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'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

Satisfaction with inpatient care in a population-based Hong Kong Chinese sample

Objective To measure self-reported inpatient experience in Hong Kong. Design Data were derived from the 2005 Thematic Household Survey. Setting and participants 24 364 non-institutional and 3390 institutionalised respondents aged at least 18 years systematically drawn to represent the Hong Kong adult population, 6.9% of whom were admitted at least once as an inpatient during the previous 12 months. Data from this group was analysed. Main outcome measure Picker Patient Experience Questionnaire-15. Results Overall, respondents scored their last inpatient episode 39.6 (range=0-100, the lower the score, the better the patient experience). Patients who sought care from private hospitals reported a lower Picker Patient Experience Questionnaire-15 score than those cared for in public facilities (31.1 vs 41.8 respectively, p<0.001). We observed substantial differences between public hospital geographic clusters that were confirmed by multivariable regression. When benchmarked against the UK, Germany and the USA, Hong Kong patients tended to report a significantly higher number of problems. Conclusions We found systematic differences between the level of satisfaction and type of problems reported by Hong Kong Chinese compared to those in Euro-American settings. The observed heterogeneities among different public hospitals, between the private and public sectors, and among subgroups of inpatients should provide an evidence based on which quality improvement initiatives can be designed and evaluated.link_to_subscribed_fulltex

Prepayment was superior to postpayment cash incentives in a randomized postal survey among physicians

Objective Improving response rates, particularly among physicians, is important to minimize nonresponder bias and increase the effective sample size in epidemiologic research. We conducted a randomized trial to examine the impact of prepayment vs. postpayment incentives on response rates. Study design and setting Self-completion postal questionnaires were mailed to 949 physicians who were respondents to an earlier survey and representative of the general physician population in Hong Kong. These physicians were randomly allocated to receive a HK$20 cash prepayment incentive that accompanied the survey (n=474) or a postpayment reward of the same amount on receipt of the completed questionnaire (n=475). Results The final prepayment response rate was 82.9$42.7, prepayment with three mailings at HK$66.5 and prepayment with three mailings and telephone follow-up at HK$112.1 per responder recruited (US$1=HK$7.8). Conclusion The findings demonstrate that prepayment cash incentives are superior to postpayment of the equivalent amount in improving response rates among a representative sample of Hong Kong physicians. Further research should concentrate on confirming the generalizability of these findings in other health care occupation groups and settings. © 2004 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex