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

     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:           

 
(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

 
2017-18

2018-19

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

 
(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.

 
     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: