Domestic health expenditure in Hong Kong: 1989/90 to 2001/02

Objective. To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. Methods. The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. Results. Total domestic health expenditure was $68 620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals' share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting. Conclusion. These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies.published_or_final_versio

Hong Kong's domestic health spending—financial years 1989/90 through 2004/05

This report presents the latest estimates of Hong Kong’s domestic health spending between fiscal years 1989/90 and 2004/05, cross-stratified and categorised by financing source, provider and function on an annual basis. Total expenditure on health was HK$67 807 million in fiscal year 2004/05. In real erms, total expenditure on health showed positive growth averaging 7This increase was largely driven by the rise in public spending, which rose 9Of the$67 807 million total health expenditure in 2004/05, current xpenditure comprised $65 429 million (96$2378 million (4%) were apital expenses (ie investment in medical facilities). Services of curative care ccounted for the largest share of total health spending (67%) which were made p of ambulatory services (35%), in-patient curative care (28%), day patient ospital services (3%), and home care (1%). The next largest share of total health xpenditure was spent on medical goods outside the patient care setting (10%). Analysed by health care provider, hospitals accounted for the largest share (46%) and providers of ambulatory health care the second largest share (30%) f total health spending in 2004/05. We observed a system-wide trend towards ervice consolidation at institutions (as opposed to free-standing ambulatory linics, most of which are staffed by solo practitioner). In 2004/05, public expenditure on health amounted to $35 247 million (53.9$30 182 million) was mostly incurred at providers of mbulatory health care (54.6%). This reflects the mixed health care economy of ong Kong where public hospitals generally account for about 90% of total beddays nd private doctors (including Western and Chinese medicine practitioners) rovide 75% to 80% of out-patient care. While both public and private spending were mostly expended on personal ealth care services and goods (92.9%), the distributional patterns among functional ategories differed. Public expenditure was targeted at in-patient care (54.2%) and ubstantially less on out-patient care (24.5%), especially low-intensity first-contact are. In comparison, private spending was mostly concentrated on out-patient care (49.6%), whereas medical goods outside the patient care setting (22 .6%) and inpatient are (18.8%) comprised the majority of the remaining share. Compared to OECD countries, Hong Kong has devoted a relatively low percentage of gross domestic product to health in he last decade. As a share of total spending, public funding (either general government revenue or social security funds) was lso lower than in most comparably developed economies, although commensurate with its public revenue collection base.published_or_final_versio

Hong Kong domestic health spending: Financial years 1989/90 to 2006/07

This report presents the latest estimates of Hong Kong domestic health spending for fiscal years 1989/90 to 2006/07, cross-stratified and categorised by financing source, provider, and function. Total expenditure on health (TEH) was HK$75 048 million in fiscal year 2006/07, which represents an increase of HK$4405 million or 6.2% over the preceding year. Represented as a percentage of gross domestic product (GDP), TEH increased from 3.6% in 1989/90 to 5.6% in 2003/04 and then decreased to 5.0% by 2006/07. Taking population growth into account, total health spending per capita (at constant 2007 prices) grew at an average annual rate of 5.1%, which was faster than the average annual growth rate of per capita GDP by 2.1 percentage points. In 2006/07, government financing of health expenditure was HK$37 417 million (49.9$37 631 million) in the last decade as a result of the continued growth of private spending (averaging 9.5% per annum in real terms since 2002/03). The second important source of health financing was out-of-pocket payments by households (35.2%), followed by employer-provided medical benefits (7.4%) and private insurance (5.6%). Private insurance has taken on an increasingly important role for financing private spending, whereas household and employer expenditure together has shown a corresponding decrease during the same period. Of the HK$75 048 million total health expenditure in 2006/07, current expenditure comprised HK$71 888 million (95.8%), whereas HK$3161 million (4.2by health care function, services for curative care accounted for the largest share of total health spending (66.2care, private hospitals had increased capital expenditure leading to an observed increase in investment in medical facilities from 2.2Analysed by health care provider, hospitals accounted for the largest share (42.7Not taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$35 437 million (49.3% of total current expenditure) in 2006/07 with the remaining HK$36 451 million made up of private sources of funds. Expenditure on hospital care (HK$32 069 million) was predominately funded by general government revenue (83.8%), whereas that on providers of ambulatory health care (HK$23 201 million) was by private household out-of-pocket payments (67.3%). This reflects the mixed health care economy of Hong Kong, where public hospitals generally account for about 90% of total bed-days and private doctors (including western and Chinese medicine practitioners) provide about 70% of the out-patient care. Although both public and private spending were mostly expended on personal health care services and goods (92.2% of total spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (53.3%) and substantially less at out-patient care (24.4%), especially first-contact care. In comparison, private spending was mostly concentrated on out-patient care (48.7%), whereas medical goods outside the patient care setting (22.4%) and in-patient care (18.9%) comprised the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base.published_or_final_versio

