I was fascinated to read the following missive this week in the BMJ
http://bmj.com/cgi/content/full/325/7376/1318 and I transcribe the
appropriate section:
<Charging emergency patients in Hong Kong cuts numbers: Hong Kong's public
hospitals began charging $HK100 (£8; $US13; 13) for emergency ward services
in November (16 November, p1130). Immediately patient attendance dropped by
24% well in excess of government expectations. One hospital recorded a 41%
drop. The fees do not apply to chronically ill or elderly patients or
patients receiving welfare benefits.>
These figures are very impressive. I doubt very much if we could achieve
such dramatic gains in British units. And the authors have not yet reported
on any downside; I'm sure there will be the occasional headline case of a
patient attending moribund because they tried to save their £8 to the very
last minute! Rob Cocks used to be on this List; it would be interesting to
hear further details from someone out there.
The ROI have been charging emergency patients for years and I've never heard
of any horror stories there, but maybe charges there do not deter
"inappropriate usage". I'm sure Pat Plunkett wrote a paper on this issue a
few years ago. There must be considerable north American experience too.
But even if we could surmount the ideological barriers preventing such
charging in Britain, would it do any good? If we could achieve Hong Kong
figures it would turn round our emergency departments overnight. Might be an
interesting study there for a very keen registrar (in A&E or Public Health)!
Adrian Fogarty
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