A social organisation has proposed a three-tier safety net to exempt low-income families from paying full charges for accident and emergency services should the Hospital Authority introduce them. The Hong Kong Christian Service said they should remain free for those on Comprehensive Social Security Assistance (CSSA) and for the needy, for example families not covered by CSSA and patients with chronic conditions. Elderly people should be given a half-price discount, it said. The Christian service put forward its proposal after carrying out a study last month of 649 elderly people and 94 parents of children with mental illnesses and chronic conditions. Dr Alvin Kwok Ngai-kuen, of the Christian Service, estimated at least 1.6 million people would benefit should the government adopt its proposal. He suggested penalties and random checks could be introduced to ensure patients seeking to waive charges provided genuine information. In all, 45.9 per cent of those surveyed supported the government plan to charge for accident and emergency services in order to avoid abuse by those using it who were not in genuine need. On average, parents said the authority should not charge more than $77 for visits, while the elderly gave an average of no more than $40. Half of the parents and 68.7 per cent of the elderly could not afford more than $77, it found. The authority has warned the public to expect drastic increases to medical fees in public hospitals after it recorded a $225 million budget deficit last financial year, its first. The figure is projected to rise to $580 million this financial year. It prompted the authority's new chief, Dr Leong Che-hung, to say: 'If we only charge for the accident and emergency services which are free, or slightly raise the inpatient medical fees, which are now $68 a day, we will not see the wood for the trees.' A Health, Welfare and Food Bureau spokesman said yesterday it would consider the proposal. Separately, a Kwong Wah Hospital study found almost 4.7 per cent of 105,000 patients visiting its specialist clinic in the second half of last year had also made appointments with specialist clinics at other hospitals in advance. The Hospital Authority said it had also detected repeat bookings in other public hospitals, probably due to patients seeking the quickest appointment amid different hospital waiting times. Dr Choy Kai-ming, the authority's executive manager, said repeat bookings would lead to misuse of resources and adversely affect hospital waiting times. Under a new policy to be introduced by the authority next month, patients found to have duplicated appointments will have one cancelled.