LCQ14: Services of the accident and emergency departments of public hospitals

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     Following is a question by Dr the Hon Pierre Chan and a written reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (January 15):
 
Question:
 
     On June 18, 2017, the Hospital Authority (HA) raised the charge payable by eligible persons for using the services of the accident and emergency (A&E) departments of public hospitals from $100 to $180, so as to encourage A&E patients whose conditions are not the most urgent to switch to using outpatient services. In this connection, will the Government inform this Council if it knows:
 
(1) the attendances of the A&E departments of public hospitals in each month of the past three financial years and the current financial year (up to December 31, 2019), with a breakdown by the triage category to which the patients belonged (set out in tables of the same format as the table below);
 
Financial year:           

Year and month Attendances of A&E departments
Category I
(Critical)
Category II
(Emergency)
Category III
(Urgent)
Category IV
(Semi-urgent)
Category V
(Non-urgent)
           

 
(2) whether HA has reviewed the effectiveness of raising the charge for using the services of the A&E departments on reducing those A&E attendances of patients belonging to triage Categories IV and V; if HA has, of the outcome (including the duration for which the effect has lasted); if not, the reasons for that; and
 
(3) (i) the average cost per attendance and (ii) the average waiting time of patients of each triage category in respect of the services of the A&E departments of public hospitals in each of the past three financial years and the current financial year (up to December 31, 2019)?
 
Reply:
 
President,
 
     In consultation with the Hospital Authority (HA), I provide a reply to the various parts of the question raised by Dr the Hon Pierre Chan as follows:
 
(1) The tables below set out the numbers of accident and emergency (A&E) attendances of HA hospitals by triage category in the recent four financial years:
 
2016-17

Month Number of A&E attendances
Triage 1
(Critical)
Triage 2
(Emergency)
Triage 3
(Urgent)
Triage 4
(Semi-urgent)
Triage 5
(Non-urgent)
April 2016 1 567 3 954 60 798 109 451 10 746
May 2016 1 618 3 970 63 080 115 918 11 039
June 2016 1 498 3 665 57 776 105 442 8 360
July 2016 1 528 3 816 59 094 106 604 8 803
August 2016 1 488 3 780 59 302 103 678 8 491
September 2016 1 551 3 884 59 190 108 121 8 883
October 2016 1 569 3 831 60 937 111 283 9 257
November 2016 1 690 3 810 58 883 103 052 8 278
December 2016 1 913 4 079 60 690 101 591 8 914
January 2017 2 004 4 322 60 197 98 624 7 834
February 2017 1 867 3 956 57 639 91 755 7 628
March 2017 1 917 4 424 65 145 109 849 9 412

 
2017-18

Month Number of A&E attendances
Triage 1
(Critical)
Triage 2
(Emergency)
Triage 3
(Urgent)
Triage 4
(Semi-urgent)
Triage 5
(Non-urgent)
April 2017 1 693 4 093 62 334 107 161 9 839
May 2017 1 661 4 198 65 435 112 939 10 005
June 2017 1 711 4 253 64 429 106 330 8 216
July 2017 1 873 4 361 65 887 104 965 8 471
August 2017 1 634 4 194 59 193 93 461 7 046
September 2017 1 590 4 123 58 529 93 995 7 065
October 2017 1 726 4 172 61 341 101 731 7 786
November 2017 1 718 4 081 61 050 97 361 7 005
December 2017 2 042 4 621 63 620 97 224 7 757
January 2018 2 262 4 858 66 364 102 374 7 730
February 2018 2 370 4 572 58 140 88 828 6 666
March 2018 1 864 4 585 62 857 99 052 7 089

