Decision on SIG-2026-0235

[MSOM Conference]

08-May-2026

Re: SIG-2026-0235, "Heterogeneous Patient Response to Uniform Increase in Emergency Department Attendance Fee: A Territory-Wide Study"

SIG Day Decision: Reject

Dear Author (this is to ensure anonymity):

We received many excellent submissions for the Healthcare Operations Management SIG-Day Conference. Unfortunately, we could not accept all of them to be included in the program, and we are sorry to say that your paper was not accepted to the SIG-Day conference.

If you also submitted an extended abstract of your paper to the main MSOM Conference, a decision on that submission will be made separately.


Sincerely,

Healthcare Operations;SIG Co-Chairs

MSOM Healthcare Operations Management SIG-Day Co-Chair

---------------------
Referee: 1
Strengths SIG Only: The paper utilizes a large ED visit dataset (2million patients) in HK to identify the impact of an exogenous policy change --- an increase in the ED fee— on ED traffic flow and patient outcome. It applies a difference-in-difference method based on the time of policy implementation and two patient cohorts (those who need to pay and those who don’t). Several robustness checks are performed.

Referee: 2
Strengths SIG Only: I like this paper because it rigorously quantify the impact of cost increase on ED utilizations for various populations using a DID approach. The presentation of the paper is also nice with model free evidence, clear execution of the main analysis, and robustness checks.

Referee: 3
Strengths SIG Only: The dataset is unique: A nationwide increase in Emergency Department copay, and the authors have data from all the hospitals in the nation. Better yet, because some people are exempt from the fee, this creates a good control group with which to do a standard Diff in Diff study. This allows for clean identification and allows the authors to explore many aspects of the fee increase.

Referee: 1
Limitations: In my view, the paper has several major limitations.

Empirical: the paper applies a one-time DiD method for identification. A main limitation of such method is that there may be other potential shocks around the same time, thus confounding the estimated effects. This is possible in the paper’s empirical setting, given there may be other policy/clinical changes in the year of 2017. While the paper carefully handled the opening of a major hospital in HK, it cannot rule out other confounding shocks.

Another limitation is that the paper excludes patients older than 65 years in its final cohort, which reduces its sample size by roughly a half. This can be problematic as the elderly patient cohort is the main user group of ED service in HK, and their choices/outcomes may be more susceptible to the policy change.

Managerial: While the paper studies an important public policy problem, I feel that the managerial implication remains limited. The paper shows that the increase in ED fee may discourage some less severe patients to use the ED service, but it does not significantly alter the behaviour/outcome of the severe ones. This is well expected as the fee increase (80HKD) is not a big amount of money (~10USD). I suggest the authors to have some deeper investigation on the managerial/operational implications of their empirical findings (e.g., impact on congestion, welfare, patient habit).

Referee: 2
Limitations: There has been quite some work around this topic, and I do not find the results provide new managerial insights. I also have concerns about generalizability to other universal health care systems.

Referee: 3
Limitations: One wonders about generalizability of the effects to other countries/cultures. Also, the data does not contain individual level socioeconomic factors.

Referee: 1

Comments to the Author
(There are no comments.)

Referee: 2

Comments to the Author
(There are no comments.)

Referee: 3

Comments to the Author
(There are no comments.)