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

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.