Association of ICAM3 genetic variant with severe acute respiratory syndrome

Genetic polymorphisms have been demonstrated to be associated with vulnerability to human infection. ICAM3, an intercellular adhesion molecule important for T cell activation, and FCER2 (CD23), an immune response gene, both located on chromosome 19p13.3, were investigated for host genetic susceptibility and association with clinical outcome. A case-control study based on 817 patients with confirmed severe acute respiratory syndrome (SARS), 307 health care worker control subjects, 290 outpatient control subjects, and 309 household control subjects unaffected by SARS from Hong Kong was conducted to test for genetic association. No significant association to susceptibility to SARS infection caused by the novel coronavirus (SARS-CoV) was found for the FCER2 and the ICAM3 single nucleotide polymorphisms. However, patients with SARS homozygous for ICAM3 Gly143 showed significant association with higher lactate dehydrogenase levels (P = .0067; odds ratio [OR], 4.31 [95% confidence interval {CI}, 1.37-13.56]) and lower total white blood cell counts (P = .022; OR, 0.30 [95% CI, 0.10-0.89]) on admission. These findings support the role of ICAM3 in the immunopathogenesis of SARS. © 2007 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio

Copy number variation in Hong Kong patients with autism spectrum disorder

Oral Free Paper Session: Oral Presentation 6 [best oral presentation]BACKGROUND AND AIMS: When offering chromosomal microarray for patients with autism spectrum disorder (ASD), as according to international standards, copy number variations of uncertain significance (CNV VUS) are frequently identified, which leads to challenges in genetic counselling. We aim to study the CNV findings in children with ASD in Hong Kong, and to gather information for reclassification of recurrent CNV VUS. METHODS: ASD patients from the Department of Paediatrics and Adolescent Medicine QMH/HKU were recruited if their Array Comparative Genomic Hybridization (aCGH) were done anytime from January 2011 to August 2014 in Prenatal Diagnostic Laboratory, Tsan Yuk Hospital. Diagnosis of ASD was made by developmental paediatricians and clinical psychologists using the criteria from Diagnostic and Statistical Manual of Mental Disorders, Fourth or Fifth Edition. NimbleGen CGX-135k oligonucleotide array and Agilent CGX 60k oligonucleotide array were used. Information was summarised from the literature and existing databases to re-classify CNV VUS occurring in our ASD cohort. RESULTS: Among 288 patients with ASD in our cohort, we identified 5 patients with pathogenic CNV (1.74%) and 5 patients with likely pathogenic CNV (1.74%). Among all the CNV VUS, one variant overlapping DPP10 (hg[19] chr2:116,534,689-116,672,358) was recurrently found in Chinese individuals. The frequency of this variant in our ASD cohort was 0.35% (1 in 288), and 0.96% (9 in 935) in our controls. (P=0.467, two-tailed Fisher’s exact test). Similar CNVs were suggested to be ASD-related in previous studies recruiting mainly Caucasians. However, there were Chinese individuals with typical development possessing similar CNVs identified in independent sources (9 from our internal database, 1 from Singapore Genome Variation Project, 24 from The Singapore Prospective Study Program). CONCLUSIONS: Our study explored the CNV findings in Hong Kong paediatric ASD patients. The CNV overlapping DPP10 may be a Chinese-related copy-number variation in Hong Kong Chinese, and we reclassified it to be likely benign in our locality. Our result emphasized the need to account for ethnicity to give the most precise interpretation of aCGH data.published_or_final_versio

Hong Kong's health spending projections through 2033

Objective: To derive actuarial projection estimates of Hong Kong's total domestic health expenditure to the year 2033. Methods: Disaggregating health expenditure by age, sex, unit cost and utilisation level, we estimated future health spending by projecting utilisation (by public/private, inpatient/outpatient care) to reflect demographic changes and associated increase in demand (from higher expectations and greater intensity of care), and then multiplying such by the projected unit costs (incorporating the impact of key cost drivers such as public expectations, technological changes and potential productivity gains) to obtain total expenditure estimates. Results: The model was most sensitive to the excess health care price inflation rate, i.e. the annual price/cost growth of medical goods and services over and above per capita GDP growth. Population ageing and growth per se, without taking into account related technologic innovation for chronic conditions that particularly afflict older adults, contribute relatively little to overall spending growth. Given the model assumptions, it is possible to limit total health spending to below 10% of GDP by 2033, where the public share would gradually decline from the current 57% to between 46% and 49%. Conclusions: Expenditure control through global budgeting, technology assessment and demand-side constraints should be considered although their effectiveness remains inconclusive. © 2006 Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex

Redistribution or horizontal equity in Hong Kong's mixed public-private health system: A policy conundrum

We examine the distributional characteristics of Hong Kong's mixed public-private health system to identify the net redistribution achieved through public spending on health care, compare the income-related inequality and inequity of public and private care and measure horizontal inequity in health-care delivery overall. Payments for public care are highly concentrated on the better-off whereas benefits are pro-poor. As a consequence, public health care effects significant net redistribution from the rich to the poor. Public care is skewed towards the poor in part not only because of allocation according to need but also because the rich opt out of the public sector and consume most of the private care. Overall, there is horizontal inequity favouring the rich in general outpatient care and (very marginally) inpatient care. Pro-rich bias in the distribution of private care outweighs the pro-poor bias of public care. A lesser role for private finance may improve horizontal equity of utilisation but would also reduce the degree of net redistribution through the public sector. Copyright © 2008 John Wiley & Sons, Ltd.link_to_subscribed_fulltex

Enhancement of the radiosensitivity of cervical cancer cells by overexpressing p73α

Radiation therapy is the most effective therapy for cervical cancer in advanced stages. p53 plays a critical role in the cellular response to radiation-induced DNA damage. However, p53 function is often impaired in the presence of the oncoprotein E6 from human papillomavirus, which is often associated with the development of cervical cancer. p73, a p53 family member, is highly similar to p53, but is resistant to the degradation by human papillomavirus E6. In this study, we investigated the role of p73α in relation to cellular radiosensitivity in the p53-impaired cervical cancer cells. Radiosensitivity and irradiation-induced apoptotic cell death were examined in the exogenous overexpressed p73α- and p53-impaired cells. Our results showed that the endogenous p73α expressed only in the radiosensitive cervical cancer C4-1 cells, but not in the radioresistant SiHa, Caski, and HeLa cells. Overexpression of exogenous p73α by transfection in the radioresistant cells resulted in a significant increase of cellular sensitivity to radiation. Enhanced radiosensitivity in p73α-transfected cells was attributed by increase of cellular apoptosis. Coactivation of p21 was also observed in the p73α-transfected cells upon radiation treatment. In summary, our findings suggested that p73α is an important determinant of cellular radiosensitivity in the p53-impaired cervical cancer cells. Copyright © 2006 American Association for Cancer Research.link_to_subscribed_fulltex

A Special Issue on the First International Conference on Biodiversity, Ecology and Conservation of Marine Ecosystems (BECoME 2015)

Department of Applied Biology and Chemical Technolog

Social disparities and cause-specific mortality during economic development

Social patterning of disease is pervasive and persistent. Disease patterns change with economic development and the attendant epidemiological transition. It is becoming evident that social patterns of disease are epidemiologically stage specific. In a population with a recent history of rapid economic development we examined social patterns of all-cause and cause-specific mortality over time to elucidate how economic development impacts disparities in health. We used concentration indices to provide a summary measure of disparities by income in potential years of life lost (PYLL) for the Hong Kong population from 1976 to 2006. For all-cause mortality and for each of the specific causes considered the concentration curve in 2006 dominated the 1976 concentration curve. The concentration index for all-cause PYLL was negligible in 1976, but increased over the period. PYLL attributable to injury and poisoning was fairly consistently associated with lower income, but PYLL attributable to cardiovascular diseases and cancer reversed from an association with higher income in 1976 to an association with lower income in 2006. Social disparities in health are not universal or homogeneous in origin. Attention should be focused on disease-specific causes of disparities, so that contextually specific prevention strategies can be implemented. This is of particular relevance to China and other emerging economies where there may be a window of opportunity to prevent disparities in cancer and cardiovascular diseases occurring. © 2010 Elsevier Ltd.link_to_subscribed_fulltex