Financial, Educational and Cultural ‘Revolutions’ for Emergency Medicine in Hong Kong

Ever since the establishment of the first Casualty department at Queen Mary Hospital in 1947, local and foreign attendees at Accident & Emergency (A&E) departments in Hong Kong had enjoyed free medical service for more than 50 years. However, with ever accelerating proliferation of advanced medical technology and expensive medications, coupled with the recent economic downturn and budget deficit, such free 'safety-net' healthcare was considered unsustainable and undesirable. The date of 29th November 2002 marked the end of this era of benevolence and generosity. From now on, unless exempted, all attendees at A&E departments need to pay a fee of $100 or $570 per visit, depending on whether they are residents or non-residents of Hong Kong. The new policy is aimed to change patient behaviour so that emergency service will be utilized appropriately. The charge was considered within generally accepted and affordable levels. The initial drop in A&E attendance was around 10%. There seemed to be a minimal increase in the absolute number of real 'emergencies'. What will be the longterm impact has yet to be seen.