title: Acute care service utilisation and the possible impacts of a user-fee policy in Hong Kong.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: C K
authors.initials: CK
authors.lastname: Law
authors.forename: P S F
authors.initials: PS
authors.lastname: Yip
mesh_terms: D000059:Accidents; D017677:Age Distribution; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics*; D006723:Hong Kong; D006801:Humans; D012189:Retrospective Studies; D014218:Triage