Emer­gency room fee should be raised

Feng Chi-shun writes that in bar­gain-con­scious Hong Kong, hos­pi­tals need to in­crease the emer­gency room fee, per­haps in line with the in­fla­tion rate, to re­duce pa­tients’ wait­ing times

China Daily (Hong Kong) - - COMMENT -

Wait­ing in line is a fa­vorite pas­time for Hong Kong peo­ple. We see long queues of peo­ple wait­ing al­most ev­ery­where — to buy flats, to get com­mem­o­ra­tive money notes from banks, lim­ited edi­tion toys from fast food chains, tick­ets for concerts and sport­ing events, and most of all, what­ever is deemed a bar­gain. I was in Sham Shui Po one morn­ing when a long queue started to form in front of a shop not yet open for busi­ness. I asked a woman at the end of the line what the queue was for. She said she didn’t know ei­ther, but she in­tended to find out when she got to the front of the line.

That is typ­i­cal of the schiz­o­phrenic na­ture of the collective psy­che of the Hong Kong pub­lic. Peo­ple are will­ing to wait long hours for bar­gains and yet are gen­er­ally im­pa­tient with ev­ery­thing else.

Re­cently, some­one wrote to a lo­cal news­pa­per to com­plain about hav­ing to wait six hours in a pub­lic emer­gency room to get treat­ment for a fever. That was in­cred­i­bly pa­tient of him. In­stead of wait­ing for so long, I would have paid to see a pri­vate doc­tor, or bought some medicine from a phar­ma­cist and stayed home to rest.

All our pub­lic emer­gency rooms have a triage sys­tem — a nurse screens all the new cases and as­signs them pri­or­ity of treat­ment ac­cord­ing to their ex­i­gency. Crit­i­cal cases re­ceive im­me­di­ate at­ten­tion, emer­gency cases are at­tended to within 15 min­utes, ur­gent cases within 30 min­utes, while semi-ur­gent cases have to wait longer and the non-ur­gent cases are seen when all the sicker pa­tients have been taken care of.

The rea­son our let­ter writer had to wait six hours was that our emer­gency rooms are packed with peo­ple like him suf­fer­ing from semi-ur­gent or non-ur­gent med­i­cal con­di­tions, and are will­ing to spend time but not money to take care of their med­i­cal prob­lems.

Our pub­lic emer­gency room ser­vice is great value for money. For HK$100, one gets the doc­tor’s con­sul­ta­tion, and treat­ments which may in­clude X-rays, lab­o­ra­tory tests, med­i­ca­tions, spe­cial­ist re­fer­ral, and a sick leave cer­tifi­cate. It would cost thou­sands of dol­lars in a pri­vate hospi­tal. An emer­gency room visit is a real bar­gain a true Hong Kong per­son will never pass up.

The govern­ment is bring­ing up the prospect of in­creas­ing the emer­gency room fee from HK$100 to HK$220 to cut the abuse of its use by non-ur­gent cases and to re­duce pa­tients’ wait time.

Will it work? The an­swer could best be an­swered by a panel of econ­o­mists.

I am no econ­o­mist, but I can make a few com­ments, based on my years of ex­pe­ri­ence as a pub­lic doc­tor and a Hong Kong res­i­dent.

Back in the day when emer­gency room ser­vice was free, it was even more abused than now. All kinds of pa­tients, es­pe­cially those liv­ing close by (hence, trans­porta­tion fee ex­empted as well), who had time but not money to spare, would use the emer­gency room for the small­est of non-ur­gent ail­ments. For in­stance (I’m not mak­ing it up), young men with pim­ples went there in The au­thor is a re­tired con­sul­tant pathol­o­gist for the govern­ment and St. Paul’s Hospi­tal.

The govern­ment should con­sider open­ing up walk-in clin­ics — prefer­ably right next door to all the emer­gency rooms — to cater for non-ur­gent cases, so that they don’t clog up the wait­ing ar­eas of our emer­gency rooms.”

the after-hours to get their monthly sup­ply of anti-acne lo­tion and med­i­ca­tion.

By 2002, the num­ber of an­nual emer­gency room vis­its was 2.3 mil­lion and the work­load was in­sur­mount­able. That was when the Hospi­tal Author­ity de­cided to charge a fee of HK$100 per visit. The num­ber of vis­its dropped im­me­di­ately to 1.8 mil­lion the next year, but has since crawled back up to 2.2 mil­lion in 2015.

The rea­son why the numbers are slowly climb­ing back up, I think, is that HK$100 is not what it used to be. In 2002, a neigh­bor­hood pri­vate clinic charged be­tween HK$150-250 a visit. Now it is HK$300-500.

HK$100 for an emer­gency room visit in 2016 is much more a bar­gain than in 2002. Given the propen­sity for Hong Kong peo­ple to line up for bar­gains, our emer­gency rooms have be­come over­crowded again.

In­stead of hav­ing to ini­ti­ate a con­sul­ta­tion ex­er­cise for a fee hike when­ever our emer­gency rooms suf­fer from over­crowd­ing, our govern­ment could fac­tor an in­fla­tion in­dex into the fee struc­ture for our pub­lic emer­gency rooms, and in­crease it pe­ri­od­i­cally in line with in­fla­tion, to make it peren­ni­ally less at­trac­tive for “bar­gain hun­ters”.

An­other rea­son why our pub­lic emer­gency rooms are over­crowded is that our govern­ment out­pa­tient clin­ics have a quota sys­tem, in which ad­vanced book­ing takes up a por­tion of the slots, with the re­main­ing slots avail­able on a first-come, first-served ba­sis. They are hard to come by be­cause they are quickly snatched up by long queues of peo­ple wait­ing out­side the clin­ics hours ahead of time.

The govern­ment should con­sider open­ing up walk-in clin­ics — prefer­ably right next door to all the emer­gency rooms — to cater for non-ur­gent cases, so that they don’t clog up the wait­ing ar­eas of our emer­gency rooms.

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