Does the $10,000 annual cap apply itself? A full breakdown of 2026 public hospital charges, the $400 A&E fee and fee waivers

From 1 January 2026 Hospital Authority charges were comprehensively restructured: Accident & Emergency Triage Categories I and II (critical / emergency) are free, Categories III to V are HK$400 per attendance; Specialist Out-patient Clinics are $250 per attendance plus $20 per drug item (one charging unit covers 4 weeks), and Family Medicine Clinics are $150 per attendance plus $5 per drug item. Eligible fees within a calendar year are subject to an HK$10,000 annual cap, but it does not cap anything by itself — once you reach it you still have to apply, through HA Go or a hospital shroff office, and money paid before the application is approved is generally not refunded. This article takes the new fee schedule, the 24-hour deadline for the $350 A&E refund, and that cap you have to apply for, and works through them one by one.

#How the system works — read this part first

Three ideas run through the whole article. Understand them and every fee table below makes sense.

First, whether you are an "Eligible Person" decides which schedule of charges you pay. Principally that means holders of a valid Hong Kong identity card, and Hong Kong resident children under 11; the full definition is set out below.

Second, most of the listed services are what this article calls "specified eligible fees" (the official term is "eligible medical fees and charges" [Note 1]), and they count towards the $10,000 annual cap — but self-financed drugs, privately purchased medical items, mortuary charges, medical reports and the like do not.

Third, the cap does not take effect automatically. Within the same calendar year, once eligible fees already settled reach $10,000, with no outstanding balance and provided you are not receiving hospital services the HA considers to be without clinical need, you may then apply through HA Go or a hospital shroff office; once approved, eligible fees for the rest of that year need not be paid. Fees paid before approval are generally not refunded, but can be counted towards a subsequent year.

#Why did the Government change the fees?

The reform was announced on 25 March 2025 by the Secretary for Health, and the Government stated three lines of purpose of its own.

The first is changing care-seeking habits. The HA press release of the same day stated the aim of using fees to guide the proper use of resources and ensure that limited healthcare resources are deployed precisely, and of introducing a co-payment model for non-urgent services such as radiological diagnosis and pathology testing, to reduce waste. [Note 2]

The second is strengthening protection for the seriously ill and the vulnerable. The Secretary's press release stated that the reform extends the co-payment mechanism on the principle that "those who can afford should co-pay, and minor conditions should be co-paid", strengthening medical protection in all respects for the "poor, urgent, serious and critical" patients. The HA press release quoted the Chief Executive of the HA, Dr Tony Ko, as saying that the public would be better protected by optimising the medical fee waiver mechanism, expanding the Samaritan Fund safety net and setting caps on in-patient and out-patient fees — not only caring for the disadvantaged but also preventing middle-income earners from being impoverished by serious illness; the purpose of the annual fee cap of ten thousand dollars is to care better for seriously ill patients. [Note 3]

The third is sustainability. The Secretary's release described the reform as enhancing the sustainability of the healthcare system, with the HA release using similar wording, "enhancing the sustainability of the public healthcare system", in response to challenges such as an ageing population and medical inflation. The Secretary's release also stated expressly that the Government's commitment to the public healthcare system will absolutely not be reduced, and that all proceeds of the reform will be reinvested in full in public healthcare services. [Note 4]

In other words, the official framing is not "a price rise" but moving subsidy away from minor conditions and towards serious illness and poor patients. The $400 A&E charge, the $10,000 annual cap and the relaxed fee waiver below are three legs of the same design. As for the actual effect, this article only sets out the figures the Government has published, and offers no assessment.

Who most needs to know this: anyone asking why they are suddenly paying more. The official answer is co-payment for minor conditions and a cap for serious ones; which side you are on determines whether you pay more or less.

#What changed in public hospital charges from January 2026?

There are two big changes. A&E moved from a flat $180 to a charge by triage category — Categories I and II free, Categories III to V $400 per attendance; and an annual cap of $10,000 on specified fees was introduced for the first time, a cap that has to be applied for. Non-urgent investigations are now charged in tiers, and the fee waiver threshold was relaxed. The new arrangements took effect on 1 January 2026.

