PATIENTS may be required to pay for implants and certain instruments in public hospitals, according to an internal Hospital Authority (HA) document. The move to consider what options to take in the area of charges for specific items comes as the Government conducts a major review on health care financing in the Towards Better Health consultation white paper. The internal document, obtained by the Sunday Morning Post, shows the HA was considering charges in institutions for specific items such as implants, prostheses, and instruments and appliances for home use. In all circumstances, these items, such as cardiac pacemakers or oxygen concentrators, could be used on only one patient. In-patients in public wards are charged only an overall fee of $43 a day, which includes accommodation, regular meals, general nursing care, clinical, biochemical, and pathological investigations and surgeries. But in a recent meeting, the HA executive committee was alerted to the fact the gazette had made provisions for extra fees to be charged. On the list is one clause which provides that services not listed in the gazette may also be charged to public patients. The clause has led to some hospitals charging patients for the costs of certain items, including implants, prostheses, consumables and appliances, as well as equipment for home use. Patients who cannot afford to pay for expensive items are assessed by medical social workers, who will either seek alternative sources of funding from charitable funds or recommend waiving part or all of the charges. Overall expenditure on these items is shared by the HA, Government, patients, and charitable funds such as the Samaritan Fund or the Heart Care Fund. The HA said there were problems with the present arrangements. ''While patients may be required to pay for certain items in some hospitals, the same items may be available to patients in another hospital free of charge,'' it said. In some circumstances, hospitals may even budget for a supply of these consumables, and the patients will be asked to pay when the stock is depleted towards the end of the financial year. This ''non-uniformity of practice'' among hospitals has aroused public concern over fairness. One option outlined in the discussion paper is to abolish all charges for specific times, allowing future expenditure on these times to be absorbed by either the Government, the HA or the hospitals, although the paper said the resource implications couldbe significant - in the order of $15 million a year. It says if the hospitals are made to shoulder the costs, patients in general may be asked to pay much higher daily fees. Another option will be for the HA to make it a standard practice to charge for implants and prostheses, instruments, appliances and equipment for home use. This will include such things as joint replacements, artificial heart valves, breast or penile prosthesis, and home haemodyalysis machine. These items range from $2,500 to $100,000. Consumables and disposable instruments used in the course of treatment and investigations will not be charged to the patients. The HA paper says an element of user payment may enhance the level of cost-consciousness and cost benefit consideration in clinical decisions regarding the use and choice of different models. Dr Ko Wing-man, senior executive manager (professional services) of the authority, said the issue was still under consideration. He hoped the authority could come up with an official view. Dr Huang Chen-ya said the HA should ensure patients who could not afford to pay would not be deprived of medical treatment. ''The issue is really whether at the current moment the Government can afford to pay these items. We have no evidence that the Government cannot afford to pay,'' he said.