2018-19

Month Number of A&E attendances
Triage 1
(Critical)
Triage 2
(Emergency)
Triage 3
(Urgent)
Triage 4
(Semi-urgent)
Triage 5
(Non-urgent)
April 2018 1 674 4 278 59 506 96 679 7 216
May 2018 1 690 4 273 62 959 102 583 7 117
June 2018 1 600 3 939 59 094 95 680 6 019
July 2018 1 670 4 195 62 916 98 873 6 329
August 2018 1 813 4 268 62 567 96 504 6 175
September 2018 1 596 4 177 59 526 94 963 6 175
October 2018 1 812 4 350 63 840 103 051 6 831
November 2018 1 828 4 166 62 644 100 337 6 475
December 2018 2 161 4 542 64 804 100 102 6 717
January 2019 2 411 4 909 67 445 105 497 7 002
February 2019 1 919 4 134 56 398 88 061 6 042
March 2019 2 056 4 785 66 944 105 803 7 161

 
2019-20 (as at November 30, 2019) [provisional figures]

Month Number of A&E attendances
Triage 1
 (Critical)
Triage 2
(Emergency)
Triage 3
 (Urgent)
Triage 4
(Semi-urgent)
Triage 5
(Non-urgent)
April 2019 1 777 4 392 64 761 106 111 7 192
May 2019 1 760 4 582 66 535 109 892 7 272
June 2019 1 737 4 420 63 870 105 284 6 168
July 2019 1 769 4 396 65 577 105 694 5 564
August 2019 1 780 4 382 61 264 95 862 5 141
September 2019 1 718 4 387 61 390 99 702 5 558
October 2019 1 804 4 421 61 847 100 508 5 667
November 2019 1 808 4 511 60 807 94 945 5 265

 
(2) The fee for A&E services at public hospitals was revised from $100 to $180 on June 18, 2017.  According to the HA’s information, the overall number of A&E attendances between July 2017 and June 2018 had decreased by about 4.4 per cent when compared with the corresponding period before the fee revision.  The numbers of Triage 4 (Semi-urgent) and Triage 5 (Non-urgent) attendances had decreased by 6.9 per cent and 17.6 per cent respectively, while the total number of Triage 1 (Critical), Triage 2 (Emergency) and Triage 3 (Urgent) attendances had increased by 1.3 per cent.
 
     As for the period from July 2018 to June 2019, the numbers of Triage 4 (Semi-urgent) and Triage 5 (Non-urgent) attendances had decreased by 3.7 per cent and 24.7 per cent respectively, while the total number of Triage 1 (Critical), Triage 2 (Emergency) and Triage 3 (Urgent) attendances had increased by 4.4 per cent when compared with the corresponding period before the fee revision two years ago.
 
     The number of attendances before and after the fee revision may, to some extent, show that the fee revision has led to certain behavioural change of patients with less urgent conditions (i.e. Triage 4 and 5) in seeking medical consultation.  Nonetheless, it is likely that the fee revision does not have much impact on the behavior of patients with more urgent conditions (i.e. Triage 1, 2 and 3) in seeking medical consultation.
 
     The Government and the HA will continue to monitor the utilisation and quality of A&E services to ensure timely treatment for patients in need.
 
(3) The table below sets out the average cost per attendance of A&E services provided by the HA from 2016-17 to 2018-19.  The average cost per attendance of A&E services provided by the HA for 2019-20 is not yet available.

Year Average cost per attendance ($)
2016-17 1,300
2017-18 1,390
2018-19 1,530

 
     The HA's service costs include direct staff costs (such as salary expenditure on doctors and nurses) for providing services to patients; expenditure incurred for various clinical support services (such as pharmacy, diagnostic radiology and pathology tests); and other operating costs (such as utility expenses and repair and maintenance costs of medical equipment).  The average cost per attendance represents an average computed with reference to the total A&E service costs and the corresponding activities (in terms of attendances) provided.
 
     The table below sets out the average waiting time for HA's A&E services under each triage category in the recent four financial years:

Year Average waiting time (minute) for A&E services
 Triage 1
(Critical)
 Triage 2 (Emergency) Triage 3 (Urgent) Triage 4 (Semi-urgent) Triage 15 (Non-urgent)
2016-17 0 8 24 103 126
2017-18 0 8 26 114 127
2018-19 0 8 26 111 125
2019-20
(as at November 30, 2019)
[provisional figures]
0 7 26 121 134

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