Seasonal flu and the coronavirus have combined to raise pressure on the public health system. Patients and medical staff alike are feeling it. Waiting times are lengthening and workloads rising. So are the costs to the public purse.
This has helped prompt Secretary for Health Lo Chung-mau and Chief Executive John Lee Ka-chiu to propose a review of the flat, low fee for a visit to a public hospital accident and emergency centre.
Lo says people who “abuse” A&E services by seeking treatment for minor complaints could face higher fees, similar to the cost of a consultation with a private family doctor. But patients in urgent need of treatment might be charged a lower rate.
Lee says the city should review A&E charges as “in the past, we saw a lot of people using A&E services when they did not need them”. He says focus on preventing abuse could cut waiting times and improve service quality.
The government’s concern is understandable. The city has an enviable reputation for its universal healthcare system. But the accessibility and affordability for which it is renowned come at a price. The annual government grant to the Hospital Authority is set to exceed HK$100 billion.
Hong Kong should review A&E fees to prevent abuse of healthcare system: John Lee
Lo said that under the fee scale being considered for five categories of patients, those in the two most urgent could pay a lower fee than the current HK$180. A change was needed to prevent abuse of the system, especially for services charged at low rates.
“Patients of category five should understand A&E is not for handling mild cases,” Lo said.
The government is to be commended for reviewing the system to enhance the value for money of a huge outlay on public health in an ageing society.
But it remains to be seen how a fee-based deterrent of A&E visits for minor ailments would be implemented under the universal care principle without complementary action.
Convincing vulnerable elderly people, for example, that they should suddenly pay more for a minor ailment is an unenviable task.
The proposal may need to be related to further development of the government’s subsidised primary care plan for treatment and prevention of chronic illnesses through district health centres and private clinics.
That would be in keeping with the vision of a public-private partnership to ease the burden on the public hospital sector.
The reality is that the current inadequate level of community primary healthcare in Hong Kong results in people using A&E emergency services as a fallback, not to mention the cost factor.
The A&E centres are the front line of a system that serves most of the population. The government should find ways to stop abuse by weeding out clearly non-urgent cases and referring them somewhere else they can trust that is accessible and affordable.