The figures the Government has published on the effect run as follows. In its press release of 9 January 2026 the Government said that in the first seven days of the new arrangements a total of 32 147 patients attended the 18 Accident & Emergency Departments under the Hospital Authority, a significant decrease of 11.9 per cent compared with the same period last year; the announcement of 20 January further stated that semi-urgent and non-urgent (Categories IV–V) attendances decreased substantially by more than 20 per cent, by 21.3 per cent, compared with the same period last year. [Note 5]

On waivers, the official announcement said the number of eligible low-income persons rose substantially from about 300 000 in the past to about 1.4 million; the same reply added that, together with the approximately 600 000 people already exempted without a means test, the low-income population potentially benefiting rose in total from about 900 000 to about 2 million. [Note 6]

Who most needs to know this: if you use public services only occasionally, remember A&E is $400, with critical and emergency free; if you attend follow-ups long-term or are admitted repeatedly, the point that matters is how to apply for the $10,000 cap below.

#Who counts as an "Eligible Person"?

In brief: holders of a valid Hong Kong identity card issued under the Registration of Persons Ordinance (Cap. 177), other than certain persons who obtained the card on the strength of a permission to stay that has since expired; Hong Kong residents who are children under 11; and other persons approved by the Chief Executive of the Hospital Authority. These three groups are the definition the HA's "Annual Spending Cap" web page sets out according to the Gazette [Note 7], and the footnote in the English edition of the Guide on Annual Spending Cap lists the same three [Note 8]. Note: the corresponding footnote in the Chinese edition of the guide names only holders of Hong Kong Identity Cards; it does not list children who are Hong Kong residents and under 11, nor other persons approved by the Chief Executive [Note 8]. If you are unsure about a child, ask at a hospital shroff office.

#What does each service actually cost?

"Family Medicine Clinic" is the HA's current name (it includes General Out-patient Clinics). For out-patient drugs, "per 4 weeks" is one charging unit.

#What does the $400 A&E charge cover, and which investigations are charged separately?

The $400 A&E charge (Categories III–V) covers that A&E attendance. The HA's fee reform FAQ describes the A&E first attendance charge as "covering diagnostic services, such as radiology examinations and blood tests and drugs that are clinically-indicated during the visit" — so the $400 already includes clinically indicated drugs, radiology and laboratory tests. The tiered radiology and laboratory charges in the table above apply mainly to specified out-patient settings, rather than being added item by item for investigations immediately necessary within A&E. Individual cases are governed by the HA's own explanation.

#The A&E refund: how do you get the $350 back?

An Eligible Person in Categories III–V who leaves after triage has been completed but before being seen by a doctor may apply, within 24 hours of registering at the A&E department, through HA Go or the A&E registration counter; HK$350 is refunded after deduction of an administrative fee.

⚠️ The 24 hours is the deadline for applying, not a threshold. It does not mean "having waited 24 hours without being treated", and it does not require "an initial medical assessment" first.

#How do you actually use the HK$10,000 annual cap?

The annual fee cap does not take effect automatically, and this is the single thing readers most often miss.

Once an Eligible Person has, within the same calendar year, settled eligible medical fees counting towards the cap totalling HK$10,000, has no related outstanding balance, and is not receiving hospital services the HA considers to be without clinical need, they must then apply through HA Go or a hospital shroff office.

Several points govern how it works in practice.

Deadline: 31 March of the following year. The cap page states: "Applications are accepted on a calendar-year basis starting from 1 January of the concerned calendar year of application to 31 March of the following calendar year. Late applications will not be accepted." [Note 7] So fees for 2026 must be applied for by 31 March 2027 at the latest.

Time to approval: generally 14 days. The same page states: "The assessment process generally takes 14 calendar days. A progress update will be given for assessments that cannot be completed within this period." [Note 7] Bills issued while an application is pending still have to be paid; once the application is approved, eligible medical fees for the remainder of that calendar year need not be paid.

Charges under the General Outpatient Clinic PPP count too. Besides public charges, the eligible fees the guide lists include what a patient pays private practitioners under Public-Private Partnership Programmes set at the same level as the HA's charges for the equivalent service, and the list includes the "General Outpatient Clinic PPP" [Note 8].

Money paid before the cap is approved: the guide says there is no refund; the cap page says that in exceptional circumstances (for example, the patient's death) a refund can be applied for. The guide states that "there will not be any refund" of eligible spending exceeding HK$10,000 paid before the effective date of the Annual Spending Cap, the excess being carried over as a credit for subsequent years [Note 8]; the cap page states: "Under exceptional circumstances (e.g. for deceased patients), applicants may approach hospitals to apply for refund arrangement." [Note 7] The two documents are worded differently; if your circumstances are exceptional, ask the HA (a hospital shroff office) directly.

Self-financed drugs, privately purchased medical items, mortuary charges, drug delivery, medical reports and records and the like are not included. Approval runs only to 31 December of that year, and a fresh application is required for the following year.

