Acute care service utilisation and the possible impacts of a user-fee policy in Hong Kong

CK Law, PSF Yip
Department of Statistics and Actuarial Science; Centre of Asian Studies; Medical and Health Research Network, The University of Hong Kong, Pokfulam, Hong Kong

OBJECTIVES. To examine the utilisation pattern of accident and emergency services and to study the possible impact of a user-fee policy on non-emergency attendances in Hong Kong.

DESIGN. Retrospective study.

METHODS. Four different scenarios are postulated to examine the impact on the number of accident and emergency attendances of a user-fee policy from 2000 to 2029. Patient volume data of accident and emergency attendances for 2000 were made available by the Hospital Authority of Hong Kong.

RESULTS. Non-emergency use of the accident and emergency service is the main cause of over-utilisation and contributes to more than 70.0% of its use. Only 22.0% of patients attending accident and emergency departments were admitted to a ward for further treatment. By 2029, the number of accident and emergency attendances would increase by more than 47.0% if the present utilisation pattern prevails. However, if patients at triage levels 3, 4, and 5 were discouraged from using the accident and emergency service, the number of attendances would decrease by 76.4%.

CONCLUSION. The proposed user-fee policy would act as a deterrent by preventing unnecessary use of accident and emergency services. However, the use of out-patient services may be increased as a result and attendance should be carefully monitored. Community health education and civic education relating to abuse of accident and emergency services would be effective in reducing over-utilisation of these services.

Hong Kong Med J 2002;8:348-53

Key words: Emergency service, hospital; Health care reform; Social welfare