Andrew Work (24th November 2005)
Economics seems like an esoteric subject for many, best left to crusty academics, pedantic politicians and think- tank policy wonks. However, it becomes much more relevant when your life, or the life of a loved one hangs in the balance as you wait for an ambulance to arrive at your door.
The Fire Services Department has launched a campaign to encourage responsible use of ambulance services. Its appeal is being made directly to the public through public statements and with the help of the Cantopop star and Ambassador of Ambulance Services Ho Wan-sze. The campaign encourages the public to use normal public transport and taxis when afflicted by minor ailments and injuries. They are also pushing for the use of a type of on-the-phone triage – that is, a system whereby phone operators can determine the urgency of a situation to determine who gets an ambulance first.
While this may seem obvious to most, you may be surprised to find out that the current system is a first-come, first-served system. If the call for a broken fingernail comes in before a heart attack, the fingernail gets served first. In other jurisdictions, they have had Ambulance Medical Priority Dispatch Systems in place for decades. The Chinese University of Hong Kong Accident and Emergency Medicine Academic Unit, and the Fire Services Department support the adoption of this system as an obvious means of improving ambulance services in Hong Kong.
So why do we need such a service in the first place? For most of the 90s, ambulance services in Hong Kong had a target of responding to calls within 10 minutes, 90 percent of the time. That target was abandoned as unrealistic and now is 12 minutes. In most Organisation for Economic Co-operation and Development jurisdictions, it is four to six minutes. Lives are being lost in over this issue.
There are a number of factors affecting this. One is the baffling and sickening response of Hong Kong drivers to emergency vehicles. Or rather, their non-response. Not much more needs to be said on this other than, if you are a driver, do whatever you can to get out of the way. Someone could be dying.
So where does the economics come in? One of the challenges facing the service is an alarming rise in ambulance usage – 5 to 7 percent a year for the last decade. While this may not sound like much, at 7 percent, it would be a doubling of usage in 10 years. I assure you funding for staff and equipment has not kept pace. Are the people of Hong Kong becoming more accident-prone? No, many have found that it is more convenient to call an ambulance to go to the hospital rather than hail a taxi for problems no more severe than a runny nose. Under the current system, the service cannot say no.
One very effective way to deter frivolous use, other than asking “please,” is to impose user fees. Some throw up the alarmist argument that little old ladies will die in their flats rather than risk a small user fee. The fact is that now they die in their flat while ambulances cater to people too lazy to walk down the street to a private clinic when a free taxi service to the under-priced emergency room is more convenient.
Furthermore, with each ambulance trip costing HK$1,500, overuse leads to a lack of funds for equipment and staff – leading to more problems that cost lives. It also results in incredibly stressed and overworked staff, frustrated when they know they could be doing more to save lives.
Even a small user fee acts as a big deterrent to frivolous users. The fee need not be large, but big enough to deter irresponsible use. At a recent presentation on alternative ambulance provision models made to the disciplinary services, user fees were the most popular item for discussion. Some claim that the administration costs would be prohibitive. However, it would be very easy to monitor cost recovery through revenues and a drop in usage.
At HK$1,500 a ride, the impact could be tremendous. In many jurisdictions around the world, private companies are responsible for fee collection and even dispatch, leaving the ambulance drivers to focus on what they do best – saving lives.
Union leaders, Legco, and Exco members need only to speak to frontline ambulance staff to find out why our system is under strain. It is incumbent upon them to petition our government to introduce life-saving measures like the Ambulance Medical Priority Dispatch System, possibly paid for with the funds saved through user fees. These two things would make Hong Kong a safer place.
Oh, and if you hear the sirens – get out of the way.