If you cannot afford the charges and have not reached $10,000, the safety net to look at is a different one: How do you apply for a medical fee waiver?

Working the numbers (a hypothetical scenario, taking an adult Eligible Person, with all charges as in the gazetted public fee schedule): an adult Eligible Person attends A&E on 2 occasions in the year (Categories III–V, $400 × 2 ＝ $800), spends 10 days in an acute bed ($300 × 10 ＝ $3,000), attends specialist out-patient follow-ups 8 times ($250 × 8 ＝ $2,000), and receives 12 "per item per 4 weeks" charging units of specialist drugs ($20 × 12 ＝ $240) — $6,040 in total, below the cap. Add a further 14 days as an in-patient ($4,200) and the total reaches $10,240, crossing $10,000: at that point (having settled the fees, with no outstanding balance) they can apply through HA Go or a hospital shroff office, and once approved the eligible fees for the rest of the year need not be paid. Note the order of events: the $10,240 already paid before the application is approved is generally not refunded, and the excess can be counted towards a subsequent year's cap. For a child under 12, or an infant who cannot be discharged together with the mother, in-patient fees are halved (see note 4 to the table above) and the total would be correspondingly lower, and might not cross $10,000.

Who most needs to know this: families with chronic conditions attending several specialties, or with more than one or two admissions in a year. This calculation may well apply to you, so keep your payment records from the start of the year.

#What changed at A&E after the reform?

According to Government announcements: from 1 to 7 January 2026 the 18 A&E departments recorded 32,147 attendances in total, down 11.9 per cent on the same period last year; over the 1st to the 18th of the same month average daily attendances fell 14.6 per cent, of which semi-urgent and non-urgent (Categories IV–V) attendances numbered 42,632, down 21.3 per cent.

On fee waivers, as at 31 March 2026 the HA had approved 224,039 medical fee waiver applications from Eligible Persons. (The above are first-hand figures from Government press releases, for the statistical periods stated in the text.)

To compare public waiting times with private charges, see our 〈Public Specialist Out-patient Waiting Times〉 and 〈Common Private Hospital Surgical Charges〉 tools.

#What to do next

1. Work out which category you are in. Holders of a valid Hong Kong identity card and Hong Kong resident children under 11 pay at the public charges; if you are not sure, the full definition is on the HA's "Annual Spending Cap" web page (the footnote in the Chinese edition of the guide does not list children under 11).
2. Remember the two A&E boxes. Categories I–II are free, Categories III–V are $400 per attendance. The triage category is decided by A&E, not by you.
3. If you leave after triage but before seeing a doctor, apply for the refund within 24 hours. Through HA Go or the A&E registration counter; $350 is returned after the administrative fee is deducted. After 24 hours you cannot apply.
4. Keep your payment records from the start of the year. The cap runs by calendar year, and money paid before approval is generally not refunded — only complete records tell you when you have crossed $10,000.
5. Once you cross $10,000, go and apply. Through HA Go or a hospital shroff office, by 31 March of the following year at the latest. Without an application the cap does not take effect; the assessment generally takes 14 days.
6. Remember what the cap does not cover. Self-financed drugs, privately purchased medical items, mortuary charges, drug delivery, medical reports and records are all excluded. Approval runs only to 31 December, and the following year needs a fresh application.

#Frequently asked questions

How much does A&E cost now?

By triage category: Categories I–II (critical / emergency) are free; Categories III–V are $400 per attendance. The triage category is determined by A&E triage.

Is the $10,000 annual cap an automatic ceiling?

No. Once eligible fees within the same calendar year total $10,000, with no outstanding balance and provided you are not receiving hospital services the HA considers to be without clinical need, you must apply through HA Go or a hospital shroff office; applications close on 31 March of the following year, and the assessment generally takes 14 days. Fees paid before approval are generally not refunded, but can be counted towards a subsequent cap; the cap page says that in exceptional circumstances (for example, for deceased patients) a refund arrangement can be applied for at the hospital. Self-financed drugs, privately purchased medical items, medical reports and the like are not included, and approval runs only to 31 December of that year.

How do you apply for the $350 A&E refund?

An Eligible Person in Categories III–V who leaves after triage has been completed but before being seen by a doctor may apply within 24 hours of registering at A&E, through HA Go or the A&E registration counter. The 24 hours is the deadline for applying, not a waiting threshold.

How much are Specialist Out-patient Clinics and Family Medicine Clinics per attendance?

Specialist out-patient attendance is $250 plus $20 per drug item (one charging unit covers 4 weeks); Family Medicine Clinic attendance is $150 plus $5 per drug item (per 4 weeks).

Who counts as an "Eligible Person"?

In brief: holders of a valid Hong Kong identity card under the Registration of Persons Ordinance (with certain exceptions), Hong Kong residents who are children under 11, and other persons approved by the Chief Executive of the HA. For the full definition, see the HA's "Annual Spending Cap" web page; the footnote in the Chinese edition of the guide lists only holders of Hong Kong Identity Cards.

#Notes: the official wording

[Note 1] The official term used for the annual spending cap. The HA's annual spending cap guide writes it as "eligible medical fees and charges".

[Note 2] Government press release "Hospital Authority takes forward fee reform to rationalise healthcare services and strengthen patient protection" (25 March 2025): the aim of "using fees to change the public's care-seeking habits, guiding the proper use of resources and ensuring that limited healthcare resources can be deployed precisely…", and of introducing "a co-payment model for non-urgent services such as radiological diagnosis and pathology testing…".

[Note 3] Government press release "Secretary for Health announces public healthcare fee reform (with photos)" (25 March 2025): the reform extends the co-payment mechanism on the principle that "those who can afford should co-pay, and minor conditions should be co-paid", to "strengthen medical protection in all respects for the 'poor, urgent, serious and critical' patients". The HA press release of the same day quoted the Chief Executive, Dr Tony Ko, on the annual fee cap of ten thousand dollars as being to "better care for seriously ill patients".

[Note 4] The same release by the Secretary: the reform is "enhancing the sustainability of the healthcare system"; the HA release has "enhancing the sustainability of the public healthcare system". The Secretary's release also states that "the Government's commitment to the public healthcare system will absolutely not be reduced, and all proceeds of the reform will be reinvested in full in public healthcare services".

[Note 5] Government press release (9 January 2026): in the first seven days of the new arrangements "a total of 32 147 patients attended the 18 Accident & Emergency Departments under the Hospital Authority, a significant decrease of 11.9 per cent compared with the same period last year". The source groups the thousands with a space, and this article reproduces it as printed. The announcement of 20 January 2026 wrote of semi-urgent and non-urgent attendances that they "decreased substantially by more than 20 per cent, by 21.3 per cent, compared with the same period last year".

[Note 6] The official announcement said the number of eligible low-income persons rose "substantially from about 300 000 in the past to about 1.4 million".

[Note 7] HA "Annual Spending Cap (For Eligible Persons)" web page (Hospital Authority's English page): "* According to the Gazette, Eligible Persons are: (i) holders of Hong Kong Identity Card issued under the Registration of Persons Ordinance (Chapter 177), except those who obtained their Hong Kong Identity Card by virtue of a previous permission to land or remain in Hong Kong granted to them and such permission has expired or ceased to be valid; (ii) children who are Hong Kong residents and under 11 years of age; or (iii) other persons approved by the Chief Executive of the Hospital Authority" "Applications are accepted on a calendar-year basis starting from 1 January of the concerned calendar year of application to 31 March of the following calendar year. Late applications will not be accepted. Eligible Medical Fees and Charges only include those billed between 1 January and 31 December of each year and fully paid upon submission of the application." "The assessment process generally takes 14 calendar days. A progress update will be given for assessments that cannot be completed within this period." "Under exceptional circumstances (e.g. for deceased patients), applicants may approach hospitals to apply for refund arrangement."

[Note 8] HA Guide on Annual Spending Cap. English edition: the PPP charges counted include the "General Outpatient Clinic PPP"; paragraph 4(b): "While there will not be any refund of any valid spending on Eligible Medical Fees and Expenses exceeding HK$10,000 prior to the effective date of the Annual Spending Cap, such paid excess will be carried over and stand as patient’s credit in HA account and will be applied to settle Eligible Medical Fees and Charges in subsequent calendar year(s). The amount settled with credit will also be counted as valid spending under Annual Spending Cap for the relevant calendar year(s)." Footnote 1 of the English edition lists three groups, including "(ii) children who are Hong Kong residents and under 11 years of age". Footnote 1 of the Chinese edition reads:

"'Eligible Persons' means, according to the Gazette, persons holding a Hong Kong identity card issued under the Registration of Persons Ordinance (Chapter 177) (except where the person obtained the identity card by virtue of a permission to land or remain that has expired or ceased to be valid). Persons outside this category are defined as 'Non-eligible Persons'." (our translation from the Chinese original)

Chinese original:

