Patients wait to be seen at the accident and emergency department in Queen Elizabeth Hospital, in Kowloon, last March. Photo: Sam Tsang

How to stop the bargain hunters crowding out Hong Kong’s hospital emergency rooms

Feng Chi-shun says the city needs a long-term strategy to stop abuse of the system, such as inflation-linked fee hikes for all services and walk-in clinics, rather than a piecemeal approach

Feng Chi-shun

Published: 2:56pm, 8 Feb 2017

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Raising fees for each visit to public emergency rooms in Hong Kong hospitals, from HK$100 to HK$220, will discourage abuse and reduce the waiting time for patients with real emergencies. Raising it to HK$320 would work even better.

The people of Hong Kong, although generally impatient, will wait patiently for bargains. That’s why we see long queues to buy promotional merchandise, commemorative banknotes, limited edition toys from fast food chains, or any deal where they can turn a quick profit on by reselling.

Our public hospital emergency room service is too good a bargain to pass up. For a nominal fee, one gets a doctor’s consultation, and treatment which may include X-rays, lab tests, medicine and a specialist referral, as well as a sick-leave certificate. It would add up to thousands of dollars in a private health care facility.

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When the emergency room service was free, many years ago, it was abused even more than today.

There were cases of teenagers who went there after school to have their pimples examined, so they could obtain their monthly supply of anti-acne lotion and medication (I am not making it up).

By 2002, the number of annual emergency room visits stood at 2.3 million, and the workload was insurmountable. That was when the Hospital Authority decided to introduce a charge of HK$100 per visit.

Elderly Hongkongers protest outside the government headquarters against the proposed introduction of consultation fees at the accident and emergency departments of public hospitals, and a scheme requiring patients to pay for certain drugs at public clinics, in September 2002. Photo: David Wong

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The number of visits dropped quickly, to 1.8 million the next year, but had gone back up to 2.2 million by 2015.

The reason? Probably because HK$100 is not what it used to be. In 2002, a neighbourhood private clinic charged between HK$150 and HK$250 a visit. Now it is HK$300-HK$500.

So, HK$100 for a public emergency room visit today is much more of a bargain than it was in 2002. Given the propensity of Hongkongers to line up for such bargains, our emergency rooms have become overcrowded again.

The triage station at the A&E ward in Tuen Mun Hospital last December 6. Photo: Nora Tam

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Instead of reacting to the problem every few years by seeking a public consultation on a fee hike, the Hospital Authority should consider a long-term strategy, such as factoring an inflation index into the fee structure of all its services, to make them less attractive to “bargain hunters”.

Many patients attending our public emergency rooms suffer from ailments that could easily be handled by outpatient clinics. But they operate a quota system, and slots are hard to come by because they are quickly snapped up, with long queues of people waiting outside the clinics ahead of opening time.

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

Dr Feng Chi-shun is an author and a retired pathologist

This article appeared in the South China Morning Post print edition as: Link hospital fees to inflation

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