Replies to LegCo questions
LCQ5: Charge for Accident and Emergency services
Following is a question by the Dr Hon Lo Wing-lok and a reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (October 30):
Question:
It has been reported that the Hospital Authority is planning to levy a charge for Accident and Emergency services at public hospitals at a rate of $100, starting from the end of this year. In this regard, will the Government inform this Council if it knows:
(a) The Authority's purposes of introducing the charge, and whether the Authority has evidence to show that the charge can achieve such purposes;
(b) how HA will assess the effectiveness of the charge in order to ascertain if the intended purposes have been achieved; and
(c) the categories of persons who are exempted from the charge and the criteria for determining their eligibility?
Reply:
Madam President,
(1) The review of the fee structure of our public health care services is one of the strategic directions proposed in the Health Care Reform consultation Document. The purpose of this review is to ensure that our finite public funds can be targeted to provide the appropriate level of subsidies for the different types of medical and health services. The review examines how the relative priorities of services provided may be reflected in the subsidy level and how inappropriate use and misuse of services can be minimised. Following the review and any subsequent revisions of the fee structure, the level of charges will continue to be affordable. We will also build on our fee waiver system to assist those who have insufficient income or who have difficulty to pay for even the heavily subsidised services because of serious or chronic illnesses.
Accident & Emergency (A&E) service is designed for patients with emergency and life-threatening conditions, and is therefore very different from other out-patient services by nature. A&E service provided without a use charge serves as an incentive for misuse for non-emergency conditions which are more appropriately treated in primary care clinics. The total number of attendances in A&E departments has increased from 2,080,000 in 1996/97 to 2,523,000 in 2001/02, a growth of 21 per cent in five years. Of the 2,523,000 attendances in 2001/02, some 75 per cent were classified as semi-urgent or non-urgent attendances.
Most developed economies have introduced a user charge for A&E service, and Hong Kong is a very rare exception to this practice. International experience also indicates that imposing a user charge for A&E service could discourage inappropriate use and reduce the total utilisation by about 15 to 25 per cent.
At the same time, there is no evidence that such a user charge would lead to delayed health seeking by patients or higher eventual costs as illness have became more serious.
(2) Upon implementation of new charges for the A&E service, HA will make use of the existing mechanism, which classifies A&E users into five different categories according to the seriousness of patients' illnesses, to closely monitor and evaluate the effects of the new fee charges. Specifically, HA will evaluate the impact on utilisation rate and usage pattern.
(3) We are committed to uphold our long-held policy of ensuring that no one is denied adequate medical care because of insufficient means, and that appropriate assistance will be given to the lower income groups, chronic patients and the older persons with limited resources. After the introduction of A&E charge, the existing mechanism, designed for patients who have difficulty to pay for even the highly subsidised services because of serious or chronic illnesses to seek financial assistance from Medical Social Workers (MSWs) stationed in the public hospitals, will continue to apply.
End/Wednesday, October 30, 2002
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