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SCMP Reporter

I refer to your editorial of March 3 headlined, 'Bill of health', about the Legislative Council motion that torpedoed plans to impose charges for accident and emergency services. I was in the minority, voting against the motion.

 Regarding accident and emergency services, while the surface problem is long queues in casualty wards, the underlying problems are:   Inadequate supply of out-patient services, because of the very limited quota offered by public clinics and short operation hours of both the public and private clinics.

  Poor health education.

  The fee structure.

 As long as clinical services are not available, the long queues in the casualty wards will stay. People have no choice but to opt for emergency services that operate round the clock. Statistics show emergency services to be in high demand until midnight, and there are only 22 public clinics with evening services running up to 10 pm. But, the daily quota for the number of patients is full at an even earlier hour. The Department of Health should increase the daily quota and extend the hours of public clinics.

 In addition, when examining primary health care services, a community-based approach should be employed.

 Both public and private services should be within the scope of such a review. The private sector should have a role to play in our primary health care and should help relieve the pressure placed on the public sector.

 According to the Hospital Authority, nearly 70 per cent of the patients who visit casualty wards are 'semi-urgent' or 'non-urgent' cases. Patients' groups say most people go to these wards because:   They do not have the knowledge to judge whether or not their case is urgent.

  They or their relatives are so anxious that they want the patients to receive treatment as soon as possible.

  They cannot find medical services available in certain areas and at certain times.

 In order to offer a choice to patients, we welcome the experimental 24-hour clinic running in conjunction with a casualty ward.

 Patients who require emergency treatment as prescribed by the clinical doctor, will be admitted to hospital immediately and will not suffer any delays through double registration.

 Regarding the fee structure, the motion passed in Legco has only put off the debate to a later date.

 The motion does not mean a ban, once and for all, of charges for emergency services. Therefore, I do not see the point in delaying this debate.

 The imposition of charges alone will not eliminate the long queues in our casualty wards. However, when adequate clinical services are provided with patients charged and emergency services remain free of charge, what incentive is there for people to avoid the casualty ward?  We have to ensure that patients will not be deprived of medical treatment, because of poverty. Charges for emergency services should be waived for - those people over the age of 65, social security recipients, people in the low-income category and patients who suffer from chronic diseases.

 The average cost for each consultation in the public clinics is $218, and the patient pays $44. On the other hand, each case in the casualty wards costs, on average, $621, but the service is free. The difference between costs and charges, is paid for with taxpayers' money.

 The casualty ward is more expensive, because of medical apparatus and specialists. If non-urgent cases could be diverted to clinics, which are cheaper, this would represent a better utilisation of resources.

 Such changes will require careful consideration and planning, but I do not underestimate the wisdom of Hong Kong people. The community together with politicians can make the right decisions on this matter, as long as there is an extensive public debate.

 CYD HO SAU-LAN Legislative Councillor The Frontier 



Legco must face up to fee structure issue