Better-off patients should brace themselves for higher fees at public hospitals under plans to set up a schedule based on ability to pay, the Hospital Authority chairman has warned. Dr Leong Che-hung said imposing a $100 fee for accident and emergency services from November 29 was just the beginning. 'Government money should be used for the most needy. The poor will get the most subsidies, the rich will get less. Minor illnesses should be subsidised less, major illnesses will be subsidised more,' Dr Leong said. Secretary for Health, Welfare and Food Dr Yeoh Eng-kiong said on Tuesday public hospital charges would rise by an average of 26 per cent and each item of medicine would cost $10 after April 1. The policy was subject to the government's approval. He added that the Hospital Authority - which is facing a $580 million deficit this year - was reviewing the pay scale for new recruits and cutting management grades. On Tuesday, a senior government source said a fee scale tied to income had not been ruled out. But Dr Gabriel Leung, clinical assistant professor at the University of Hong Kong's department of community medicine and an expert in health-care financing, said he did not believe the government had any plans to have a 'floating fee scale' where rich people paid more. Dr Leung, however, welcomed the new charges. 'The whole exercise is aimed at changing the culture and mind-set. Charging for emergency room fees is the first step in the grand scale of things,' he said. He believed most people would be willing to pay $100 and not delay emergency treatment if they thought their condition was urgent. But he urged the government to ensure that no one was deprived of treatment because of a lack of means. Legislator for the medical sector Dr Lo Wing-lok said he would oppose any drastic change in fees. 'It is the same treatment, but at different prices according to affordability. But these patients would be seen by the same doctor, stay in the same ward and if you are richer you have to pay more? I do not want to see that,' Dr Lo said. David Maltby, managing director of BUPA Health Insurance, said a sliding fee scale was 'sensible but the government will have tremendous difficulty in administering the system'. He said people should be encouraged to go private through tax breaks and subsidies for those who take out insurance. Dr Alvin Kwok Ngai-kuen, social policy assistant of the Hong Kong Christian Service, said: 'We should ensure that no one will suffer. That is the main objective of a public medical service.' Dr Kwok said the government should set up a three-tier safety net. The first tier - Comprehensive Social Security Assistance recipients, single-parent families, the chronically ill and the underprivileged - should be exempt, he said. The second tier, the over-60s, should be given a 50 per cent discount, while the third tier of low-income groups should be means-tested, he said.