To cut Hong Kong A&E abuse, higher fees only part of healthcare solution

Addressing why people go to the accident and emergency department for non-urgent conditions requires a holistic approach, including better primary care and community support for the elderly, and health literacy

Dicky ChowandDorothy Yeung

Published: 9:30am, 23 Jan 2024

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The recent debate over a potential increase in accident and emergency (A&E) charges at public hospitals has reignited the discussion on how to address the misuse of emergency services in Hong Kong. While some say that raising the fees would be a sufficient deterrent, a more comprehensive strategy is required to address the complex factors that drive people to A&E departments for non-urgent issues.

Instead of focusing on fees only, we must adopt a more holistic approach that prioritises primary care services, together with adjustments to A&E charges and enhanced patient education, to address the issues involved and promote a more sustainable healthcare system.

While imposing higher fees can be part of the solution as they would discourage people from seeking immediate care for non-urgent conditions, it is essential to recognise that many turn to A&E departments because they have limited access to primary care services, a lack of understanding of their healthcare options or concerns about affordability. Imposing higher fees alone, without guiding people towards the appropriate care settings, may have a limited impact on changing behaviour.

In addition to adjusting A&E charges, a more effective and sustainable solution lies in strengthening primary care services. Primary care provides comprehensive and preventive care, addressing non-urgent issues before they escalate into emergencies. By expanding accessibility and leveraging primary care providers, we can divert general patients away from A&E departments, reduce waiting times and ensure that emergency resources are reserved for genuinely life-threatening situations.

To fully realise the benefits of primary care, we must adopt a network-based approach. Primary care networks, built upon the existing district health centre model, can provide a continuum of care, encompassing preventive, curative and rehabilitative services through multidisciplinary teams. By connecting patients to the appropriate services and optimising resource use, primary care networks can deliver improved healthcare outcomes with significant cost-saving potential.

A local study has shown that for every HK$1 invested in community health, there is a saving of HK$8.40 (US$1) in acute care costs. This is because primary care services can prevent the progression of chronic health conditions and reduce unnecessary hospital admissions, ultimately saving healthcare resources and reducing healthcare expenditure.

Elderly patients wait for treatment at the A&E department in Queen Elizabeth Hospital, Jordan, on January 9. Photo: Eugene Lee

One area we can strategically target is the use of A&E services by senior citizens. Recent data shows a significant increase in the percentage of seniors using A&E services, from over 28 per cent in 2015/16 to 37 per cent in 2022/23.

To address this, we can consider scaling up community services that have showed positive outcomes. For example, the “ageing in place” scheme by the Hong Kong Housing Society offers housing, health and social care support to seniors in Housing Society rental estates. A&E visits by those in the scheme showed a significant drop from 31 per cent to 24 per cent over just three years.

Another noteworthy example is the Jockey Club End-of-Life Community Care Project, which focuses on enhancing end-of-life care through integrating medical and social care in the community. Within three months of joining the programme, patients had reduced their A&E usage by 0.6 times compared to other patients in the late stages of life.

These examples highlight the potential of community support and multidisciplinary care in lowering unnecessary A&E visits. By scaling up successful programmes and implementing similar models across primary care networks, we can make significant strides in improving healthcare outcomes for seniors and optimising resource allocation.

Elderly Hongkongers rest at a park in Sham Shui Po on August 20. Photo: Yik Yeung-man

To further expand access to primary care, we must explore innovative methods of delivering care, such as offering more out-of-hours services and telehealth options in general outpatient clinics. These initiatives could significantly improve access for those who face challenges because of their work schedules and ensure that timely primary care services are available.

Drawing inspiration from successful initiatives implemented in other healthcare systems, like the National Health Service (NHS) in Britain, we can implement measures to manage the high demand for A&E services. One such measure is the NHS 111 hotline, where patients are triaged online and directed to the appropriate care setting.

Apart from NHS 111, upon arrival at an A&E, patients undergo an initial clinical assessment, where clinicians determine the level of urgency and the appropriate care service required. Patients with less urgent conditions are directed to co-located primary care services to lower A&E departments’ caseload.

A&E system needs to be reviewed to gain the best value for money

Some other measures to alleviate demand for A&E services include offering more general practitioner services in the evenings and on weekends, which are seen to be effective in reducing demand for A&E services. The Hong Kong government should consider implementing these measures to leverage primary care services, in addition to raising A&E charges, to change people’s help-seeking behaviour.

Additionally, patient education and empowerment play a crucial role in reducing reliance on A&E departments. By promoting self-care practices and encouraging patients to differentiate between non-urgent and emergency situations, primary care providers can empower people to make informed decisions about their healthcare needs.

The healthcare landscape in Hong Kong demands a paradigm shift that prioritises primary care as the foundation of a sustainable and effective system. By investing in infrastructure, expanding community-based services and prioritising patient education, we can address the issues that contribute to the misuse of emergency services, improve healthcare outcomes and ensure the long-term health of our population.

Dicky Chow is a researcher at Our Hong Kong Foundation

Dorothy Yeung is an assistant researcher at Our Hong Kong Foundation