With the return of the peak flu season as winter approaches, it is expected that there will be a flood of patients who want to seek treatment for flu and related diseases in the accident and emergency (A&E) departments. While some patients may need to wait for more than 10 hours to see a doctor, healthcare professionals may also need to work extremely long hours to cope with the demand.

In March 2016, when Hong Kong’s public hospitals were overloaded and doctors were occupied, there were even cases where nurses had been asked to take care of patients with more stable conditions. “Some doctors were working almost 80 hours a week rather than the usual 44 hours,” said Dr Pierre Chan Pui-yin, president of Public Doctors’ Association.

Doctors question the effectiveness of raising the fee to drive away non-urgent patients

Although the Secretary for Food and Health Dr Ko Wing-man said he had not received any proposal from the Hospital Authority in November 2016, there is speculation that consultants for the Hospital Authority have proposed raising the fee for A&E services from HK$100 to HK$220 in order to deter patients who visit emergency wards unnecessarily, alleviating the pressure on overburdened wards.

As medical costs skyrocketed over the years, it has resulted in the Hong Kong government subsidising approximately 92% of the budget per each patient’s visit, a heavy burden on the budget. Raising the A&E fees may help lower the amount of government subsidy to be closer to 82%, the intended proportion originally set in 2003.

Dr Axel Siu Yuet-chung, vice-president of the Hong Kong College of Emergency Medicine, said that the introduction of the HK$100 charge for emergency ward services in 2002 had not been effective in deterring patients who do not have urgent medical needs. “The number of patients dropped within a short period, but then the number increased gradually in 2004 onwards,” he said.

Will raising the fee drive away underprivileged patients who indeed need help?

In Hong Kong, the public hospitals charge HK$100 for its A&E services while the private clinics can cost more than HK$300. Because of the significant price difference, public hospitals are still the more affordable option for the poor compared to private hospitals or clinics despite the long wait. Raising the A&E fees in public hospital can result in the poor having less access to emergency healthcare.

Professor Samuel Wong Yeung-shan at Chinese University’s School of Public Health and Primary Care led his team and interviewed 2,236 people from April 2014 to August last year. Surprisingly, 8% of the surveyed respondents said they had avoided seeing doctors in the past year because they cannot afford the services. “At first we assumed the number should be zero. We feel that no one should be deprived of medical care because they have no money,” he said.

Can integrated care interventions be the way out?

The concept of integrated care intervention has been put forward to improve overall patients' experience through coordination across infrastructures. By facilitating more patient contact, treatment and follow-up in the community, it aims to reduce the number of patients who visit emergency departments in hospitals, and facilitate efficient discharge from hospitals to other settings.

“If we have better infrastructure, some patients could in fact be transferred back to primary care services,” said Dr Axel Siu, adding that general outpatient clinics can be a better alternative to many semi-urgent and non-urgent patients. MIMS

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