Law C K, Yip P S F
Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong.
Hong Kong Med J. 2002 Oct;8(5):348-53.
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.
Retrospective study.
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.
Non-emergency use of the accident and emergency services 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 services, the number of attendances would decrease by 76.4%.
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.
研究香港急症室服务的使用模式，并探讨收费政策对非紧急求诊人次可能产生的影响。
回顾性研究。
假设四种不同情况，以研究2000年至2029年收费政策对急症室求诊人次的影响。香港医院管理局提供了2000年急症室求诊的病人数量数据。
非紧急使用急症室服务是过度使用的主要原因，占其使用量的70.0%以上。只有22.0%到急症室就诊的病人被收住入院接受进一步治疗。到2029年，如果目前的使用模式持续下去，急症室求诊人次将增加47.0%以上。然而，如果劝阻3、4和5级分流的病人使用急症室服务，求诊人次将减少76.4%。
拟议的收费政策将通过防止不必要地使用急症室服务起到威慑作用。然而，这可能会导致门诊服务使用量增加，因此应仔细监测就诊情况。开展有关滥用急症室服务的社区健康教育和公民教育，将有效减少这些服务的过度使用。