「「符合資格人士」是指根據憲報，持有根據《人事登記條例》(第177章) 所簽發香港身份證的人(但若該人士是憑藉其已獲入境或逗留准許而獲簽發香港身份證，而該准許已經逾期或不再有效則除外)。 此類別以外的人士將被定義為「非符合資格人士」。」

#What this article does not state

• What any individual patient will actually pay. What this article lists is the items and unit charges in the gazetted public fee schedule; the actual bill for an attendance depends on triage category, days in hospital, and which drugs and investigations were used, and this article does not estimate it.
• Charges for persons who are not Eligible Persons. The table of charges covers only the Eligible Person column.
• The approval criteria and the income or asset thresholds for fee waivers. This article quotes only the officially published numbers of beneficiaries; it does not reproduce the means-test criteria, which are covered in "How do you apply for a medical fee waiver?" on this platform.
• An assessment of whether the reform worked. This article sets out the attendance figures and percentage changes the Government has published; it does not judge whether those numbers are good or bad, and does not infer what caused them.
• An item-by-item list of which investigations inside A&E are charged separately. This article states only that the tiered charges apply mainly to specified out-patient settings; individual cases are governed by the HA's own explanation.

#Sources

• GoodDoctor.hk first-hand public fee dataset, taken from the HA "Fees and Charges" page https://www.ha.org.hk/visitor/ha_view_content.asp?Parent_ID=10044&Content_ID=10045&Dimension=100&Lang=CHIB5&Ver=HTML&Change_Page=1, effective 2026-01-01, verified 2026-06-10; fee list (annex to Government press release P2026010100711 of 2026-01-01; the statutory notice is G.N. 6792 published 2025-10-31, Gazette No. 44 of 2025) https://gia.info.gov.hk/general/202601/01/P2026010100711_527079_1_1767268930486.pdf, retrieved 2026-07-27.
• HA annual spending cap guide (the $10,000 cap requires an application; definition of Eligible Persons; excluded items): English version https://www.ha.org.hk/haho/ho/frm/asc_guide_en.pdf; Chinese version https://www.ha.org.hk/haho/ho/frm/asc_guide_tc.pdf, retrieved 2026-07-27 (the PPP list, footnote 1 and paragraph 4(b) on refunds re-checked on 2026-09-25 against a fresh download, both editions byte-identical to the previous day's).
• HA "Annual Spending Cap (For Eligible Persons)" web page (the three groups of Eligible Persons; applications until 31 March of the following year; assessment generally 14 days; refund arrangement in exceptional circumstances): Chinese https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=281820&Lang=CHIB5&Dimension=100&Ver=HTML; English https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=281820&Lang=ENG&Dimension=100&Ver=HTML, retrieved 2026-09-25.
• Fee reform page / FAQ (the 24-hour A&E refund application deadline; free triage categories; what the A&E charge covers): https://www.ha.org.hk/ho/corpcomm/fncr/index-tc.html, retrieved 2026-07-27 (the coverage sentence retrieved 2026-09-24); English edition: https://www.ha.org.hk/ho/corpcomm/fncr/index-en.html, retrieved 2026-09-24.
• Policy purposes of the reform ("those who can afford should co-pay, minor conditions should be co-paid"; strengthened protection for "poor, urgent, serious and critical" patients; commitment not reduced; sustainability): Government press release "Secretary for Health announces public healthcare fee reform (with photos)", 2025-03-25 https://www.info.gov.hk/gia/general/202503/25/P2025032500298.htm; guiding the proper use of resources, co-payment for non-urgent radiology and laboratory tests, support for low-income families, and the annual cap caring for seriously ill patients: Government press release "Hospital Authority takes forward fee reform to rationalise healthcare services and strengthen patient protection", 2025-03-25 https://www.info.gov.hk/gia/general/202503/25/P2025032500555.htm. Retrieved 2026-07-31.
• Figures on the effect of the reform: Government press releases 2026-01-09 https://www.info.gov.hk/gia/general/202601/09/P2026010900429.htm and 2026-01-20 https://www.info.gov.hk/gia/general/202601/20/P2026011900628.htm; cumulative waiver figures 2026-04-29 https://www.info.gov.hk/gia/general/202604/29/P2026042900474.htm, retrieved 2026-07-27.

Status of this material: a compilation of official charges, legislation and statistics; every figure is sourced at the point it appears.

#Further reading

• On this platform: Alternatives to the public queue
• On this platform: How do you apply for a medical fee waiver?

This article was compiled by the editorial team from official and academic sources; all clinical content is sourced. It is health information, not medical advice.