon Shiu Ka-fai and Hon Chan Hoi-yan further pressed on operational details where patients are transferred between hospitals or fall into a coma. The Hospital Authority stressed that family members have no legal authority to override a directive validly made by the patient while mentally competent, but clinical teams will engage in early communication to minimise conflict.

中大醫院議程押後　下次續議

會議接近下午1時，議員就是否延時討論中大醫院議題出現分歧。鄧家彪提議延長半小時，但邵家輝、陳凱欣、陳永光等認為剩餘時間不足以處理複雜財務問題，主席林哲玄最終宣布會議結束，議題押後至下個會期。林哲玄另透露，將邀請委員稍後參觀預計10月分段投入服務的新醫院。

CUHK Medical Centre Agenda Deferred; To Resume at Next Meeting

As the meeting approached 1:00 pm, members were divided over whether to extend the session to discuss the CUHK Medical Centre agenda. Hon Tang Ka-piu proposed a 30-minute extension, but Hon Shiu Ka-fai, Hon Chan Hoi-yan and Hon Chan Wing-kwong argued that the remaining time would be insufficient to handle complex financial issues. Chairman Dr David Lam ultimately declared the meeting closed, deferring the item to the next session. Dr Lam also revealed that members will be invited to visit the new hospital, which is scheduled to commence services in phases starting October.

下次會議議程

Next Meeting Agenda

1. 加強醫療服務的專業規管

Strengthening professional regulation of healthcare services

2. 醫療人力推算2026

Healthcare Manpower Projection 2026

3.《體重管理行動計劃》

Action Plan on Weight Management

持續跟進政策動向

Madison 將繼續密切跟進立法會衞生事務委員會的不同議程進展，並就相關醫療政策對業界的影響作深入分析。如欲了解更多資訊，或就相關議題作進一步交流，歡迎與我們聯絡。

Ongoing Monitoring of Policy Developments

Madison will continue to closely track the progress of various items before the LegCo Panel on Health Services and provide in‑depth analysis of the implications for the healthcare sector. For further information or to discuss any of the above topics, please feel free to contact us.