Dicky ChowandDorothy Yeung

Opinion | To cut Hong Kong A&E abuse, higher fees only part of healthcare solution

Addressing why people go to the accident and emergency department for non-urgent conditions requires a holistic approach, including better primary care and community support for the elderly, and health literacy

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People wait in the A&E department at Kwong Wah Hospital in Mong Kok, on January 6. Photo: Edmond So

Dicky ChowandDorothy Yeung

Published: 9:30am, 23 Jan 2024

The recent debate over a potential increase in accident and emergency (A&E) charges at public hospitals has reignited the discussion on how to address the misuse of emergency services in Hong Kong. While some say that raising the fees would be a sufficient deterrent, a more comprehensive strategy is required to address the complex factors that drive people to A&E departments for non-urgent issues.

Instead of focusing on fees only, we must adopt a more holistic approach that prioritises primary care services, together with adjustments to A&E charges and enhanced patient education, to address the issues involved and promote a more sustainable healthcare system.

While imposing higher fees can be part of the solution as they would discourage people from seeking immediate care for non-urgent conditions, it is essential to recognise that many turn to A&E departments because they have limited access to primary care services, a lack of understanding of their healthcare options or concerns about affordability. Imposing higher fees alone, without guiding people towards the appropriate care settings, may have a limited impact on changing behaviour.

In addition to adjusting A&E charges, a more effective and sustainable solution lies in strengthening primary care services. Primary care provides comprehensive and preventive care, addressing non-urgent issues before they escalate into emergencies. By expanding accessibility and leveraging primary care providers, we can divert general patients away from A&E departments, reduce waiting times and ensure that emergency resources are reserved for genuinely life-threatening situations.

To fully realise the benefits of primary care, we must adopt a network-based approach. Primary care networks, built upon the existing district health centre model, can provide a continuum of care, encompassing preventive, curative and rehabilitative services through multidisciplinary teams. By connecting patients to the appropriate services and optimising resource use, primary care networks can deliver improved healthcare outcomes with significant cost-saving potential.

A local study has shown that for every HK$1 invested in community health, there is a saving of HK$8.40 (US$1) in acute care costs. This is because primary care services can prevent the progression of chronic health conditions and reduce unnecessary hospital admissions, ultimately saving healthcare resources and reducing healthcare expenditure.